ARMY MEDICAL LIBRARY FOUNDED 1836 WASHINGTON, DC. 



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Surgeon General's o ffif f i c 3 MxWMxLMIBf? is, 







'reports or HOSPITAL PHYSICIANS, AND OTHBR DOCUMENTS IN RELATION TO THE EPIDEMIC CHOLERA OF 1832. PUBLISHED BY ORDER OF THE BOARD OF HEALTH. EDITED^BY DUDLEY 'ATKINS, M. D E.aTE SECRETARY TO IHB SriCUJi MEDICAL COUNCIL. VNEW-'VORK : C. AC* H. CARVILL, No. 103 BROADWAY. 1839. 



we The Board of Health of the city of New- York, for the year 1832, consisted of the following gentlemen :—: — Hon. WALTER BOWNE, Mayor. Hon. RICHARD RIKER, Recorder. 

Aldermen. 

JOHN Y. CEBRA, PETER SHARPE, WILLIAM MANDETILLE, GEORGE E. SMITH, MYNDERT VAN SCHAICK, JOHN R. RHINELANDEK, JAMES R. WHITING, ERASTUS BARNES, 

HENRY MEIGS, JOHN PALMER, HENRY P. ROBERTSON, CHARLES H. HALL. JAMES PALMER, THOMAS T. WOODRUFF, JAMES B. MURRAY. 

i 

Kn mini Committee. 

THOMAS T. WOODRUFF, WILLIAM MANDEVILLE, HENRY P. ROBERTSON 

Entered according to Act of Congress, in the year 1832, by G. & C. & H. Carvi m the office of the Clerk of the Southern District of New-York. 







llt is felt that an apology is due to the blic, for the very imperfect form in which the ;uments composing this volume appear. Our >logy must be this : that we deemed it our ty to impart at once to the profession the ults of our experience, in order that no time jht be lost in rendering them available to ers. We are aware that we add but little the stock of actual knowledge in regard to olera, but we hope that little may be of 









Board of Health for the year 1832, 2 

>. I. — A Sketch of the History of the Epidemic Cholera, hich prevailed In New- York in the summer of 1832, . 5 

Art. II. — Communication from W. Shaler, in regard to Asiatic Cholera, with Reports in regard to its prevention 

and treatment, 52 

B. 111. — Questions by the Board of Health as to the best cans of protecting the system against Cholera, with the 

answers of the Council, 61 

Art. IV. — Report of practice in the Greenwich Hospital, by Stephen C. Roe, M. D., '. 69 

BY. — Report of practice adopted in the Park Hospital, Peter C. Tappen, M. D., 74 

X Vl.— Report of the Rivington-street Hospital, by Maus Willett, M. D., 93 

¦. VII. — Report of the practice pursued in the Hospital Corlaer's Hook, by Samuel Akeily, M. D., .... 112 

X Vlll. —Reports in relation to Cholera, at the Bellevue ls-house, &c, 150 

Art. IX.— Cases of Cholera, 167 





IN RELATION TO CHOLERA. 

Art. I. — A Sketch of the History of the Epidemic (Cholera, which prevailed in the City of New -York and throughout the United States, in the Summer of 1832. By Dudley Atkins, M. D. 

The winter of 1831-2 was unusually protracted and severe, and fuel of all kinds was exceedingly dear in this city, so that the effects of cold were felt by the poor and laboring classes to an uncommon degree. The spring brought little relief, for it was very cold, so much so, that fires were quite agreeable till late in May. The spring was very dry as well as cold ; which circumstances united to render it the most backward season in thirty years : the weather continued dry until July, during which, and the following months, showers were frequent and heavy, and the rain abundant : but from the first of March until the end of June the quantity of rain was exceedingly small. The weather continued to be very cold till about the middle of June, when the temperature suddenly rose to the greatest heat of Midsummer. During twelve days, from the 18th to the 30th of June, the mean temperature at 12 M. was 81°, at six in the morning it was 69°, and at 6 P. M. 

A very remarkable feature of the season has been an unusual prevalence of easterly and south-easterly winds ; the same fact was noticed in Canada, where with only five days intermission, an easterly wind prevailed from the Ist of May to the 10th of June. It is usual in this latitude for 

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I -ins and showers to be followed by a fresh west, northit, or north wind, with fine and clear weather ; but ing the greater part of this spring and summer it has n observed, that the wind had continued at east after rain had ceased ; and that at night a breeze from the t has set in, which has contributed largely to increase dampness and chilliness of the nights. And it was a imon observation in June and July, that the nights felt October : a thing quite unusual in this climate. 

In Canada the same state of things has prevailed, and it is stated that stoves were found to be quite comfortable at Quebec on the 4th of June, when the thermometer was as low as 40°. Many of the harbors in Newfoundland and Nova Scotia were obstructed with ice until near the middle of June. The weather at Quebec was very changeable, and there was an unusual prevalence of easterly winds. 

In the fall of 1831, influenza prevailed to a great extent. It appeared first in November, and continued until January, 1832; it was very severe and fatal, especially to aged and infirm persons. Its most remarkable feature was a great irritability of the stomach and intestines. This existed to such a degree, that antimonial medicines could be used only with the greatest caution, and purgatives of all sorts operated with an unusual degree of severity. During the winter scarlatina prevailed to a considerable degree, and was of a malignant character. It often presented instances of collapse and unexpected death, nearly resembling in many respects the disease of the summer : it also presented the same irritable state of the gastro-intestinal mucous membrane. 

Ethe spring intermittent fevers in the lower and damper of the city were found to show a tendency to the kind of collapse. 

But the most remarkable feature of the season, and that 



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which led many to expect the subsequent prevalence of complaints of the stomach and bowels, and even of malignant Cholera, was the occurrence of many cases of cholera morbus and of dysentery during the depth of the winter. Several cases of the first disease terminated fatally. A circumstance of so novel a character naturally excited observation ; for although a single case of either of those diseases may occur at any time, yet that fifty or a hundred cases should be met with in January or February is certainly a circumstance quite unknown to this climate. A similar circumstance is stated to have been observed at Montreal, where the cholera which is endemic in summer showed itself in April. There were in that month several mild cases, and one or two malignant. The season was throughout very sickly, and the mortality by other diseases great. In the Montreal Herald for June 9, it is stated that the interments from January 1 to June G, amounted to 554 for one parish only. During the whole winter and spring all diseases manifested the greatest irregularity, and in April infantile diarrhoea was quite common. There was also sickness of an unusual character in the interior of Canada; for in the Canadian of July IG, there is an account, by a "voyageur," of a disease which appeared among the Indians of Schomonchouan, 100 leagues from the sea, which exhibited all the appearances of Cholera. It was attended with vomiting, diarrhoea and cramps, producing entire prostration in four hours. It was treated, with uniform success, by a decoction of equal parts of bark of white birch and the larch fir, given frequently in small doses. At New London, in Connecticut, a disease prevailed in the early part of the spring, which was quite analogous to Cholera in all its principal phenomena, although it was considered at the time to bear a close affinity to spotted fever, a disease well known in that State. A mode of treatment very 



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analogous to that most approved by experience in cases of malignant Cholera was also found to be highly successful. 

fis also stated to me by Dr. Ell wood, of Rochester, '?* that cases of pneumonia in the winter assumed a oid form, so that depletion was not admissible, and in h the patients sunk with rapidity — a circumstance h he has rarely observed during a residence of fifteen sin that place. From the same source I learn also, diarrhoea was very prevalent in Rochester and its ity from the first of June, that is, for six weeks pre-3 to the appearance of the first case of Cholera. 

The present epidemic and malignant Cholera first appeared upon this continent at Quebec upon the Bth of June. In the Quebec Mercury of Saturday, June 9, it was stated, that on Friday, the Bth, there were eight cases in that city, three of which had terminated fatally upon noon on Saturday ; and at 3 P. M. the same day, there were known to have been fifteen cases of Cholera and seven deaths. F-rom the same paper we learn, that no attempt to trace it to any vessel had been successful, although the first cases were among emigrants. This circumstance was thought to be easily accounted for by the habits of the emigrants, and the filthy, crowded condition of their houses: for it is stated by the Board of Health of that city, that the disease broke out in a low, uncleanly, and ill-ventilated part of the city, crowded with a population of emigrants of the lowest description. The sickness on board the Carrick and other vessels suspected, was found to have been ship fever, small pox, &c. ; and although there had been Cholera on board one of these vessels, yet there had been no case for thirty days previous to her arrival. In the first two weeks of its prevalence there were 1,000 deaths. 





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It next appeared at Montreal, and for the following facts we are indebted to a report by Dr. Robert Nelson, Health Commissioner of that city. With the month of June diarrhoot showed itself as a common or predominant symptom in every form of disease, and about the first of June there was one case of severe Cholera. But on Saturday the 9th, the malignant Cholera made its appearance as an epidemic. On the evening of that day a passenger was landed from the Voyageur steamboat, sick with Cholera, who died the same evening. It is stated by Dr. Nelson, that during the same night several native inhabitants in various parts of the city, remote from the port and from each other, and having no communication with the port or place of landing, sickened, and most, if not all of them, died during twenty-four hours. On Sunday, the 10th, another emigrant from the same boat died. From this time it continued to spread, and soon prevailed universally. In two weeks eight hundred persons had died of it. It continued its progress from one place to another, along the river and lakes, "soon outstripping the emigrants," and early in July had reached Detroit. 

I Without having shown itself at any intermediate spot tween Canada and New-York, it appeared in this city out the last of June. The first known case of Cholera New- York is that of Mr. Fitzgerald, an Irish emigrant, 10 arrived at Quebec in the autumn of 1831. He resided Albany from September to May, and on the 3d of May jk the first floor of a house in Cherry-street near Jameseet. He was by trade a tailor, and a steady and temrate man. His wife was also a neat housekeeper, so that this case neither of the most common causes of Cholera, i. dirt and intemperance, were present. 

On Monday, June 25, after spending the day at Brooklyn, he returned late in the evening, and was taken sick in the night, but was seen by no physician until Tuesday. In 



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a few days he was convalescent. Early on Tuesday morning two of his children were attacked with the disease, who both died on Wednesday, the 27th. They were seen by many physicians, who considered their symptoms to be those of spasmodic Cholera. On Thursday, after eating some sour strawberries, the mother was attacked with Cholera, at 12 M., and died on Friday, the 29th. 

lOn the same day an Irishman named O'Neil was seized th malignant Cholera, and died the next day. He lived Greenwich, at least two miles from the first cases, and dat the Medical Mansion in Greenwich. He was very emperate, had been drunk all the week, and had fallen, ile intoxicated, into the North River. 

On Saturday morning, June 30, a man who lodged with Mr. Hannasy, at No. 15, James-slip, was seized with the disease, and died on Sunday morning. He was a temperate man, and was not known to have had any communication with the family in Cherry-street. Another lodger in the same house sickened and died on Sunday. The keeper of the house and several others were subsequently taken sick and died, either there, or at places to which they were removed. They were all intemperate, were drunk at the time, and the house was most disgustingly filthy. On Monday cases occurred in Water-street near James-street, and on Wednesday, July 4, it had shown itself at various places upon the opposite side of the city. From this time cases continued to multiply daily, and all efforts to trace these cases to any foreign source had thus far been wholly unsuccessful. 

On Tuesday, July 3, public alarm was excited to the highest degree, and the Board of Health, feeling deeply the novelty and importance of the crisis, appointed a Special Medical Council to ascertain the real nature of the cases reported to be spasmodic or Asiatic Cholera, and to devise 



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|:h measures as the emergency required. This measure )pily quieted the fears and restored the confidence of public. The council consisted of Dr. Alex. H. Steis, President ; Drs. Joseph Bayley, Gilbert Smith, John ilson, William J. Macneven, Hugh M'Lean, Richard K. it'man; to whom after a few days was added Dr. Anthony Anderson. 

Ehese gentlemen continued to superintend the public ical arrangements until the decline of the epidemic. 

The Record Office in the Park being vacant, was immediately occupied as a hospital, and by the end of the week three other large and commodious hospitals were organized, to which a fifth was afterward added. During the nine weeks from the Ist of July to the Ist of September, there were treated in them 2,030 patients, of whom 852 died, 1117 were cured, and 62 were convalescent at the time of closing them. In addition to these benevolent provisions for the poor, physicians were appointed, and a medical station fixed in each ward, that prompt assistance might be always at hand in every quarter of the city. To these arrangements, and to the unceasing assiduity of these gentlemen, the saving of many lives is undoubtedly to be ascribed, as the number prescribed for in some wards has exceeded two thousand persons, many of whom, but for this early attention, would have been the victims of this frightful pestilence. 

About the same time that the disease made its appearance in the city, it also appeared at the Almshouse at Bellevue, two and a half miles from town. The first cases, which occurred in June, are of rather a doubtful character. A detail of them will be found in Dr. Devan's report. It is therein stated, that they were not seen by the physician of the house. The first case, of which the accounts are perfectly satisfactory, occurred on the Ist of July. (See the report of the committee on that subject, in this volume.} 



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The first supposed cases were all in "^arts of the house quite distant from that in which the case of July 1 occurred, as will be seen by reference to a plan of the house accompanying Dr. Devan's paper. The whole number of cases at Bellevue was 555, of whom 300 died. 

At Albany the disease next showed itself, upon the 3d of July, having been preceded for some weeks by disorders of the bowels. On the 17th July it appeared at the State Prison at Sing Sing, particular remarks in regard to which will be made in discussing the contagious or atmospheric character of the disease. During the latter part of July it appeared at Norfolk, Va., in Philadelphia, and in a letter from Natchez, of August 3, it is stated to prevail in that vicinity to a considerable extent : — and during the month of August it has numbered victims in almost every considerable town in New-York and New-Jersey, while it has prevailed to a less extent in parts of Connecticut, Rhode Island, Pennsylvania, and various other States. 

I 'he total number of cases in this city, including those he hospitals as well as those reported to the Board of kith, had been 5835, on the Ist of September. The total iber of deaths by Cholera, to September 1, was 2996. 'ill be observed upon reference to the table at the end his paper, that during the prevalence of Cholera, the tality by other diseases has Leen much increased, so the deaths by all other diseases exceed those for the c period of the last year by 374. In three weeks from time of its first appearance, it was at its height ; that is, it the 21st of July. 

II was confined for the most part to a few portions he city, so that there were definite and limited neighloods, which were to a remarkable degree more sickly i others. Of these, that portion of the 6th ward, wn as the vicinity of the Five Points, and the 



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resort of all the vicious and dissolute, was the most heavily visited. This portion of the city was originally a swampy, low piece of ground, the centre of which was occupied by a very deep pond, from which issued a spring and brook of water ; this has been for some years filled up, but the soil must still retain its character as low and damp. The other parts of the city where the disease chiefly prevailed, were for the most part of a low, dirty, and unhealthy character, consisting chiefly of confined narrow streets, and dirty dwellings, inhabited by the poorest and lowest part of the population. The two neighborhoods at the foot of Duane-street, and of Vestry and Desbrosses streets, both upon the North River, constituted exceptions to this rule. It should, however, be stated, that the ground at the foot of the first street is made land. The three lower wards, nearest to the Battery, consisting of large and airy dwellings and stores, with rather a scattered population, afforded very few cases, and those, with one remarkable exception, were in low damp situations, and among dirty people. The exception alluded to was presented in the house No. 2G Broad-street, not far from Wall-street, where the disease assumed so malignant a form, that three ladies and four nurses and servants died in the course of a few days. A child of four years, that was one day and night in the house only, died upon returning home. The three first and one of the last died in the house, the others at their own homes or at the hospitals ; the two nurses were young, healthy, and temperate women, from Brooklyn ; they were taken sick upon leaving the house, and died the next day. It was remarked, that all who died, had slept or were habitually employed in the basement rooms, under which was a small rain-water drain, and contiguous to which, was a cellar where hides and bones were stored. It should, however, be stated, that not one of the occupants of the 

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fe, or of those employed in removing the hides, &c., in the least degree affected with any form of disease, was the cellar containing them in any manner offensive. 

The disease fell in a very remarkable degree upon the dissolute and the intemperate. Habitual drunkards and prostitutes constituted a majority of its subjects. The cases in which it occurred in persons of regular habits of life were comparatively few. And in most of these it could be distinctly traced to some act of gross imprudence. The two neighborhoods above specified, however, of Duane and Vestry streets, must be regarded as exceptions to this rule also, for in those the cause producing the disease appeared to have a concentration, that enabled it to attack individuals not predisposed. The greater number of cases occurred in persons of middle age : but the number of lildren attacked was much greater than is believed to have en common elsewhere, for it was found that children of elve years and under constituted one tenth part of all the cases reported, exclusive of the hospitals. A reference to the table at the end of the paper will show that there was no increase of mortality among children of one year and under, but that children between one and live years died in a much larger proportion than usual. The number of deaths among old people will be perceived to be remarkably large. 

tery small irregularities in diet were found to be highly *erous, so that food, which in common seasons would 5 been quite wholesome, was now found to expose to a len attack of the destroyer. Thus whortleberries and , and raspberries and milk, have been the cause of lera in a number of cases. In one house in Madisonit, a father and three children all died within twentyhours, after partaking of similar food. 

The disease generally prevailed in one fiuarter of the 



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iy until it appeared to have exhausted all its subjects, and in subsided ; appearing immediately in some other, and rhaps quite distant part. It was most uniformly violent its character during the first few weeks, but afterward the of bad cases was not so great. 

iAs a class of people, the low Irish suffered most, being ceedingly dirty in their habits, much addicted to intemrance, and crowded together in the worst portions of the y, both as regards the kind of houses and the quarter which they resided. 

Cellars and basement rooms, which in this city are from four to six feet below the level of the ground, furnished the greater proportion, and the worst form of cases : upper stories were comparatively exempt ; as were wide and spacious streets and houses in every part of the city. Back buildings in courts and court-yards were found to be very subject to the visits of Cholera. Of forty inmates of one house in Sheriff-street, as is stated by Dr. Hibbard, " consisting of persons of all colors, and from all countries," and excessively filthy and vicious, twenty-three had diarrhoea, which passed on to collapse in nine, and to death in seven ; of the last, six were children. Other houses produced from six or eight to thirteen, and in one instance eighteen cases. It frequently happened, that a house would present one or two cases daily until all had been affected or removed ; on the other hand it was frequently observed that one case only occurred in a house, and that the other members of the family escaped with a diarrhoea on'y, although the house was both crowded and dirty. In the country, it has been very generally remarked, that in those places where intermittent fevers prevail to great extent, Cholera has been most malignant in its character. 

The greater number of attacks took place at night, generally between midnight and sunrise ; that is to say, many 



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tc were seized during this than any other equal portion he day. In more than one instance three persons c attacked in one house daring the night ; in another : two persons were seized within the first twelve hours, three in the next twenty-four. Attendants upon sick were sometimes attacked, but in the majority of mces they were either persons of intemperate habits, thus predisposed to the disease, or they were from oklyn, or other country places, where the disease was not at the time prevailing, and therefore destitute of that protection which is enjoyed by those who are acclimated. 

Of nine nurses who had Cholera at the Park hospital, (til were intemperate drinkers. But it was often observed, that those who were much about the sick had diarrhoea, or a tendency to it. 

In truth it is a subject well worthy of remark, that the disease was almost universally preceded by diarrhoea, which, if neglected, ran into malignant Cholera ; but if properly treated, was perfectly under the control of medicine. So common was this form of disease of the bowels, and so I 1I 1 ntly connected with the subsequent collapse, that it has properly termed the first stage, or milder form of the se itself; in fact, it is a rare thing to meet a person in ity, who has not experienced this milder, or premonitory of Cholera in some one of its shapes: and it is safe to t, that it is still more rare to find a person who has proper attention to this diarrhoea, and has subsequently attacked by Cholera. From observing this universal exion of the two forms of disease, and the uniform idence of diarrhoea, it has been well proposed by Dr. ard to term it malignant .Diarrhoea, in order that the public attention may be still more loudly called to that stage of the disease, when and when only it is a manageable complaint. In this view, the stage of collapse is only the 



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ting scene of that, which is in truth the most prevalent 1 of the disease, viz. the diarrhoea. 

Khis diarrhoea is stated also to have prevailed In many > of the country, where Cholera has not hcen seen at all. 

At Kingston on the Hudson, at Orange and Newark, N. J., in the most healthy parts of Pennsylvania, in Canada, it has been the prevailing disorder of the season. 

We cannot leave this subject without paying a tribute of gratitude to Dr. Kirk, of Grecnock, to whom is due the praise of having been the first to ascertain and publish the general fact, that diarrhoea is a universal precursor of the attacks of Cholera. To the knowledge of this fact, we owe the preservation of the lives of thousands in this city, and throughout the country. 

iPhe subjects of the disease have been in general very •le to relapses, and several instances have been known oersons being attacked for the third time in consequence relapse. It has been doubted whether the disease ever icks a second time the same person, after the health is npletely restored: sucli cases are certainly not common. 

The circumstances which predisposed to the disease were found to be the following : — 1 . A peculiar state of the atmosphere, producing a tendency to diarrhoea. This, as has been remarked, has been observed in parts of the country widely remote from each other, and may therefore be considered as the cause most general in its operation. The influence of the same state of the air has shown itself in the production of a very viscid and heavy sweat in those not affected with diarrhoea, and great weakness, attended with a disposition to cramp in the calves of the legs : the sweat, as wiped from the forehead, has felt to the finger like a slippery mucilage, and garments moistened by it have very soon exhaled an unpleasant odor, rendering ¦ daily change of clothing necessary. 



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12. Habits of intemperance, and what has been well called Dr. J. M. Smith, the alcoholic diathesis, has been found be the next most common predisposing cause of Cholera, fact the disease has appeared to exhibit a peculiar affinity this kind of subject and constitution : that is to say, vstem exhausted by drunkenness and debauchery. 

3. Low and damp situations, either as regards the quarter of the city, or the part of the house occupied. 

4. Local filth and dirt, either of premises or persons. 

5. It has been observed, that persons of irritable bowels, and who are habitually subject to diarrhoea, have been very liable to Cholera ; and this has been peculiarly the case with the inmates of those places of which diarrhoea may be said to be the endemic complaint ; as alms-houses and prisons. 

Plmong the exciting causes of the disease the most comi has been found to be some error in diet. The eating indigestible food ; of unripe and even of ripe fruit ; indigestible vegetables of all sorts, or large quantities of Xi usually esteemed digestible ; milk, especially if eaten fruit, and cider at all times ; shell-fish, as clams and s, &c. 

Venereal excesses, and debauchery in general, exposed in many cases to very sudden and fatal attacks. In truth there is perhaps no more common cause of a sudden and Klly fatal attack, especially if preceded by a neglected hcea, than a midnight debauch. 

I.ny anxiety of mind, as fear for personal safety during prevalence of the disease, dread of Cholera, grief for ness or loss of friends and relations, care about business, read of losses or total failure, have been found in many cases to have been the cause of Cholera. In many instances a sudden attack of diarrhoea was induced by some 



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[Getting wet and remaining exposed to the night air in t clothes produced diarrhrea in a majority of the persons isent at a fire, and Cholera in several others. 

I The smell of choleric discharges has in some instances en observed to produce sudden vomiting and purging in healthy person, and the air of a house where persons ire sick with malignant Cholera, has been known in /eral instances, perhaps twenty, to produce Cholera in rsons who had been engaged in attendance upon the k : but as ha 3 been stated, they were mostly persons 10 could be fairly regarded as peculiarly predisposed to i disease. 

A number of very interesting facts have been stated, which go far to prove, that Cholera is at least sometimes and under certain circumstances communicated by contagion. 

Dr. Stevens has received the following statement from Dr. King at Newport, which he has kindly permitted me to extract from that gentleman's letter. 

|3n the 17th of July, two females left New-York for wport, at which place they arrived the next day, After ng detained a week at quarantine, on the 25th they re permitted to land. They were found to be laboring ler spasmodic Cholera, of which they both died, one in evening, the other in the night of the day upon which y landed. On the 30th, Mr. Foster, who had assisted in ying them, was attacked with bilious colic, of which, :r several recurrences of the symptoms, he eventually overed. Subsequently to this, four members of his lily, viz. his wife and three children, were affected with olera, of whom the wife and two children died. 

The first subject of the disease was a nursing child, aged eighteen months, which died upon the 4th of August. The w* VUv Illllllt^r TT \* I\s IJl\, I { Ivlii -J ₯vU I\J \.ll\s li\J . t'II Li I 



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by a Mr. Gibbs, wlio was employed as their nurse : Mrs. Foster died the day after their removal, and a child of three years was taken sick with Cholera upon the morning of the same day, and afterward recovered. At 12 P. M. the other child, aged ten years, was taken sick, and died the next day. After this two nurses of the hospital had the disease and died. They were men of from 50 to GO years of age, and of intemperate habits. One of them was seized upon the 9th and died the 10th of August ; the second was seized the 11th and died on the 12th. The remaining occupants of the hospital were then removed to an island in the harbor, and there were no more cases of Cholera up to the 22d of August. The town of Newport at the time was perfectly healthy, and the house in which Foster lived, was in a healthy part of the town ; so there was no ground to suspect the operation of any local cause. It should still, however, be stated that both the nurses who died had been at the house, and employed, the one in removing the family, the other in cleaning the house. 

I^rom Dr. Ellwood, whose interesting letter has been jre referred to, I have the following statement. A man d had attended some friends sick of Cholera at Roches- Avent to Mendon, a small village 16 miles east of that ;e. He died of Cholera the following night : there had nno case of the disease there before this. Of six pers, who attended him during his sickness and buried him, one escaped an attack, and four died within a week. 2ie were afterward thirteen deaths by Cholera in a ulation of only 150 persons. 

ft Manchester, Ontario county, a similar fact was rved. A lady arrived there and died, five days after ing New-York. Her sister, who resided at Manchester, was with her during her illness, died two days after. 

In Oneida county, some Indians were employed to bury 



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rson who had died of Cholera in a canal boat, six ot m died of Cholera very soon after. 

At Ancram, a village not far from Hudson, a woman died of Cholera, who had arrived there from New-York. It has been stated to me upon the most respectable authority, that four persons, who attended her and watched with her, all subsequently died of the same disease. 

Eacts of this kind, as Dr. Ellwood well remarks, are too lerous to be regarded as mere coincident or fortuitous umstances. 

IDn the other hand it is remarked by Dr. Coventry of ca, in an answer he was so kind as to make to some :stions addressed to him, " that a number of cases might produced to prove that Cholera can originate there." c same remark must be considered as applicable to the t cases in New-York, where no facts have been brought ight, which enable us to trace the disease to any other t, or to any other person than the first known subject 

Ehe same observation has been made at Troy,* and at >us other places. 

These statements naturally lead us to the consideration of the great question as to the manner in which malignant Cholera is produced, and propagated. That is to say, whether it is an atmospheric disease, and simply epidemic, or is circulated by contagion from person to person. By those who maintain the latter opinion it is said : — 

I. That the disease is highly contagious, as is proved by facts above stated, and by numerous others of a similar racter, as also by the fact that nurses and attendants frequently taken the disease from those they attended. 

f. That it has actually been carried, within our own wledge, to Newport, New-Haven, Flatbush, &c. 

? See letter from Dr. Goodrich, No. 2. 

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E. That it began at Quebec, where numbers of emigrants just landed from sickly vessels, and who were also the victims of its attacks on shore. 

Kl. That it appeared first at Montreal upon the same day night, that a man died there of Cholera, who had just ded from the Voyageur steamer from Quebec. 

15. That, from Quebec to Detroit, and from Albany to ifialo, it has followed the line of the great lakes and the nal, infecting many large towns upon the latter, and all villages upon the former, wherever the emigrants in :ir progress had scattered the seeds of pestilence. That hus has exhibited the same tendency to follow the great ite of trade and intercourse, that it has before exhibited Europe. 

6. That in places truly interior it has not appeared, as in the internal portions of New-York, Pennsylvania, and the great western States, where real epidemics, as influenza, &c, never fail to be seen, and to be severely felt. 

| r . It is remarked by those who support this opinion, that he disease were owing to an epidemic influence arising ti a peculiar state of the air, which for ten years has n travelling westward, and has at length reached our itinent, it would have appeared first at places farthest t. But this has not been the case. The whole coast n the St. Lawrence to New- York has been exempt from disease, as well as the whole of Nova Scotia, Newinswick, and New-England. Whereas, on the other id, it has actually appeared first at the great northern t of entry, where, upon the supposition of its foreign ( r in, we should naturally expect to see it appear. 

(i. It is said by some, that although the disease is truly pagated by contagion, yet that it may require a peculiar lemic state of the atmosphere to prepare the system its reception. This they think well illustrated by 



23 

the character and circumstances of epidemic small-pox, measles, &c, which are communicated by personal contagion only, and yet when they are epidemic, there is united with them a peculiar state of the atmosphere which predisposes to receive their infection. 

11. It is said, that at first the disease was wholly limited Quebec and Montreal, while the country adjacent was mpt from it, and that it was transmitted directly from city to the other, without showing itself at any of the irmediate points. It is also stated by them, that it preed only in the low parts of Quebec, while the elevated tion of the city, known as the Cape, remained nearly or ;e free from disease. 

On the other hand it is replied by those who believe its origin to be strictly atmospheric, Ist. That this last fact is wholly against the doctrine of it 3 communication by contagion. For, if this were the mode of its propagation, no reason can be assigned why it should not be carried to the high as well as to the lower parts of the town. But that on the contrary, it has always been observed in India that elevated places were free from the disease, and it is found to require the combination of a moist and low situation. That it should spread therefore in those parts only of Quebec, Montreal, New- York, &c, which presented these characters, whiie the higher and better portions were exempt, shows that it is a disease of atmospheric or telluric origin, to the production of which these situations are peculiarly suited. 

K. They further remark, that a striking evidence of a and peculiar state of the atmosphere is to be found in prevalent diseases of the past winter and spring. 

3. That a remarkable tendency in the season to produce Cholera is presented in the fact of the occurrence of this disease, which is a summer complaint, in the depth of 



24 

Montreal. This, they say, is a phenomenon, which can only be accounted for by supposing a state of the ttmosphere strongly disposing to complaints of the stomach and bowels. 

11. Farther and still stronger evidence of the same fact is nd, in the extraordinary prevalence of diarrhoea, which two or three months past has exhibited itself in almost :ry part of the northern and middle sections of the United ites. This diarrhoea has been found to prevail, not only places where it was accompanied by Cholera, and intitely connected with it, but in many places where Cholera i not appeared. In many country places it has affected whole population. 

5. The connexion of this epidemic diarrhoea with Cholera is shown by the fact, that although perfectly manageable if attended to, yet if neglected it has almost invariably passed into malignant Cholera : so much so is this the ease, that it is now regarded by those who have seen most of the disease, as not merely premonitory of Cholera, but as constituting the milder form of the disease itself. 

6. That the disease has travelled too rapidly to have been carried in any other way than by the air. It appeared in Quebec upon the 9th of June only, and the next night it broke out in several different parts of Montreal. It was only known to exist in Quebec on Saturday noon, and during Saturday night it appeared in Montreal. But admitting it to have been brought up the St. Lawrence in the Voyageur, the man who died of Cholera was not landed until after dark, and before morning " there were seven or eight cases in streets quite remote from each other and from the port." They find great difficulty in connecting these events with the landing a sick man the evening previous. 



25 

7. They lay great stress upon the fact, that it has been impossible to connect the idea of importation from any foreig ft source, with the first cases in New-York; the subjects of them having been nearly two months in this city, and there being no cases known to exist at the time at any point south of the frontier of Canada. 

8. That the facts stated in regard to the importation or foreign origin of the disease at Quebec have not been proved ; but that the public authorities, and those who had the best opportunities for inquiry, are of the opposite opinion : as were also the New-York commissioners, who made their inquiries upon the spot. 

!. The appearance of communication by contagion is ight to be amply accounted for by the fact of the exfie degree of terror which prevails throughout the counin relation to Cholera. This terror is known to be so it as totally to break down the restraints of moral and jious feelings — so that people leave their nearest kin- Ito die alone. In this state of mind they are suddenly jght in contact with a person affected by Cholera ; they ird it as necessarily fatal to themselves, and the result is too often found to fulfil their expectations. In town isands are placed in similar circumstances ; but they 3 no fears, and they take no Cholera.* 

10. Lastly, they say that the disease has broken out and prevailed to a great extent, in several places, and under circumstances which render the suspicion of any foreign intercourse almost impossible — of which kind are the Almshouse at Bellevue, and the State Prison at Sing Sing. 

Ehat these places should really be viewed in this light think is proved by the following statement in regard ich. 





26 

of the committee upon that subject, that the first well authenticated case of Cholera occurred in a person who had not been out of the house for some time previous — and who, of course, could not have been exposed to any foreign causes of the disease. By admitting the cases in June, as detailed by Dr. Devan, to be genuine, the argument will be stronger yet ; for at that date, June 25, there teas not a case of Cholera in New - York. They think, therefore, that it is undeniable that the disease originated in the house. 

The state of things at Sing Sing is of a still stronger character, on account of the rigid discipline which is there enforced, and which renders it highly improbable that any foreign communication should take place, which could escape detection. 

In regard to the occurrence of malignant Cholera at this place, and the improbability that it was carried there from any other, they make the following remarks : — 

tit is the decided opinion of the very enlightened ;rintendent and Physician of that Institution, that the tse lately prevailing there, was not brought there from ad, but that it originated in the prison. 

Khe only circumstances that have been stated that could grounds for any doubt as to the truth of this opinion, 

tThe general fact, that many vessels from New-York, other places, are constantly loaded with marble at the m Dock. By these, it has been said, the disease may been communicated to the prisoners. 

Rlt has been reported that there was a man sick of lera on board one of these vessels ; thus showing, as supposed, the actual source of the disease. 



27 

i*. It has been reported, that a man sickened and died of olera at Sing Sing, previously to the 1 7th July, who had n away from the prison, and was said to have been in w-York. 

K. It has been supposed that prisoners might have been itted from places where Cholera existed. 

These various circumstances deserve notice ; and it has been remarked, 1, That it is quite improbable that vessels in ballast or loaded with such articles as are taken to Sing Sing, as iron, steel, provisions, &c, and manned by healthy crews, should convey the contagion of Cholera or any other disease. 

The vessels which go to Sing Sing, it is said, are perfectly clean, being loaded and unloaded frequently, and for the most part carrying only marb .vi blocks. It cannot be supposed, therefore, that the holds of these vessels could contain any thing which should create disease. 

If there were any articles of a kind calculated to produce this effect, they would be found in the cabin or the forecastle of the vessels. But these are parts with which the convicts have nothing to do, as they merely load the vessels with marble, . and are allowed no communication with the 

tis, therefore, in the highest degree improbable, that source of infection should exist on board of these Is. 

2. A satisfactory comment upon this point will be found in the fact, which has been ascertained, that the vessel in question was four days in New -York on her passage from Sing Sing to South River, and that the man sickened and died between New- York and New-Jersey. Of course, it has no bearing upon the present subject. 

K. In answer to this it is stated by the Superintendent no such case ever occurred there. 



28 

4. To this also it has been replied upon the authority of the Superintendent, Mr. Wiltse, that only one prisoner had been admitted after the appearance of Cholera in New- York, who came from King's county, where Cholera did not exist. It is true that he had Cholera ; but it was not until it had prevailed four days at Sing Sing that he was 

11. It is stated by Mr. Carmichael, an officer of the prison, that the first four or live cases occurred in persons having no communication with the dock, but either employed in a remote part of the yard, or at the quarries. He farther states, " That it was actually a subject of remark at the lime, that none of the first cases were among persons employed in the loading of vessels." 

Buch are a few of the facts and arguments which have i urged on the respective sides of this question, — 

Non nostrum tantas componerc lites. 

IV c will only remark, that the case of the State Prison ing Sing, goes at least to show, that whether contas or not, there is no probability of its being excluded ny quarantine regulations. For if it was carried to place, it was carried in clean and empty vessels and by thy crews, and communicated in ways that are neither eptible of being traced or guarded against, as any one t be convinced who is acquainted with the lex loci. 

Khe disease manifested itself in every form, from th« est diarrhoea to the malignant Cholera, which was jtimes fatal in from three to six hours. 

Eie mildest and most prevalent form of the disease was rrhcea attended with frequent watery discharges, and with pain in the bowels. There were also frequent ttoms of derangement of the nervous system, as dizzi- 



29 

ness, ringing- in the ears, slight cramps, &c. In other cases there seemed to be much greater derangement of the bowels, extending to the liver and stomach, as was evinced by the discharge of a great quantity of yeast- like fermenting matter, and a great tendency to an absence of bile, the evacuations resembling gruel, or dirty whey, or bread and water ; these cases were very numerous. 

I^hcse symptoms, which have been commonly termed premonitory symptoms of Cholera, must, as has been )re remarked, be considered as the Cholera itself in a ter form, and under more manageable circumstances ; scarcely has a single instance been known of a person, ) had had this diarrhoea and given it prompt attention, ) was subsequently attacked with malignant Cholera. 1 on the other hand, it ran on, when neglected, into ate of collapse, and fully developed Cholera. 

I^his form of the disease has prevailed very generally, ost universally, throughout the United States, in places :re Cholera was rife, and in remote country towns ire it has not yet appeared. 

This diarrhoea has been found to be a perfectly manageable disease. It has been treated upon the same principles with ordinary diarrhoea, with uniform success : so true is this, that I have not as yet been able to find an instance in which Cholera occurred after a diarrhoea which had received proper medical treatment. 

f'he next form of the disease, both in regard to extenness of prevalence and in the degree of violence, was spasmodic. 

In this state there were vomiting and dejections of fluid like rice-water or gruel, with a uniform absence of bile, pains in the bowels, oppression and anxiety about the stomach, but above all, cramps or spasms of the whole body, and especially of the legs, with great restlessness and 

a 



30 

agitation. In some cases there was a bluish appearance of the skin at the iirst onset of the disease, with coldness of the extremities and surface, a small, weak, and frequent pulse, while in others the pulse was quite good, and the heat natural. If relief, however, were not soon obtained, it passed on into the collapsed or sinking stage. 

IFhere was also a very remarkable absence of all secreis. The eye was dry and tearless. There was an tost entire absence of urine, and when the catheter was oduced, the bladder was found to be empty. After th it was uniformly contracted to a small size, and wn quite to the bottom of the pubis. The biliary seorei, as will be presently remarked, was also suspended in imarkable manner. 

In persons of good hahits and constitution such cases were in general found to be manageable. Whereas in the most malignant class of cases, recovery was comparatively rare. The spasmodic form or stage of cholera generally terminated in from twelve to thirty-six hours, according to its degree of violence, the propriety of the means used, &c. 

Ii all cases there was a great tendency to excessive piration ; so that whether warm or cold, the skin Id be covered with a clammy viscid sweat, which in the »t cases, appeared to ooze mechanically from the skin, ist as it was wiped away. It was thus a cause of great lustion to the patient. This excessive sweat was supd by some to be the cause of the peculiar shrivelled :arance of the skin. 

In cases of collapse the patients seemed to sink prostrate at once under the malignant operation of the causes of the disease. They betake themselves to bed from a sense of faintness and exhaustion ; the skin is cold, and often reeking with a cold, clammy sweat ; the pulse is almost or quite imperceptible ; the tongue is cold as marble ; the eyes are 



31 

I a few hours sunken and hollow, as in a person dying m long continued exhaustion, as one starved to death, th an expression of indescribable distress and anxiety, lere were frequently cramps of the limbs and abdominal iscles, but they are not of so constant occurrence in this in the spasmodic stage. There is a great load and and a sense of tightness about the epigastrium, that the patient sighs or groans frequently, or sometimes »uts in the most frightful manner, thus presenting all the jearances of malignant disease in its most concentrated form. Frequently the voice is diminished to a low whisper. In the meantime there is frequent vomiting, and constant lafing of the kind of fluid before described, or sometimes i pure liquid like water : in all cases there is a total jnce of bile, which may be considered diagnostic of the ase ; and in some cases still more malignant and sudden ieir onset, there are no evacuations at all. As the case inces the pulse is imperceptible, the distress lessens with strength, the frequent sighs and groans are changed to w moan, or to perfect silence, and death ensues. 

In others the attack commences with violent abdominal pain, like colic, with twisting and writhing of the body, which is soon, however, followed by the dreadful symptoms of collapse. In these cases there had been previous indigestion, and the pain appeared to be caused by undigested food in the bowels. 

fn many of the worst cases the asphyxiated form of the ase was exhibited, when in connexion with the usual ptoms of collapse, the skin over the whole body was i, and almost black, like the skin of a person who had 1 smeared over with ink, and only partially washed. In c cases the disposition to colliquative sweat was most arkable. It is doubtful if any cases of this description linated favorably. 



32 

Ii other cases the poison seemed to benumb the nervous jm so as to produce complete torpor, so that the patient \ the beginning would lay silent and make no complaint ss spoken to : these were in general rapidly fatal, as in or six hours ; while some were of a more protracted •acter. In the first instance they seemed literally to lie n and die, and their death was quiet and easy, in some mbling common sleep. 

In a child of ten years the disease exhibited the following appearances : it was well the day previous, and was attacked with vomiting and purging ; it complained of neither pain or spasms, the countenance was unusually haggard, the eyes rolling in their orbits, without any fixedness, and lifeless, surrounded by a broad brown circle ; when not aroused, they were half open and rolled up : the skin was mottled and rather livid ; there was frequent deep sighing ; the pulse was not perceptible; the strength and vital powers seemed to be prostrated beyond all proportion to the evacuations, which in themselves appear insufficient to have produced so alarming a condition. This case terminated 

Cases of collapse were generally of not more than twentyfour hours' duration, unless reaction took place, when there was commonly a greater or less degree of consecutive fever, which was observed to occur more commonly as the epidemic drew near its close. When no reaction took place, they were generally fatal in from twelve to twenty-four 

The consecutive fever presented in general very much the appearance of common typhus fever, differing from it chiefly in the copious discharges of dark green bile, which was thrown off in immense quantities when calomel had been freely used ; these discharges continued often for a 



33 

The most common as well as dangerous symptom of the consecutive fever was congestion of the head. This was evinced by a peculiarly heavy breathing, restlessness, frequent tossing about in the bed, sighing and moaning, the eyes, particularly the lower portion, congested, half open and rolled up ; the skin dry and slightly above the natural temperature ; the tongue dry and generally clean ; great thirst, stupor and sleeplessness alternating with each other. Congestion in any other part was less frequent than that in the head ; and if there were no affection of the head, the secondary fever was less dangerous. This form of the disease did not seem to be infallibly prevented by any mode of treatment, for it occurred in cases when the liver had been freely unloaded of bile, and when the system was fairly under the influence of mercury. 

It is worthy of observation, that pulmonary congestion, eh, earlier in the season was found to be so common in is, and elsewhere, has been exceedingly uncommon 3. 

for a more particular detail of symptoms I refer the ler to the cases at the close of the volume. As also the result of dissections. 

Ec. — My friend, Dr. Alfred C. Post, informs me, that in four out of five :ts whom he had examined, he found the right auricle and the left vondistended with blood to a remarkable degree — that is the greater circula¦thc lesser or pulmonary circulation being empty. 

The deficiency of blood in the pulmonary circulation, and its consequent accumulation in the other portions of the heart, and in the larger vessels, may, perhaps, be accounted for by the circumstance, that during the stage of collapse the respiration becomes gradually more and more imperfect. The lungs ceasing to be dilated with air, are collapsed, and no longer give froc passage to the blood, which is of course accumulated in the other parts of the circulation. 

They are perhaps, also, for the same reason the first part to die, and thus the first to be deprived of their circulation. 



SHOWING THE RELATIVE MORTALITY FOR THE MONTHS OF JULY AND AUGVST, 1832 AND 1831. lbo"-. Average i>er week Veek ending July 7 14 21 28 Aug. 4 11 18 25 Sept. 1 Total nearly hildren of 1 year, and under 1, 37 46 GO ! 59 55 G5 85 70 62 543 ~60 V of 5, and under 5, 56 83 137 166 143 137 167 151 130 1139 126 'ersons over 60 years, 16 64 100 79 51 47 30 37 26 450 50 Dotal of interments per wmk, 191 510 887 1879 580 467 444 391 324 4673 519 Total of interments of persons dead of Cholera, 56 ] 336 716 689 383 281 222 178 138 2996 333 Do. of other diseases, 125 174 171 ' 190 197 186 222 213 186 1677 185 — — — . . ntemients in week ending July 9 16 23 30 Aug. 6 13 20 27 Sept. 3. Total For 1831 Children of 1 year, and under 1, 27 55 63 64 68 52 63 70 48 500 55 )o. of 5, and under 5, 50 83 96 85 99 82 98 99 76 768 85 Vrsons oi 60, and over 60, 12 9 11 3 11 6 7 12 9 80 9 Total interments, 97 143 144 128 156 144 163 186 142 1303 144 These tables demonstrate an increased mortality by other diseases daring the prevalence of Cholera, of 40 per week, or about 2S >er cent. Among children of 1 year, and under, the mortality seems but slightly increased. Among children from 1 to 5 years, the ncrease of mortality is 100 per cent., or as 2 to 1. Among persons of 60 years, and upward, the increase of mortality is as 5J to 1. The total increase of mortality during the two months of July and August, 1832, is as 3i to 1, nearly. The excess of deaths by other diseases than Cholera during the same period over the whole sum of deaths the preceding year, is 374, or about 25 percent., and 







No. I. 

Kocliostrr, August fitli, 1«32 

Kr, — I had the honor to receive your communication of the Ist iti.stant a day o .since, and cheerfully reply to your inquiries so far as my knowledge of enables me to do so. 

Ist. The first case of malignant Cholera appeared here on the 12th day of July. 

¦I, An epidemic diarrhea* has prevailed to a great extent, not only at this \\n\t also at most of the towns in this section of the State, since about the of June. ¦ 

il. The first two cases of malignant Cholera that occurred here were ight from abroad; one, a resident of Michigan, on his return from the city few-York, which place he left on the Gth of July, and arrived here 3ick on 12th ; the other, an emigrant woman from the Isle of Man, via. New- York Albany, which places she left five or six days previous to her arrival and ure at this place on the 14th July. After this cases began gradually to »ar in various parts of the town, and often in persons between whom and sick no previous communication could be traced. 

4th. We have no facts which unequivocally establish the contagious nature of Cholera. 

ih. Scarlatina prevailed epidemically during the past winter, but with no iual characteristics. Several cases of pneumonia occurred, which assumed I'lionl character, would not bear the lancet except in the very earliest •s, if at all, and rapidly sunk down and had a fatal termination. This a very unusual character for diseases to assume in this section of country as I have rarely observed during a residence of fifteen years. With these ptions, nothing unusual was observed in the diseases of the winter and 

I cannot drop this subject without stating a few additional facts which I conceive may throw some light upon a subject involved in great obscurity : — that of the origin and propagation of this disease. Is this disease contagious or is it not 1 We certainly are not in the possession of any facts which decidedly prove it contagious in the same manner as smallpox, and many other diseases ; and yet it is impossible, in my mind, to reconcile all the phenomena upon the supposition of atmospheric or telluric causes alone. The diarrhoea prevailing throughout the country, evidently depends upon some atmospheric cause ; and this same cause, I belie\e, also predisposes to Cholera, but is of itself insufficient to produce 



36 

g\ 11111110 Cholera without the aid of sonic additional poison derivable from [KTiiliar localities, animal miasma or contagion. This common diarrhoea prevails throughout the country, apparently in all places alike or nearly so, and yet in very few towns has malignant Cholera appeared. At this place it existed six weeks before the occurrence of a single case of Cholera, and then it was not till after the introduction of that disease from abroad, that our citizens were attacked by it, — a fact strongly favoring the idea of contagion. At Mendon, a small village sixteen miles east of this, the disease was introduced in the same way. A stage driver, who had attended some friends sick of the disease at this place, (Rochester,) left here in the morning and died with Cholera the following night, at that village, where the disease had not before existed. Of six persons, who attended him during his illness, and laid out and buried him after death, not one escaped an attack, and four of them died in less than one week. It afterward continued to spread there, and 13 have died out of a population of about 150. At Manchester, Ontario county, a similar fact was observed. A lady came there from New-York, and dun] live days after leaving the city. Her sister, a resident of Manchester, who was with her during her illness, also died of the disease two days after. In Oneida county, some Indians were employed to bury a corpse, dead of Cholera, from oft" a canal boat, in a perfectly healthy situation ; six of them died very soon after. Facts of this kind have now become too numerous to be regarded in the light of mere coincident or fortuitous circumstances ; and if, when considered in connexion with other phenomena, they do not cstalitish the doctrine of contagion on grounds harmonizing with its hitherto recognised laws and principles, some further cxtcntion must, I think, be given them. Another circumstance which ought to furnish corroborative evidence of contagion, i-> the well known fact, that when one in a family has had an attack others in the same family arc exceedingly linlilc to the disease. My own impressions, from what I have seen, lead me to place this in one of Dr. Hosack's divisions of contagious diseases. 1 believe that there is some general atmospheric cause giving rise to a diarrhoea and common cholera : that this, of itself, is insufficient to produce genuine malignant Cholera; but this combined with some other principles arising from certain localities, but more often with a miasm emanating abundantly from the bodies of the sick, and more sparingly from the well, when crowded together in great numbers in ill-ventilated apartments, prisons, or on ship lward, as in the case of the prisoners at Sing Sing and in Philadelphia, the steamboats conveying troops on the western lakes, and numerous other instances, will give rise to a compound vitiating the atmosphere to a considerable distance around and producing Cholera in its most malignant form. Upon no other ground can I reconcile the mass of testimony that has been urged both against and in favor of the doctrine of contagion. 

In haste, I am very respectfully, 

John B. El wood. 

IV F) Aviim \f M \. Vr»rL* 



37 

No. 11. 

EE following is an extract from a communication made by Dr. Goodrich, >y, to the Board of Health of that placo, and by them transmitted to the il Medical Council of New- York. 

Troy, September Bth, 1832. 

Hon. George Tibbits, Mayor, and President of the Board of Health : — 

Sir, — The following inquiries were addressed, by the Special Medical Council of the city of New- York, indirectly to the Board of Health of this city. The communication having been referred to me, I herewith transmit a brief 

Ist. "What was the date of your first case of malignant Cholera 1 

X" Was it preceded, accompanied, or succeeded by a general prevalence of oca? 

3d. " What was the supposed origin of the first cases — was there any evidence that they were communicated from a foreign source 1 

4th. "Have you seen any facts to prove Cholera contagious? 

»h. " What peculiarities have you observed in the disease of the past spring winter?" 

Ii answering the foregoing inquiries, allow me to premise, that the populaof Troy is about 13,000, — the health of the city is generally good, and xtpulation free from malignant diseases, — and that intermitting fevers are y seen except occasionally cases of foreign origin. During the prevalence m- epidemic Cholera Morbus there have occurred in the city, in round bers, 50 fatal cases, and with very few exceptions, they have occurred in ins more or less accustomed to the intemperate use of alcoholic drinks. I ye I can safely say in the "execpted cases" the disease in every instance attributable to gross imprudence or neglected diarrhoea. 

E'stiou Ist. The first case of epidemic Cholera Morbus reported to the of Health, occurred on the 16th of July, and proved fatal. The patient man of dissipated habits, and in consequence had been exposed the previous to attack, to cold and dampness, followed by diarrhoea. The symptoms characteristic of the disease, supervened. He died in the >on. 

Question 2d. Previous to the existence of the above case, there was observed a general tendency to gastric derangement, more or less severe. This obtained mostly in adults. Some time anterior to the breaking out of the Cholera and during the continuance of it in our city, there was evidently a peculiar constitution of atmosphere inducing disease and increasing the number of cases of bowel complaints. This had been noticed by most of our physicians and in the reports of the day, the Board of Health recognised the fact. 

Question 3d. The first cases were obviously of domestic origin, and could not be traced to any " foreign source." The first cases, as well as subsequent ones, were found in constitutions injured and worn out by previous Irregular 

C 



38 

Its ; among persons living in close, damp, unvcntilated, and crowded t merits; and also in that class of individuals who arc imprudent in eating drinking, exposing themselves after fatigue to the dampness of the night md who from ignorance or carelessness, neglect for hours or days the lonitory symptom, diarrhoea. It is believed that every fatal case may be buted to some obvious, local, exciting cause. 

Question 4. There has appeared nothing in the history of the disease in this place to induce a belief of its contagious nature. Facts are decidedly in favor of its noncontagious character. It is true there have been instances where two or three have died in the same house and at first view favoring contagion. The subsequent cases, however, can perhaps in every instance be traced to the same exciting cause with the first, and probably superadded to this, personal anxiety and fatigue. So far as the fatal character of the disease is concerned, it has been strictly local. When fatal, it has been confined principally to certain sections of the city, generally filthy, and for the most part in the immediate vicinity of dampness, especially damp and wet cellars. In many whole neighborhoods, not a case has occurred. 

Question sth. Physicians have remarked that for. thejast six or nine months diseases in general have in the early stages, indicated more than ordinary debility, and have not consequently allowed depletory means to the extent that is common. During the spring and first part of summer, diseases approximating intermittent fevers in some of their characteristics and differing in others, were frequent and unusual ; so much so that they excited the observation of the faculty at the time, and were subjects of professional speculation after- 

I have thus answered, so far as practicable the inquiries of the Special Medical Council of New- York, but cannot flatter myself that it will be altogether satisfactory to them or to many others of the profession. —So far as facts are stated, the Board and our community generally can attest; the opinions are my own, and for their correctness I appeal to the profession generally, and to the " Board of Physicians" you have appointed, in particular. 

Respectfully submitted. 

C. S. J. Goodrich, M. D. 

Physician qftke Board. 

No. 111. 

My friend Dr. Cookc, of the Navy, has stated to me a very interesting example of the manner in which fear operates in producing a fatal result of disease. He was surgeon of a ship upon the West India station during the prevalence of yellow fever : knowing the dread in which this disease was held by the seamen, he forbade it to be spoken of, and the cases were all called cases of bilious fever. They uniformly recovered. In another ship in every 



39 

i:s were all called by that name. The consequence was, that every man > was taken, gave himself up at once as lost, and it was but too true, that r all or nearly all died. Some men, who were doing well in the first ship "¦ to be transferred to the other : although affected with yellow fever, they not know it ; but they knew that it prevailed in the other ship. It was in i that they and their benevolent surgeon entreated that they might be wed to remain where they were. They were removed, and all died. 

METEOROLOGICAL TABLES. 

By the politeness of Dr. Baxter, Chairman of the Meteorological Committee of the Medical Society of New- York, I am enabled to append to this paper his report to that Society for the last two quarters of the year 1831, and the first I-ter of the year 1832. To these he has kindly permitted me to add an act from his journal comprising the months of April, May, June, July, August. 

To these I have thought it interesting to add the journal of the weather at Quebec during the months of April, May, and June to the 25th, as furnished by the Health Officers of that city to the New York Committee. The journal of temperature was taken from a Reaumur's thermometer : I have therefore changed it to the corresponding degrees of Fahrenheit, according to the regular formula, omitting the fractions only. In these tables it is very interesting to observe the remarkable prevalence of easterly winds for six weeks preceding the date of the appearance of Cholera at Quebec, viz. June 9th, as also the very great drought during the whole period of nearly three months. The great changeableness of the weather during the month of June, is also remarkable, the thermometer varying from 84° to 43° for the month, and falling from 81° to 50° between the 16th and 17th of June. 

K PORTS OF THE METEOROLOGICAL COMMITTEE OF THE MEDICAL SOCIETY. 

Ihe Committee beg leave to offer the results cf the observations for the two quarters of the year 1831, and for the first quarter of the year 1832; of se some contrast in these results will appear from the tabular views which now lay before the Society. 

I.c first quarter comprehends the months of July, August, and September, g which we cannot say that any thing unusual occurred. July being as a warm month, the thermometer rising to 93° as the highest on the last f that month, and falling the same day in 15 minutes 24°, attended with wind and electrical phenomena ; the lowest point at which the thermo¦ fell the same month was 54° on the 11th. The greatest barometrical 



40 

premnre raised the barometer to 30.4 inches, which was the \M and 3d of the month ; the least pressure observed was at 29.74 inches. There were four times electrical phenomena during the month, all attended with heavy rain ; and the whole quantity of rain which fell during the month at nine different times, was 7.03 inches. The prevalent winds during this month were, with but few exceptions of two or three days, from S. \Y. to S. E. ; these are our most prevalent winds at this season. It is remarkable that a wind directly S. seldom or ever prevails here. 

In August the thermometer rose to 92° as the highest, and fell to 55° as the lowest. The change of the barometrical pressure was from 30.4 inches to 29.87, being 0.53 of an inch. The falls of rain were frequent, and there was more moisture than last year ; the electrical phenomena were in small quantities and but four times ; the whole quantity of rain fallen was but 2.7*2 inches at nine different times. The most prevalent winds were from the S. W , some S. £? and a few W. and N. W. 

In September the variation of the temperature was from 88° on the 11th, down to 45° on the 30th, making 43°. The barometrical pressure varied from 30.28 inches to 29.61, making a range of only 0.57 inch. This month wu remarkable for the absence of electrical phenomena, of which there was only a slight appearance once, showing an equal distribution of the electric fluid. A more than usual quantity of moisture was prevalent also, and there fell during the month 5.45 inches of rain in six times, being exactly double the quantity which fell last month in nino times raining. The prevalence of the S. W. winds were much diminished this month, and the W., which are always coldest, and N. W. became more frequent and continuous, and the S. E. winds were but few. So that we can only attribute the increased moisture to the northerly winds returning and condensing the evaporated moisture from the earth and ocean during the past months. 

luring this quarter, therefore, we see the highest range of the thermometer been 93°, and the lowest 45°, and the difference 48°. Of the barometer ¦ange has been from 30.40 to 29.61, making a difference of 0.79 inch, leu an inch, and the average 30.005. The whole quantity of rain which fell quarter was 15.20 inches. 

The next quarter will comprehend the months of October, November, and December, 1831. 

In October the variation of the thermometer was from 78° on the 3d and 4th, to 37° on the 28th and 29th, making a difference of 41°, and the mean temperature 57 J v . The barometer ranged from 30.41, rather an increase on the last quarter, to 29.59 inches or 0.82 inch, making the mean pressure 30 inches. There were no electric phenomena, but the quantity of rain which fell amounted to 5.20 inches in 4 times, there being a very great fall on the 9th, 10th and 11th, and the quantity of moisture generally was large. The winds were very variable, and ranging from all points of the compass, so that it was difficult to determine which wa» most prevalent. 



41 

frost, and ite continuance through the month. For although the thermometer rose as high as 66° on the 11th, it was but once, and before that it was down to 36°, which was productive of frost, and it continued falling until the last of the month, when it was 24°, which gives a difference of 42°, and mean temperature of 45°; and although this is not very low, yet the continuance of cold by cooling so early the earth and waters laid the foundation for a tedious season afterward, and closed the smaller streams earlier than usual, which by embargoing our supplies of fuel and provisions was productive of much distress in the city and sea coast, and those who were dependent on daily supplies would of course suffer. How far it may have affected the prevalent diseases which have been rife during this season is worthy of consideration, and will furnish further evidence perhaps of the connexion of meteoric phenomena with popular sufferings by want and disease. The lowness of the barometrical pressure this month was a circumstance worthy of notice ; it only in one instance rose to 30.32 inches, was generally below 30, and on one occasion, viz. on the night of the 22d instant, during a burst of electricity, attended with hail, rain, snow, and very high wind, it fell to 29.10, and I was informed by Mr. Pike that it was during the night at 29, a very uncommon depression of this instrument. The mean pressure from these data would be 29.72, which is, however, too low, —it might be 29.90. There was another occurrence of electrical phenomena on the 18th ; these, however, are not unusual in our winter months. The depth of rain this month was 2.24 inches, at four times. The most prevalent winds were from the N. E. and N. W. and W. 

In December the thermometer in no case indicated a higher temperature than 40°, which was on the 24th, but kept falling from the beginning of the month until the 16th, when it was at 1 1° above zero : it again rose until the 23d, when it fell again to 11, and continued low, and making the mean 25°. The barometrical pressure was as high as 30.43 inches on the 10th, and on the 17th fell as low as 29.38, making a difference of 1.05 inch, and the mean pressure 29.90. 

The quantity of water fallen was but 1.30 inch, at three different times ; the last was a heavy fall of snow on the 28th. The prevailing winds were \V. and N. W. and the weather generally clear. 

I see hence a change of temperature this quarter of 67° ; the thermometer ; from 78° on the 4th of October to 11° on the 16th December. The commencement of the winter in the first week of November, and the continuance of the cold, which although not severe, was yet constant, evalence at the same time of influenza, and the eruptive diseases vanola, a, scarlatina, &c., which continued through this and the following r with the effects already mentioned, tended not a little to make this a vhat distressing season to those dependent on their daily labors. 

The whole quantity of rain which fell this quarter was 8.74 inches. 



42 

The succeeding quarter will include the first months of 1833, January, February, and March. 

In January a thaw commenced at the beginning of the month which soon carried off much of the snow ; it continued to prevail for some time, the thermometer rising on the 19th to 57°, and the weather was mild and pleasant until the 25th, when a change of temperature commenced, and on Ui« 27th the thermometer fell to 3° above zero, and some have said that in some situations it was at zero ; this, however, we did not observe. It was, however, the coldest period during the season. A severe snow storm occurred on the night of the 25th, and on that of the 26th ice formed across the North River, quite thick at Sing Sing, and a thin sheet in the harbor. The barometer rose to 30.5 inches on the 26th and 27th, and did not fall below 29.6 inches on the Bth, making a difference of 0.90 inch, and the mean being at 30.05. There was 4.36 inches of rain fell in six times. No electrical phenomena occurred. The winds were for the most part from the S. W. and S. E. until the 25th, after which N. W. winds prevailed. 

§ February, although the thermometer indicated 59° and did not fall 11^, which was on the 21th, yet the temperature generally was of a grade than last month, the mean being 35°. 

Ec barometer rose to an uncommon height this month, higher than we ever noticed it, viz. to 30.74 inches, this was on the 24th ; the lowest it it made was on the 20th to 29.67 inches, making a difference H inch, and placing the mean pressure of the atmosphere at 30.205 

The whole amount of water fallen was 2.30 inches in five different times of rain and snow. The prevalent winds were mostly N. W., N. E., and S. E. 

The temperature of March was mild at the beginning and until the 14th, when a sudden change occurred, and the thermometer fell suddenly to 20°, it having been on the 12th at 67° ; on the 18th it fell still lower to 15°, the difference being 52° and the mean temperature 41°, after which it rose very gradually. The pressure indicated by the barometer was 30.55 inches as the maximum, and 29.61 inches as the minimum, giving a difference of 0.91 inch, and a mean pressure of 30.08 inches. 

The quantity of rain fallen was but 1.78 inch. Electric phenomena occurred on the 12th, and high winds on the 17th and 26th, at which periods a sudden and considerable change of atmospheric pressure occurred — on the 12 and 17th it was by falling, and on the 26th by rising. The most prevalent winds were from the S. W., S. E., and N. W. 

The greatest difference of temperature this quarter was between the 27th of January and the 12th of March — 64°. The protracted coldness of the atmosphere this quarter, but added to the tcdiousness of its early commencement in the previous quarter. The whole quantity of rain which fell this quarter amounted to 8.44 inches. The barometrical pressure, as we have already remarked, was very prrat. 



43 

The Committee cannot but remark that the past season is an additional admonition to our fellow citizens not to place too much reliance upon a continuous melioration of our climate : for although this has without doubt taken place since the year 1805,* — and even the past season can by no means be put upon a par with the winters our fathers experienced, when every precaution was made use of at the commencement of the season, in October and November, in going as it were into winter quarters, — yet, that the seasons do as it were retrograde occasionally, there can be no doubt. It is not many years since we had another instance more severe than the past, and when the North River was passable on the ice j (this was in 1821 jt) which although it may not occur again, still the barring of the navigation of the smaller streams by a lesser cold is as great if not a greater evil, as it prevents that rapid communication over the medium of permanent snows which continued to furnish some of those supplies now entirely cut off by a lesser cold, and which gives so much occasion for regret of the want of foresight and caution in those who are most exposed to the storms and cold of winter, with the concomitant 

The past season has been one not devoid of interest with respect to the connexion of meteorological phenomena with epidemic diseases ; but H does not belong to this Committee to point out those epidemics in their progress, or to descant even on their causes, — this would be infringing on the duties of another Committee. This Committee therefore can only point out those occasional circumstances of disease, as they occur, by which we are surrounded, in the temperature and pressure of the atmosphere, its electrical changes, change of winds, &c, circumstances whose continual changes will necessarily continue to affect the human organization in its physiological functions through the medium of its external surface, its respiratory organs, its circulatory system, its nervous system, its digestive organs, &c, and thus become the prolific cause of dieascs. The Committee therefore hope by the continuance of its labors, (especially at this period, when much excitement is produced respecting an epidemic disease apparently passing round our globe, and which there is much reason to ascribe to meteoric influence,) and their connexion with the labors of the Committee on diseases, to be useful in tracing the causes of some of our epidemic as well as endemic diseases. 

J. Baxter, Chairman. 

' Although 1905-£ was a rery severe winter, the following year wm a Tery mild one, since which the winters have moderated. 

E thermometer in 1821 was down to 3° below zero, and closed the North River; it been bo low as the past season but once since, which was in 1827, when it was 



44 

METEOROLOGICAL OBSERVATIONS FOR APRIL, 1832. 

Days of Barometer. | Thermometer. p reva iling De P' iph^c Month. 9 A.MJ3 P. M. 11 P. M. Morn. Noon Night WindB - Rain tk^T April 1 29.83 29.71 29.90 45 62 42 W. Clear 2 30.05 30. 29.99 37 54 44 N.W. Cloudy 3 29.63 29.54 29.82 41 55 38 S.E. .32 Clear 4 30. 29.85 29.8 30 56 50 W. Clear 5 30.1 30.2 30.3 33 46 35 W. Clear 6 30.4 30.36 30.37 28 45 35 N.K. Clear 7 30.3 30.2 30.1 30 51 38 N.E. Clear 8 30.22 30.22 30.3 35 50 33 N.E. Clear 9 30.37 30.37 30.37 27 44 33 N. Clear 10 30.37 30.22 30.17 31 51 43 S.E. Clear 11 30.03 30. 29.97 40 68 51 S.E. Cloudy 12 29.95 29.95 29.90 40 69 55 S.YV. Clear 13 29.88 29.8 29.78 47 77 57 S.W. Clear 14 29.73 29.75 29.83 51 79 44 S.W. Clear 15 30. 29.97 30. 40 51 40 N.E. Cloudy 16 29 90 29.83 29.80 39 44 42 N.E. 1.32 Rain 17 29.72 29.72 29.8 40 46 40 N.E. 1.20 Rain 18 29.88 29.91 29.95 39 44 40 N.E. 0.30 Rain 19 29.92 29.92 29.93 38 46 40 N.E. 0.10 Rain 20 29.89 29.89 29.91 38 50 46 N.E. Cloudy 21 29.91 29.91 29.91 40 62 51 N.W. Clear 22 30.03 30.03 30.14 44 59 44 N.W. Clear 23 30.25 30.2 30.16 36 52 38 N.E. Clear 24 30.1 30.1 30.21 36 62 44 N.W. Clear 25 30.2 30.06 29.94 39 66 52 S.E. Clear 26 29.86 29.7 29.75 49 80 64 S.W. Clear 27 29.75 29.82 29.92 60 80 62 S.W. Clear 28 30.05 30.20 30.23 45 50 45 N.E. 0.56 Cloudy 29 30.23 30.23 30.22 42 49 44 N.E. Cloudy 30 30.2 30.14 30.14 42 48 45 N.E. 0.66 Rain 4.46 inches. 

Mean temperature, - ...--- i 

Mean temperature for April, 1831, .... 50° 

Mean temperature at Quebec for April, 1832, - 





45 

METEOROLOGICAL OBSERVATIONS FOR MAY, 1832. _____________ ____ =====^:^==^=:==^=^== Daysot Bar^inetcr. "Thermometer. Prevailing Dj< *f,Tri"c ' Month. 9A. MJ3 P.M. 11 P.M. Morn. Noon Night VVin s " Rain Uoim. Mayl 29.9 29.88 29.88" 43 6G 43 S.W. Clear 2 29.78 30.06 30.07 45 62 48 N.W. Cear 3 30.10 30.10 30.08 46 44 49 S.E. Cear 4 30. 29.84 29.70 50 72 60 S.E. Coudy 529 84 30. 30.02 54 64 54 N.W. Clear 6 30.26 30.31 30.37 53 62 50 N.W. Cc« 7 30.46 30.46 30.44 45 60 45 N.E. Cear 8 30.35 30.30 30.23 45 72 60 S.E. Cloudy 9 30.24 30.26 30.20 57 75 57 N.E. Clear 10 30.4 30.4 30.51 53 68 49 N.E. Clear 11 30.55 30.55 30.55 47 62 45 N.W. Clear 12 30.50 30.41 30.36 43 70 58 S.W. Clear 13 30.33 30.23 30.25 55 78 64 S.W. Clear 14 30.2 30.11 30.10 58 85 60 S.E. Coudy 15 30. 29.93 29.91 60 76 60 S.E. .16 Coudy 16 29.97 29.94 30.02 58 83 62 S.W. Clear 17 30.02 30.05 30.03 54 77 62 S.W. Cear 18 30. 29.94 29.95 54 79 66 S.E. Coudy 19 29.93 29.80 29.76 55 79 57 S.E. 1.90 Cear 20 29.76 29.64 29.68 57 61 57 N.E. 0.28 Cloudy 21 29.74 29.74 29.9 49 68 55 N.W. Cear 22 29.96 29.96 30.05 51 70 54 N.W. Clear 23 30.1 30.11 30.05 48 62 48 S.E. Cloudy 24 29.92 29.90 29.95 44 59 42 S.E. .87 Rain 25 29.95 29.90 29.90 42 62 48 S.W. Cloudy 26 29.80 29.7 29.60 45 67 50 S.E. .50 Cloudy 27 29.61 29.79 29.80 47 62 46 N.W. Clear 28 29 9 30. 30. 46 68 55 S.W. Clear 29 30.04 30.04 29.97 44 79 60 S.W. Cear 30 29 67 29.6 29.66 54 64 52 N.W. .66 Clear 31 29.7 29.76 29.9 50 61 51 N.E. .16, Ram 4.53 inches. 

Mean temperature, - 

Mean temperature for May, 1831, .... 

Mean temperature at Quebec for May, 1832, - - - 45| c 

Quantity of rain for May, 1831, 2.67 inches. 

7 



46 

METEOROLOGICAL OBSERVATIONS FOR JUNE, 1832. Daysof Barometer. Thermometer. p reV ailing Dc P th | £{,«£ the Winds V«rii- Month.9A.M. 3 P.M. 11P.M. Morn. Noon Night ' ₯inus - Rain. liom. 1 29.90 29.90 29.90 50 74 59 S.W. Clear 2 29.86 29.76 29.76 56 82 62 N.W. Clear 3 29.71 29.70 29.77 56 63 52 N.E. .16 Rain 4 29.80 29.80 29.86 50 63 53 S.E. Cloudy 5 29.86 29.86 29.93 51 63 53 S.E. Cloudy 6 29.90 29.90 29.92 51 75 56 S.E. Cloudy 7 29.93 29.92 29.93 55 70 57 S.W. .46 Clear 8 30. 30. 30.1 55 72 55 S.E. Clear 9 30.11 30.11 30.1 55 70 53 S.E. Clear 10 30.1 30.05 30.1 53 75 56 S.E. Cloudy 82*11 30.10 30.05 30.05 56 79 65 S.W. Clear 12 30.06 30.06 30.01 63 93 75 S.W. Clear 13 30.23 30.23 30.23 65 78 60 N.W. Clear 14 30.13 30.1 30. 57 78 66 S.E. fcloudy ££,15 29.93 29.86 29.87 63 90 70 S.W. Clear 16 29.87 29.81 29.81 69 94 78 S.W. Clear 17 29.80 29.8 29.9 74 94 78 S.W. piear 18 29.80 29.7 29.79 69 88 74 S.W. .28 Rain 19J 29.9 30. 30.14 60 74 60 N.W. Cloudy 20 30.30 30.23 30.26 54 75 65 N.W. Clear 21 30.30 30.33 30.31 60 81 66 S.E. Clear 22 30.30 30.3 30.2 63 83 67 S.E. Clear 23 30.20 30.1 30.1 61 88 71 N.W. Clear 24 30.14 30.2 30.18 67 84 69 N.W. Clear 25 30.18 30.1 30.1 67 90 74 S.W. Clear 26 30.10 30.04 30. 68 90 70 S.W. Clear 27 29.85 29.83 29.85 70 90 75 S.W. fcloudy 28 29.90 29.93 30.11 72 87 68 W. Clear 29 30.22 30.22 30.27 62 87 67 S.E. Clear 301 SO- 30 S O - 3 30 - 25 63 85 G 8 SE - ' Clear .90 inches. Mean temperature, - ...... 68§° Mean temperature for Juno, 1831, .... 70J° Mean temperature at Quebec for June, 1832, - 58§° 

Quantity of rain for June, 1831, 1.91 inches. 



47 

METEOROLOGICAL OBSERVATIONS 

FOR JULY, 1832. Dav.ofl Barometer. Thermometer. Prevai , ing I>cpth *££ the Winds ' of V*i«- Month. 9 A. M. 3 P. M. 11 P. M. Morn. Noon Night ' *>*»¦ ~~l 30.22 30.18 30.14~ 65 94 78 S.W. Clear 2 30.12 30.07 30.03 72 95 76 S.W. Clear 3 30.01 29.96 29.94 74 94 78 S.W. C ear 4 30.04 30.07 30.11 72 88 70 N.W. Clear 5 30.11 30.16 30.16 68 87 68 S.E. C ear 6 30.14 30.05 30.03 65 89 74 S.E. C ear 7 30. 29.97 29.97 72 95 78 S. C ear 8 30.01 29.97 29.94 65 82 65 N.E. .10 Cloudy 9 29.89 29.82 29.80 64 72 63 N.E. Rain 10 29.82 29.85 29.87 62 76 65 E. .76 Cloudy 11 29.87 29.87 29.87 63 67 59 N.W. 3.56 Ram 12 29.82 29.82 29.82 59 80 65 W. C ear 13 29.82 29.79 29.86 60 81 61 W. .20 C ear 14 29.82 29.95 30.06 58 81 65 N.W. C ear 15 30.11 30.11 30.13 61 87 71 S.W. C ear gS. 16 30.13 30.10 30.14 65 85 67 S.W. .06 Clear 17 30.14 30.15 30.20 65 83 70 S.W. Cear 18 30.20 30.19 30.10 67 84 71 S.W. C ear SJS, 19 30. 29.9 29.85 69 94 72 S.E. .78 Clear ' 20 29.80 29.79 29.76 68 89 75 S.W. .05 Clear 21 29.71 29.69 29.81 72 91 70 W. Clear 22 29.9 30. 30.1 64 79 67 S.E. Clear 23 30.16 30.2 30.2 63 78 66 N.E. Clear 24 30.13 30.10 30. 62 83 70 S.E. Clear BST* 29.86 29.80 29.83 68 85 68 S.E. .76 Clear 26 29.83 29.83 29.86 64 83 67 N.W. Clear 27 30.05 30.11 30.17 64 80 69 N.W. Clear 28 30.17 30.16 30.16 65 85 70 S.E. Clear 29 30.16 30.06 30.03 67 84 70 S.E. Clear nST-30 30.02 30.02 30.02 66 87 70 S.W. .68 Clear 31 30. 30.12 30.18 66 83 72 S.E. Cloudy Mean temperature, - Mean temperature for July, 1831, .... 70J° 

Quantity of rain for July, 1831, 7.03 inches. 



48 

METEOROLOGICAL OBSERVATIONS FOR AUGUST, 1832. | , | i . . >¦ m Dayofl Barometer. Thermometer. | PrevaiHng Depth *££ the Winda Varii- Month. 9 A.M. 3 P.M. 11P.M. Morn. Noon Night TYinos - R a i n< uom. 1 30.2 30.2 30.2 70 79 70 N.E. Cloudy I' ectr 2 30.2 30.25 30.26 08 87 70 S.W. .48 Clear 3 30.26 30.22 30.20 66 84 74 S.W. Clear £"" 4 30.11 30.1 30. 72 90 74 S.E. Rain 5 30.10 30.09 30.12 72 87 74 S.W. .49 Rain 6 30.17 30.17 30.2 72 88 76 S.W. Clear ₯*£ 30.10 30.07 30.05 71 86 75. S.E. 1.50 Rain 8 30. 29.95 29.92 71 88 70 S.E. Rain 9 29.9 29.85 29.85 69 75 70 S.E. 1.90 Rain 10 29.85 29.90 30.1 68 81 68 W. Clear 11 30.21 30.27 30.3 64 80 70 N.W. Clear 12 30.32 30.32 30.32 64 81 70 S.W. Clear 13 30.35 30.35 30.32 70 84 70 S.W. Clear 14 30.32 30.26 30.26 71 86 76 S.W. Clear 15 30.2 30.05 30. 74 92 76 S.E. Clear 16 30. 30. 30. 70 90 68 S.E. Clear 17 30. 30. 30.2 66 73 62 N.E. 1.62 Rain 18 30.26 30.26 30.23 60 72 61 N.E. .64 Cloudy 19 30. 29.90 29.97 61 81 65 S.E. .10 Cloudy 20 30.20 30.20 30.25 64 79 70 N.W. Clear 21 30.26 30.2 30.14 63 83 64 S.W. Clear 22 30.06 29.91 29.91 64 83 73 S.E. Cloudy 28 29.95 29.95 30. 68 88 70 S.W. .28 Clear 24 30.02 30.02 30.15 64 85 61 S.W. Clear 25 30.20 30.62 30.23 51 67 58 W. Clear 26 30.23 30.12 30.13 54 73 65 S.W. Clear 27 30.12 30.10 30.10 60 78 66 S.W. Clear 28 30.10 30.12 30.17 62 83 67 S.E. .10 Clear 29 30.22 30.21 30.23 65 81 65 S.E. Clear 30 30.24 30.20 30.14 65 82 70 S.E. Clear KT3I 30.10 29.95 30. 69 90 73 S.E. Clear 7.99 inchea. 

Mean temperature, - 72J° 

Mean temperature for August, 1831, .... 70J° 

Quantity of rain for August, 1831, 2.72 inches. 



49 

HEALTH OFFICER'S RETURN tythe Stele of Public Health in the City of Quebec for the Months of April, May and June, 1832. METEOROLOGICAL TABLE. APRIL. MAY. Thermometer. Pre- Atmo- Thermometer. Pre- M^°r | vailing '$™£ £ filing f£Z (5 7i.M. 2p.m. 9p.m. Winds, tiom. q 7a.m. 2 p. m. 9p.m. Winds. tk>n». 1 41 45 3G S.W. Clear 1 34 34 34 N.E. Snow 2 39 36 39 S.W. Cloudy 2 36 41 39 S.E. Cloudy 3 39 34 39 N.E. Snow 3 41 50 39 S.W. Clear 4 50 36 43 S.W. Clear 4 39 41 39 N.E. Cloudy 5 50 36 43 S.W. Clear 5 41 45 41 N.E. Clear 6 50 34 41 S.W. Clear 6 41 54 41 S.W. Clear 7 41 36 41 S.W. Clear 7 43 57 41 N.E. Clear 8 43 34 43 N.E. Clear 8 50 6G 50 S.E. Cloudy 9 52 34 36 S.W. Clear 9 57 66 52 S.W. Clear 10 39 45 36 S.W. Clear 10 54 66 54 N.E. Clear 11 41 50 39 S.W. Clear 11 54 77 52 S.W. Clear 12 41 57 41 S.W. Clear 12 59 79 59 S.W. Clear 13 36 36 34 N.E. Cloudy 13 48 52 45 N.E. Clear 14 32 34 32 N.E. Clear 14 50 54 43 N.E. Cloudy 15 32 39 32 N.E. Clear 15 45 54 41 N.E. Cloudy 16 32 36 32 N.E. Cloudy 16 41 57 42 N.E. Cloudy 17 32 36 32 N.E. Snow 17 48 57 45 N.E. Clear 18 32 39 32 N.E. Cloudy 18 45 52 43 N.E. Clear 19 32 43 39 N.E. Cloudy 19 43 48 45 N.E. Cloudy 20 34 39 34 N.E. Cloudy 20 43 50 45 N.E. Rain 21 34 39 34 N.E. Clear 21 43 42 39 N.E. Rain 22 39 34 45 N.W. Clear 22 41 45 39 N.E. Cloudy 23 45 34 36 S.W. Clear 23 43 54 43 N.E. Clear 24 38 34 32 S.W. Clear 24 45 57 46 N.E. Clear 25 34 36 36 N.W. Cloudy 25 48 59 50 N.E. Cloudy 26 34 36 32 N.E. Rain 26 43 48 43 N.E. Cloudy 27 36 43 34 S.W. Clear 27 41 53 45 N.E. Clear 28 34 41 39 N.E. Clear 28 48 68 57 S.E. Clear 29 43 52 36 S.W. Clear 29 57 70 61 S.E. Clear 30 36 35 34 N.E. Cloudy 30 55 52 50 N.E. Cloudy | 31 57 72 59 S.E. Clear Mean temperature, 38°. Mean temperature, 451°. 



METEOROLOGICAL TABLE. JUNE. Thermometer. Pre- Atmo- Thermometer. Pre- M ">°r 2 vailing '$„'£ & | vailing *#|"£_ c O 7a.m 2p.m.[9 p.m. Winds., lions. <j 7A.M.2p.M.l9p.M.jWinds. tion*. 1 54 72 50 N.E. Clear 14J 59 81 54 S.W. Clear 2 50 57 44 N.E. Cloudy 15 54 81 50 N.E. Clear 3 43 50 43 N.EJCIoudy 16 C 3 81 71 S.W. Clear 4 45 54 46 N.E.lcioudy 17 50 50 49 N.E. Rain 5 45 50 46 N.E. Cloudy 18 1 54 59 50 S.W. Clear 6 48 54 50 N.E.'Cloudy 191 50 54 50 S.W. Cloudy 7 52 63 50 N.E.lClear 20! 53 72 50 S.W. Clear 8 54 66 52 N.E.|Clear j 21; 59 81 66 S.W. Clear 9 52 72 57 S.W.jClear 22 68 81 72 S.W. Clear 10 61 77 66 S.W.jClear 23; 64 77 54 S.W. Clear 11 68 84 68 S.W.Jciear 24| 52 72 58 S.W. Clear 12 61 70 52 N.E. Clear !25 57 70 N.E. Cloudy 13/ 52 68 60 S.W.-Clear Mean temperature, -- 58§°. The following interesting communication was received after the other letters were printed. It is therefore inserted in the only place we have remaining 

No. IV. 

New Utrecht, L. 1., Sept. 24th, 1832. 

Sir, — Your letter dated t.'ie Ist instant, was received a few days since, and I embrace the earliest opportunity of communicating the little information possessed by my father, Dr. Francis H. Dubois, and myself, in relation to the malignant Cholera ; about twenty severe cases of which have fallen under our observation up to this date. 

Ewer to Question Ist. Our first case of Cholera Asphyxia occurred on the f July, at a farm-house, about one mile from the village of Flatbush ; :ond case, at the same place July 22d. 

Ewer to Question 2d. There was, and had been since the month of June, erable prevalence of diarrhoea, in that neighborhood and other parts of jntry ; and it still prevails in this, and the adjacent towns. 

Answer to Question 3d. The first case above mentioned, and the first cases in the town of Gravesend, where the disease is now prevailing, were most probably of atmospheric or meteoratious origin, for they could be attributed to no other satisfactory source. Neither of them had visited New- York or any place where the disease was prevailing. There have been a few cases in Flatlands and New Utrecht, where it was supposed that the disease was contracted in New- York, (I speak of the cases under our care only.) We have soen no evidence to prove the communication of the disease from a foreign 





51 

Answer to Question lth. Very frequently, where one case of the Cholera has occurred, other members of the family have subsequently been attacked with the same disease, and this is the principal fact which I have seen, that might be urged as an argument in favor of its contagious nature. But very often, those who had little or nothing to do with the attendance of the patient, were next attacked, while those of the family who more especially attended, entirely escaped. It is also worthy of remark, that in cases, which we have attended, where the disease was supposed to have been contracted in New- York, (the patients having attended the markets, &c.) no other members of the family were subsequently attacked. From this it would appear that if Cholera ever be contagious, it is only so when some peculiar state of the atmosphere or other cause favors its prevalence. Filth and want of ventilation seem to be favorable to the development of the disease. On the whole, though some facts have created doubts, I have seen no evidence to prove Cholera decidedly contagious. 

Answer to Question sth. This part of the country wan more unhealthy than usual last winter, but there was nothing peculiar in the prevailing diseases. Rut in the latter part of the summer and autumn (preceding last winter) fevers, and especially intcrmittents assumed an unusual form. In a dissertation written in March last, I noticed it as follows, - — " During the last summer and autumn I had an opportunity of seeing a number of cases of intermittent fever, attended during the paroxysms, with a violent vomiting and purging of bilious matter, and sometimes of blood. The discharge of blood was probably owing to a congested state of the portal system. Some of these cases were alarming, and it occurred to me that there was already some atmospheric cause predisposing somewhat to Cholera ; modifying and controling other diseases in some measure," sometimes the first paroxysm only was attended with these symptoms, but most generally they recurred with every attack of fever. These symptoms were not caused by medical treatment, for they took place in cases, both where medicine had, and had not been taken. Many cases of intermittcnts last spring were attended with the same kind of diarrhoea and vomiting. Both measles and scarlatina prevailed extensively last spring ; the latter in a more severe form than usual. We have had much less of intermittent and remittent fevers this autumn than we have had for four years past ; derangements of the stomach, bowels, &c, appearing to swallow up all other diseases. There has been during the summer, and still is in all diseases prevailing here, especially fevers, a great tendency to diarrhoea ; it sometimes comes on in remittent fevers, and suddenly destroys the patient. Many cases of intcrmittents are attended with diarrhoea during every paroxysm, (similar to the cases of last fall, except that the evacuations instead of being bilious or bloody, are of a watery nature.) Yours respectfully, 

Jas. E. Dubois, M. D. 

D. Atkins, M. D. 

Sec. to Special Mcd. Council. 





DOCUMENTS, &c. 

ir. 11. Communication from W. Shaler, Consul at lavana, in regard to Asiatic Cholera, together with luestions reported by the Board of Health, and the Anwers of the Special Medical Council upon the prevention nd treatment of that disease. 

New-York, June 19, 1839. 

lir, — Having learnt by the public journals that the itic Cholera Morbus has made its appearance in Queand Montreal, I take the liberty of suggesting through to the Honorable the Board of Health, the propriety of municating through me to the Government of Cuba tever information the Board may possess in relation us awful visitation of Providence, as well as the meas of precaution, which the Board in its prudence may r into or direct, against the introduction and propagain this city of the pestilence in question. 

Such communications would certainly be regarded by the Government of Cuba as evidences of kindness and humanity, in a cause of common danger, toward the inhabitants of a neighboring island, with whom our relations rre daily becoming more intimate, and it would enable the Authorities there to adopt the necessary measures of precaution against its introduction with a proper understanding of the case, and thereby prevent, as far as possible, interruption and injury to our immense commercial relations with that island. I further take leave to advise that these communications be continued to me in Havana as long as there should be any danger : if they are sent through the 

52 



Collector of the Customs here, they will be received by the Vice Consul in my absence and immediately communicated to the Superior Authorities there. 

I have the honor to be, very respectfully, 

Sir, your obedient Servant, 

To the Hon. Richard Riker. Wm. SIIALER, 

U. S. Consul, Havana, on leave of absence. 

Hoard of Health, July 16, 1832. 

I The Mayor and Recorder, to whom were referred the ter of William Shaler, Esq., United States' Consul at the ivana, dated 19th June, 1832, 

I Report, That they have fully considered and do highly preciate the communication made to the Board of Health that able and enlightened public functionary. The wernment of Cuba can view in no other light than that kindness and humanity any communications which we c enabled to make, touching a disease which has scourged great portion of India, Asia, and Europe, and has at lgth commenced its ravages in North America. 

JThe Committee duly estimate the friendly relations that ist between the inhabitants of Cuba and the inhabitants the United States, and the more especially the near conxion which New-York bears toward the Havana in the sat and extended commerce of the two cities. 

I Your Committee are of the opinion that the Board of ealth of the city of New-York, can be of essential service, >t only to the Havana, but to many of our own villages id sister cities of the United States which the pestilence is not yet reached. 

tThe Board of Health of the city of New-York, upon the >t appearance of the pestilence of Cholera, selected a ecial Council of medical men of the highest, reputation, ¦ talents, experience, and probity. They are all per- 

8 





54 

They have all seen or read of the Cholera as it has shown itself in India, in Asia, and in Europe. And they have all seen, and most carefully marked it with all its symptoms and in all its stages in the city of New-York. Their views and opinions ought, in the judgment of your Committee, to be obtained and laid before the public. 

Ehe Committe, therefore, beg leave to submit, That the ;ial Medical Council of the Board of Health of the city ew-York be respectfully requested to answer in writing in detail, so far forth as may be essential to every able end, the following questions : — 

QUESTION I. 

K Whether in their opinion, the malignant Cholera, as it exists in the city of New- York, can be prevented, or uded, by any sanitary or quarantine regulations 1 

QUESTION 11. 

¦hether it can, or cannot ; what are the best means to ate its malignancy when it comes ? 

QUESTION 111. 

Bien it comes what are the best means to protect life st its attacks '? 

QUESTION IV. 

What regulations, especially in warm climates, ought to be adopted in regard to the dead 1 

Respectfully submitted. 

Walter Bowne, Mayor. 

R, Rikek, Recorder. 



55 

To Walter Bowne, Esq., President of the Board of Health. 

fiR, — The Special Medical Council, to whom was rred the communication of your honorable Board, prong certain queries, to which an answer was requested, leave to report the following answers :—: — 

QUESTION I. 

r Whether the Malignant Cholera, as it now exists in the of New - York, can be prevented by sanitary or quaranregulations ? 

From the limited period during which we have had an opportunity of acquiring from our own observation, a knowledge of the laws which govern the malignant Cholera, we are reluctant to express an opinion upon this subject. But inasmuch as that duty is enjoined upon us, we beg leave to say, that many statements, apparently entitled to credit, have been made, which go to show that the disease is transmissible from one place to another, by persons affected with it. Until these facts can be thoroughly investigated, the Council are unwilling to put forth an opinion which would be at variance with the great weight of medical authority on the subject ; at the same time, we feel bound to declare our conviction, that no quarantine regulations, hitherto employed or known to us, have been, or, we fear, are likely to be effectual in excluding the malignant Cholera, from any populous town or village on this continent. 

QUESTION 11. 

¦?hen it comes, what are the best means to mitigate its gnancy ? 

On the part of the authorities, the strictest attention should be given to the removal of all the common causes 



56 

privies, sinks, sewers, pools of water, should be cleansed ; the dwellings of the poor should be thoroughly cleansed and whitewashed ; they should be prevented from congregating in large numbers ; crowded houses should be emptied, and the inhabitants placed in clean and airy situations ; the sick should at once be removed to large and airy hospitals. 

En the part of private individuals, the mode of life Id be strictly temperate, and no excess should be lged in. 

I^he food should be nutritious, simple and easy of di:ion, and in sufficient quantities to preserve a healthful >r ; any article of diet that is known to be easily sustible of fermentation, in the stomach or bowels, should scrupulously avoided ; so readily is the digestive process urbed during the epidemic prevalence of malignant )lera, that with us, no fruits or any other than simply naceous vegetables can be eaten with safety. 

The destructive tendency of the disease may be further mitigated, by the early discovery and judicious treatment of such symptoms as are known to precede it, and give warning of its approach. These vary in degree, but all evince more or less disorder in the digestive organs. The milder forms of these premonitory symptoms are merely an uneasiness or pain in the bowels, accompanied sometimes with slight cramps, or dizziness ; but a looseness of the bowels or diarrhoea is by far more common, and an almost invariable precursor of the disease itself. It has been found with us, that this diarrhoea is successfully treated by purgatives, and especially by calomel ; and that it cannot be neglected without imminent danger —if neglected, the 



57 

QUESTION 111. 

Khen it comes, what are the best means to protect life \st its attack ? 

IPhe disease is characterized by vomiting and purging i fluid almost colorless and inodorous, together with mps or spasms of the extremities — the strength of the ent is rapidly exhausted — a failure of the natural heat he body, and of the circulation of the blood soon occurs, stituting the dangerous stage of collapse. A striking ure in the character of this disease, is a complete sussion of many of the secretions, especially of bile and 

It is in the first place important to allay the vomiting and spasms of the stomach. If the subject be of a constitution not enfeebled by previous disease, or habitual intemperance, and the pulse is in a condition to admit of it, general blood-letting is found to mitigate the spasms and render the system more susceptible to the action of the grand remedy, mercury. A large dose of calomel as 20 or 30 grains, alone or combined with two grains of opium, if the cramps be distressing, with the application of a large sinapism over the region of the stomach, relieves vomiting, and, especially after blood-letting, sometimes arrests the disease. Effervescing draughts, small portions of ice chewed and swallowed, or minute doses of tincture of camphor quiet the stomach. The dose of calomel should be repeated at intervals of one, two, or three hours, until the colorless evacuations assume a dark or bilious hue. In the interim, (if the pulse become very feeble or the extremities cold, with a sunken aspect of the eye,) frictions with rubefacients should be employed to allay the cramps, and means of preserving the heat of the extremities should be employed ; for which purpose, bags of hot sand answer the best dutdosc dry heat beinsr found 



58 

Iferable to its combination with moisture. If the skin be ercd with copious clammy perspiration, hot powdered Ik should be well rubbed over the body. If the pulse ome feeble or the extremities cold, indicating the apich of the state of collapse, much benefit has been ved from rubbing the whole body, especially the exaities, with an ointment composed of two parts of strong curial ointment with one of finely powdered camphor, the same quantity of cayenne pepper. 

The internal use of calomel is combined with this external medication, and when the mouth becomes sore or the discharges bilious, from the operation of mercury, the patient is comparatively safe. Hot injections of brandy and water, in large quantities and frequently repeated, are also important means of preventing the collapse. 

I^his active treatment frequently restores the circulation the lost heat of the body, and reaction follows. Frently, but most rarely under the mercurial treatment, )ndary fever succeeds. This is characterized by deterations of blood to some important organ, as the brain, lungs, or the liver, and is successfully treated by bleedgeneral or local, according to the indications of the j ; by purgatives, and small doses of nauseating mcdi- 

QUESTION IV. 

EE r hat regulations, especially in warm climates, should be ted in relation to the dead ? 

In general, putrefaction occurs more slowly after death from this than from other diseases. There need therefore be no precipitation in the burial of the dead, and sufficient time may safely intervene to make the death unquestionable. The apartments of the dead should be purified by 



59 

i iiv/i \j ii^ii vcmhi ti LiLJi 1 ¦ rtiin i iiv iiui/i 3 wiiwUivi ukj w ttfli im 

I The corpse should be covered with a cloth wet with a ution of chloride of lime. 

Alex. 11. Stevens, Prest. Jos. Bayley, Jno. Neilson, W. J. Mac Neyen, 

Gilbert Smith, H. McLean, R. K. Hoffman, A. L. Anderson. 

The concurrence of the public Medical Authorities of the cities of Philadelphia, Boston, and Albany, in the opinion expressed in the answer to the first question, viz. that in relation to quarantine regulations, was requested by the Special Medical Council of New-York ; and the following communications have been received from those bodies respectively. 

I 'he consulting Medical Committee of the Sanitary rd of the city of Philadelphia, fully concur in the ion expressed by the Special Medical Council of the rd of Health of the city of New-York, " that no quaine regulations hitherto employed, or known to us, ; been, or are likely to be effectual in excluding the gnant Cholera from any populous town or village i this continent." 

John C. Otto, Jos. Parrish, N. Chapman, Samuel Jackson, W. E. HoRNER, Richard Harlan, 

Hugh L. Hodge, J. K. Mitchell, Ch. Lukens, O. H. Taylor, Ch. D. Meigs, 



60 

Boston, Sept. 15tli, 1832. 

(The undersigned physicians of the city of Boston are of inion that no quarantine regulations hitherto employed, to us known, have been, or we fear are likely to be ectual in excluding the malignant Cholera from any pulous town or village on this continent. 

John C. Warren, 

Benjamin Shurleff, 

George Hayward, 

John Randall, 

George C. Shattuck, 

Consulting Physicians to the city of Boston. 

I Subscribed also by Jacob Bigelow, Walter Channg, and thirty-four other physicians. 

lAt a meeting of the Medical Staff, held in the City Hall, the city of Albany, 23d August, 1832, 

A communication from the Special Medical Council of the Board of Health of the city of New- York, being read, it was unanimously resolved, that the Medical Staff fully concur in the opinion expressed by the Special Medical Council of the city of New- York, on the subject of quarantine regulations. 

Resolved, That the above resolution be transmitted to the Special Medical Council of the Board of Health of the city of New- York. 

order of the Medical Staff, 





61 

DOCUMENTS, &c. 

tr. 111. — Questions by the Board of Health, as to the best means of protecting the system against Cholera. 

I Whereas, the Board of Health deem it a duty to put sir fellow citizens in possession of every information thin their power, that relates to the pestilence of malignt Cholera which still afflicts us : — Therefore resolved, lat the Special Medical Council be, and they are hereby ipectfully requested to answer fully and in detail, and writing, for the purpose of publication, the following 

QUESTION I. 

I Are there, in all cases, and without any exceptions, preinitory or warning symptoms of the approach or danger malignant Cholera ; if there be exceptions, what proporu do such exceptions bear to a given number ? 

QUESTION 11. 

What are the different premonitory or warning symptoms of the approach or danger of malignant Cholera ; and what symptoms are the most marked and usual 1 Specify such symptoms in the ordinary common terms, as well as in terms which are technical or professional. 

QUESTION 111. 

¦f during the premonitory or warning stage of malignant )lera, a physician acquainted with its action upon the 

9 



62 

tan frame, be called to the patient, what proportion oi en number of persons of ordinary constitutions, can, nown and certain medical means, be secured against h by the threatened attack ? 

QUESTION IV. 

Ehat proportion of cases of neglected diarrhoea have mated in malignant Cholera during the present season? what proportion of those were intemperate ? 

QUESTION V. 

What measures, in the judgment of the Special Medical Council, are the best to guard against the attack of malignant Cholera ? Specify them especially as relates to diet, temperance, clothing, sleeping, labor, exercise, cxposure> and the like, to the end that the same may be laid before our fellow citizens, for their government, and the safety of themselves and their families. 

QUESTION VI. 

What measures, in the judgment of the Special Medical Council, ought to be taken by our fellow citizens, who are absent from their homes, to purify and render healthy their dwellings, before their families return ? 

QUESTION VII. 

Ethe whole body of the people could be swayed by a t moral principle, and scrupulously and rigidly observe le means of protecting life, can malignant Cholera, like small pox, by human means, (those means, of course, ;ted by Providence,) be driven from our city? 

E2 Board of Health is aware of the delicacy and diffiinvolved in their last question. The Special Medical cil have had but a short period to watch the move- 



63 

tints, or to examine the nature of this hitherto, with us, known disease. The Board of Health therefore submits their Special Medical Council, the question, but leaves it :irely to them, how far they can, at this time, discreetly urn an answer thereto. 

ITo the questions proposed by the Board of Health, the ecial Medical Council have the honor to reply : — 

QUESTION I. 

Ere there, in all cases, and without any exceptions, premonior learning symptoms of the approach or danger of malig- Cholera : if there be exceptions, what proportion do such Hions bear to a given number ? 

Answer. — There are almost universally, symptoms premonitory of the attack of Cholera. The number of exceptions is exceedingly small. The actual proportion the exceptions bear to the whole number, cannot be ascertained ; but it is probable that in forty-nine cases out of fifty, some premonitory symptoms do occur. 

QUESTION 11. 

I What are the different premonitory or warning symptoms of approach or danger of malignant Cholera ; and what iploms are the most marked and usual? Specify such nptoms in the ordinary common terms, as well as in terms ich are technical or professional. 

I Answer. — The most marked and universal of the sympns premonitory of the approach of Cholera, is diarrhoea, a loose and relaxed state of the bowels, attended with quent loose or watery discharges. These discharges are netimes of an unhealthy character, as of a black color, like dirty water, when they involve a disordered state of 



64 

I stomach and liver, as well as the bowels, or they may c from simple irritation, or increase of the natural action he bowels. In the latter case, the discharges are merely lor liquid, but otherwise of a healthy character. The tis the severest form of the two. In other cases, the monition consists merely of slight pain or uneasiness of bowels, with discharges of wind. 

QUESTION 111. 

If during the premonitory or swarning tage of malignant Cholera, a physician acquainted with its action upon the human frame, be called lo the patient, what proportion of a given number of persons of ordinary constitutions, can, by known and certain medical means, be secured against death by the threatened attack ? 

iNswER. — If proper medical advice were taken, and cious application of medicine made upon the first slight trances of disorder of the stomach and bowels, ninetypersons in a hundred, of temperate habits and ordinarily 1 constitutions, would be safe from the attack of malig: Cholera. That is to say, the number of deaths from lera, if the disease were uniformly prescribed for in the 3 of diarrhoea, would be exceedingly small. 

QUESTION IV. 

What proportion of cases of neglected diarrhcea have terminated in malignant Cholera during the present season ? Jlnd what proportion of those were intemperate ? 

Answer. — A very large proportion. Among the intemperate, the proportion is believed to have been the greatest. 



65 

QUESTION V. 

I What measures, in the judgment of the Special Medical mncil, arc the best to guard against the attack of malignant \olcra ? Specify them especially as relates to diet, tempcrce, clothing, sleeping, labor, exercise, exposure, and the like, the end that the same may be laid before our fellow citizens, their government, and the safety of themselves and their nilies. 

Answer. — The following measures or rules appear to your Council to be the most important to be observed, in order to prevent an attack of Cholera. 

|[n regard to Diet. — The diet should be simple, and >uld consist of food which is both nutritious and easy of estion. In quantity there should be no excess ; in ility, it should be that which gives the greatest strength, h the least fatigue to the digestive organs. It is also >ortant to be remarked, that too great abstinence is as igerous as any form of excess ; and that the diet should better and not more sparing than usual. 

(Phe most nutricious and digestible articles are beef, tton, or chickens, plainly cooked ; eggs slightly cooked, ad made of wheaten flour, mealy potatoes and rice. : fear that this list could not be much extended, without •oducing articles that would be found less wholesome. 

ILmong articles wholesome in any common season, but id to predispose to attacks of Cholera in this city, are common green garden vegetables and fruits. There scarcely a vegetable be named, that will not be found >ng those which have been reported to your honorable Lrd as having been the cause of Cholera. Beans, peas, ches, whortleberries, raspberries, cucumbers, cabbage, dings containing raisins, and pies made of fruit have 



66 

»h been specified as the exciting cause of Cholera, in a ater or less number of cases. 

lln regard to temperance, we can only say, that the *htest excess at this time, either in eating or drinking, pears, from much experience, to be attended with great tiger. 

IPhe clothing should be warm ; it should be so regulated, to prevent the danger of a chill, and at the same time, :to exhaust the system by excessive perspiration. The Bering should be particularly warm about the bowels, 1 flannel worn next the skin. 

The regular hours of sleep should be, as far as practicable, observed ; and the body should by no means be exposed, during sleep, to a draught of night air. 

tabor and exercise should be moderate ; and taken, as as possible, neither in the heat of the day nor in the it air ; nor should any fatiguing or exhausting labor be brmed when the stomach is empty. 

Ik. state of debility, arising either from excess or inanition, it of rest or anxiety, is especially prone to invite an ck of this disease. It is therefore in the highest degree ortant, that all nurses or other persons, who watch with ittend the sick, especially if at houses where the disease occurred, should guard themselves against this unalable exposure, by not suffering their stomachs to ome empty, and their strength to be thus exhausted. s also of course evident, that grief, anxiety, and all ressing passions, must operate upon the empty and austed system with redoubled force. 

In regard to intemperance, it is now universally known, that Cholera has a most peculiar affinity for the system of a drunkard ; so much so, that it is a very rare thing for the intemperate to escape — generally speaking, it is almost as rare for the temperate and uniformly prudent to be attacked. 



67 

QUESTION VI. 

EU measures, in the judgment of the Special Medical I, ought to be taken by our fellow citizens, icho are from their homes, to purify and render healthy their gs before their families return? 

Answer. — The measures necessary to be taken by those returning to houses that have been for some time closed, are few and simple. 

let every door and window be thrown open, and kept i through the day. Let small fires be made in all rooms are to be occupied at night. Let all wood work be oughly scoured, and walls whitewashed. In three days ill be safe to occupy the house, if it be in a healthy ition. If the house be old or dirty, or in a sickly hborhood, or if there have been sickness or death in it, iously to using the above precautions, let it be filled chlorine gas, or frequently sprinkled with the dishing solutions which are every where to be had. Let process be continued for three days, the house being ed if chlorine be used, and the floors sprinkled several s daily if the liquids be used. 

Let all privies and out-houses be also most carefully cleansed and purified, either with lime, chloride of lime, or strong ley. 

KrVith the use of these precautions, your Council believe re is no danger in occupying any house, however long nay have been closed. 

QUESTION VII. 

If the whole body of the people could be swayed by a great moral principle, and scrupulously and rigidly observe all the means of protecting life, can malignant Cholera, like the small pox, by human means, (those means, of course, directed by Providence,) be driven from our cihi ? 



68 

Answer. — The grand result embraced in this question, involves, we fear, several impossibilities ; for the mass of mankind are, and there is great reason to fear, ever will be, insensible to the operation of great moral principles. 

As the attacks of Cholera are brought on, for the most part, by incurable follies, and imprudence, we despair of expelling it from our city, while the present predisposition to that disease exists. 

Still there is no reason to doubt, that among the decent and orderly portion of the community, an exemption from an attack of Cholera may be obtained in a great degree, by a strict and prudent attention to the rules above laid down. 

Alex. H. Stevens, President. 

Jos. Bayley, Jno. Neilson, 

Gilbert Smith, 

Wm. Jas. Mac Neven, 

11. McLean, 

Richard K. Hoffman, 

jV Anderson 



69 

DOCUMENTS, &c. 

t. IV. — Report of the Physician to the Greenwich Cholera Hospital. 

¦Alexander H. Stevens, M. D., President of the Special Medical Council. 

Greenwich Cholera Hospital, 

New- York, Sept. sth, 1832. 

lir, —In reporting to your Board the results of my srvations upon the nature and treatment of the prevailepidemic Cholera, I shall confine myself entirely to a ration of such facts as have come under my own inspec, without detaining you with any speculations upon pathology of the disease, or the modus operandi of the edies which I have employed. I shall take up the ase as it commonly exhibits itself in the earliest stage, . simple diarrhoea, and give an outline of the treatment eh I have adopted in its several gradations, to the last, too often fatal, stage of collapse. 

I 'he trifling causes which produce diarrhoea, such as 11 quantities of indigestible food, acid drinks, exposure light diminutions of temperature, fatigue, &c, together i the unusually violent action of cathartic medicines, y led me to suspect a highly irritable condition of the ;ous membrane of the stomach and bowels : and as sequent facts have served to convince me of the correct-3 of this suspicion, I have been anxious to abstain from irritating internal medicines, and in every stage of the ase to relieve the irritation of the mucous surfaces by srnal stimulants or revulsive applications to the skin. 

li> 



70 

It will be recollected that very few patients are brought to the hospitals while laboring under the premonitory symptoms or forming stage ; of course my opportunities of treating the disease in its earliest and mildest forms have principally occurred in private practice, while my treatment of its later and most severe forms has been almost entirely confined to the hospital. To return then to the premonitory symptoms or forming stage of the disease. Diarrhoea without pain, and diarrhoea accompanied by griping and slight cramps in the extremities and abdomen, I have treated with frictions of Cayenne pepper and brandy to the extremities, — foot baths containing Cayenne pepper, large emollient injections, confinement to bed, and tepid mucilaginous drinks or some mild herb tea, such as catmint, to encourage perspiration. I have found the uneasiness in the abdomen so much complained of, to be eiFectually relieved by a plaster of black pitch or resin heavily charged with camphor, or a poultice of bread, brandy, and finely pulverized camphor ; when the injections have not operated freely, which has not often occurred, moderate doses of fresh olive oil has generally answered the purpose very well. This practice has in my hands been so constantly successful, that I have had no inducements to make trial of any other remedies. 

When vomiting has commenced, accompanied by cramps in the extremities and abdomen, I direct blood-letting, if the pulse is full and hard ; and when the spasms are very severe, tobacco injections, as recommended by Kirk, frictions with Cayenne pepper to the extremities, particularly along the course of the large blood vessels, and a strong bath of the same to the feet. If the patient is not very soon relieved, I commence with frictions of the mercurial ointment, hereafter to be described, which, together with external heat if the patient is inclined to grow cold, frequently prevent the disease from advancing to the stage of collapse. In the 



71 

Imniencement of the epidemic, I sometimes gave opium, t subsequent experience has convinced me that it is not en required, and never in doses exceeding one grain ; ge quantities, I am convinced, will in many cases bring the most irremediable collapse. When there is vomiting a greenish matter and a heavily coated tongue, without ich purging or pain in the bowels, I have seen very good sets from the use of calomel. This remedy, repeated as lasion may require, will often quiet the stomach, and )duce those dark colored evacuations which constantly rk the abatement of the disease. But when the sympns are such as to induce me to use the mercurial ointnt, I have not often given calomel. The calomel, how:r, which I have used, was entirely freed from even the rfitest trace of corrosive sublimate, by large and repeated shings with pure rain water. 

lAt the opening of the Greenwich hospital, powerful ernal stimulants, external heat, frictions with irritating bstances, and other external revulsive means were re'ted to in the stage of collapse, with very little success ; ?n the most active and diffusible stimulants taken into the imach, appeared to have no good effect whatever. This I me early to conclude that that organ was, in this stage the disease, very little, if at all susceptible of the action any medicines received into it, and that some other mode administering remedies might be more successful. 

!The treatment which I have since pursued is extremely lple, and consists in briskly rubbing the patient from head foot with an ointment composed of strong mercurial itment 1 lb., camphor, finely pulverized, 7 oz., and the ne quantity of Cayenne pepper, intimately mixed. This applied with considerable force to the extremities, but >re gently over the chest and abdomen, and repeated at )rt intervals until reaction is established. The patient's 



72 

Eliing, imbued with the ointment, is allowed to remain n him. As soon as the frictions are performed, bags of sand, and other means of artificial heat, are constantly loyed to maintain the warmth of the surface. 

If, notwithstanding the frictions, the skin continues to be ered with a cold perspiration, I direct it to be coated r with hot chalk or whiting finely pulverized. For my wledge of the application of hot chalk as a valuable edy in collapse, I am indebted to Dr. De Kay, of this The mercury generally shows its specific effects upon gums in from five to ten hours from the commencement eaction, and then the patient is washed, to prevent the tier absorption of the mercury. One very decided mtage of this mode of treatment is, that mercurial action, n once established, either prevents entirely, or greatly crates the violence of the consecutive fever, which srwise is often accompanied with fatal congestions. 

IVhen, however, there are indications of an undue deteration of blood to the brain, (which is by far the most [vent,) or any other vital part, cups or leeches are lied with marked advantage. In a few patients of broken 'n constitutions, or of very intemperate habits, the merial action has not been followed by free salivation, but ighing of the gums has taken place, and they have sunk, r having escaped the dangers of collapse. 

I 'he foregoing comprises the principal facts respecting treatment which I have to communicate ; I will only that when the spasms have been very severe, I have etimes mixed from one to two ounces of Scotch snuff i a pound of the mercurial ointment mentioned above, principal assistant, Dr. Samuel L. Griswold, who has ;hed closely the effect of the external application of ceo, considers this a valuable addition. 



73 

The operation of transfusion into the veins has been performed on eleven patients in this hospital ; in only one case, however, has it been successful, the credit of which is due to my two younger medical assistants, Dr. Wm. A. Clarke and Alexander N. Gunn. To these gentlemen and Dr. Griswold I am greatly indebted for their persevering industry in the performance of their duties. 

¦Annexed I give you a tabular view of the patients received o the hospital, in answer to the questions proposed. 

TABULAR VIEW. To t^JS^ y^ 1 ™ 350 I 204 | 146 Of these were Foreigners. Americans. Blacks. Children. 222 | 91 | 37 | 50~~ Intemperate. Temperate. 204" ~ j~~ 146 Cases of Collapse. Cured. Dead. ~f93 1 ~~66 | 127 Collapse in Intemperate Persons. Collapse in Temperate Persons. Total. Cured. Dead. Total. Cured. Dead. "135 | 26 I 109 j 58 j 40 j 18T" Nurses attacked. Dead. Cured i? ~T ~~*~ ~T ~™ 

Dead of consecutive diseases, 52 Puerperal women, have died, - ... 3 Dead within six hours from admission, - - - 42 



74 

DOCUMENTS, &c. 

Art. V. — Report of the Physician to the Park Hospital. 

To the Special Medical Council of the Board of Health. 

Park Hospital, July 25th, 1832. 

In compliance with a resolution of the Special Medical Council, requesting the physicians of the several Cholera Kpitals to report a general outline of the medical treatit, &c, I proceed to state the plan which has been erally pursued in the Park hospital. 

Before I enter particularly upon the medical treatment, I would premise that the patients have been placed at the time of their admission in three general classes, although it has been in some cases difficult to draw the line which divides the one from the other : they are those having premonitory symptoms ; those in the first stage and approaching collapse ; and those in complete collapse. The number contained in the first stage is comparatively small, I cannot say exactly how many, because, until after I took charge of the hospital, which was on the 9th instant, no distinction was made, other than that of noting the severe cases; nor was a methodical register kept until the 11th, owing to the want of a regular clerk. Some of my statements in relation to numbers of the different classes previous to that period, must of course be general. 

fhe plan of treatment pursued in the premonitory stage, been to purge the patients actively with calomel, jalap, 



75 

&c, or with piils composed of the extract of colocynth, with extract of jalap and scammony, followed by some milder cathartic ; such as castor oil, Epsom salts, or the mixture of rhubarb and magnesia ; with very few exceptions this treatment has been successful in restoring the patient ; where it has not, we have never failed to give relief by opium, or calomel and opium combined. 

We come now to a larger class, where the premonitory symptoms have passed by, and decided symptoms of Cholera prevail, comprising, I suppose, about one third of the whole number of patients received, and of this class, about one fourth in a state approaching to collapse, when the extremities and tongue are cold, the skin putting on that peculiar lurid appearance which accompanies this disease ; when in addition to purging, there was vomiting more or less frequent — pain at the epigastrium — spasms of the extremities — general uneasiness and distress, with tossing of the arms and legs. As I have considered this a congestive disease, particularly of internal organs, I have endeavored to restore reaction and change the condition of the secretions : with this view, we endeavor to allay these symptoms as soon as possible, by draughts of laudanum and ether combined with some aromatic oil — by anodyne injection — by active friction to the extremities, either with the dry hand or with stimulating liniments, such as camphor, turpentine, and ammonia, and with sinapisms and blisters to the epigastrium. Our chief reliance for the restoration of heat in this stage, as in all others, is heated sand put in bags spread thinly and placed under the blankets on which the patient lies, and also over the blankets which cover his feet. If the patient has been robust, the pulse strong and full, benefit has been derived in this stage from moderate bleeding ; the spasms have been moderated, and other remedies have appeared to act with greater effect. In 



76 

many cases in this stage, instead of the laudanum and ether, full doses of opium in substance, combined with calomel, two or three grains of the former, with twelve or fifteen of the latter, given immediately, and followed by quarter or half grain doses of opium with two or three of calomel, every one or two. hours, have been administered with the happiest effects ; the patient has fallen into a comfortable sleep, with warm perspiration, from which he has awoke with relief of all the previous symptoms. In all the cases in this stage, whether accompanied or not with the violent symptoms above described, we have endeavored to bring the patient under the action of mercury as early as possible, and after a trial of various means, have found calomel, either alone, or combined with opium, the most efficient ; in every case where this has been effected, the patient has been preserved from a state of collapse ; but many have had to contend with another train of symptoms quite as formidable, and which shall be noticed hereafter, 1 mean the consecutive fever, and which, in this hospital, has as often followed this stage as that of collapse : lately we have endeavored to anticipate the symptoms of congestive fever by applying cpispastics to the thighs and epigastrium, and in many cases, I think, with advantage ; although it has not always prevented them, it has reduced their violence, so as to render them more controllable by other means. I would further remark under this head, that where vomiting has been a distressing symptom in this stage, we have succeeded in relieving it, in many cases, by ice swallowed in small portions, by the effervescing draught, or by one-grain doses of opium in substance. 

Where the symptoms above described have been complicated with those of approaching collapse, we have combined with the treatment mentioned the use of the more diffusible stimulants, wine, brandy, and carbonate of ammonia. 



77 

I come now to state the general plan of treatment pursued when the patients have either run into the third condition mentioned, or been received in the stage of collapse : this class comprises a very large proportion of all who have been admitted. I need not minutely detail the symptoms of collapse ; suffice it to say that where the tongue and extremities have been cold ; the pulse at the wrist nearly or quite imperceptible ; the patient speechless, or, able to articulate only in a whisper; our treatment has been to apply heat to the surface of the body by means of heated sand, heated bottles, and the hot air bath ; at the same time using diffusile stimuli internally, and injections of hot brandy and water with laudanum. These methods have been successful in some instances in restoring the heat and pulse, and bringing on general reaction, and in a few cases, in the ultimate restoration of the patient. It must be confessed, however, that our success in treating the disease in this stage has been very small ; and the number of deaths has borne a large proportion to the whole number of cases. 

I The last stage of the disease to be mentioned in describ£ our general outline of treatment is the consecutive r er : it is attended with a strong predisposition to constion of the brain, lungs, liver, and mucous membrane of i stomach. 

IWe have witnessed all these determinations, but more quently and fatally that to the brain and stomach. In 3se cases we have freely used the cupping glass and :ches to the temples and epigastrium ; blisters, sinapisms, astic purges, the lancet, and large doses of antimony, a word, we have treated it as hydrocephalus acutus. 

lln cases of severe vomiting we have found the efferjcing draught of carbonate of soda and tartaric acid to a very effectual mean of giving immediate relief. Where 

U 



78 

the vomiting has been of a greenish watery fluid, emetics tsalt in warm water have succeeded. The hot air bath not answered the expectations which were formed of It will very readily raise the temperature of the surface, seldom influences the pulse, and in a great proportion the cases in which it has been applied, the patient has rtly died in a colliquative sweat. 

Ehe nitrous oxyde was breathed by three patients, but it uced no sensible effects. 

I Several other plans of treatment have been tried at the ?estion of different individuals, but without any such ilts, as have induced us to place any confidence in their itive effects ; or, to introduce them generally into the itice of the house. Two patients, in the stage of cole, have been treated exclusively with camphor in small ;s internally, with camphorated frictions externally ; by c means, with the assistance of external heat, reaction produced, but the patients died subsequently with ptoms of cerebral congestion. 

We have made a thorough trial of the camphorated mercurial friction with capsicum, said to have been practised with remarkable success at several of the hospitals in the city, but without any more favorable results than have attended other modes of treatment. 

The tobacco enema has been used in five or six cases, but the patients have all died a short time after its administration. In one or two cases where spasms existed, it seemed to produce some temporary alleviation ; also in one case where the patient was extremely restless, tossing to and fro, and not complaining of any particular pain except at the precordia, it seemed to produce at first some benefit ; the patient was quieted, and sweated profusely, the extremities became somewhat warm, and said he felt relieved, 



79 

in less than an hour. In three cases where it was used, it was preceded by the brandy enema, but with the same unfavorable results. 

I Mercurial friction has been used in fourteen cases ; my had at least a pound rubbed in, and the friction 5 been kept up faithfully for hours ; all have died except c. This man was a decided case of collapse, the reaction it succeeded was violent, but the gums soon showed ralism ; the symptoms became more favorable, and the in may now be considered as convalescent ; but it should observed that calomel and opium had been freely admin»red as soon as the pulse indicated approaching reaction, i was persevered in until the gums became affected. 

The camphor treatment, as recommended by Dr. Charming, was adopted in two cases. They both died with symptoms of cerebral congestion ; not, however, until some time after admission. It must be added, that friction and external heat were used. 

I 'he treatment with ice exclusively in the stage of collapse been used as recommended by Broussais ; but from our erience we are not justified in relying on it solely ; it however, been used with great benefit in allaying liting, and may do good when used with other remedies ; no instance has occurred where the patients have ed under this treatment : a moist surface with some mth was in one case produced ; but the pulse did not , and the patient soon died. 

In one instance, by the suggestion of a respectable physician, bleeding and active cathartics were used ; and on the same day, upon the suggestion of another, the tonic treatment by sulphate of quinine and capsicum with calomel was tried with another, but in both cases without 



80 

So far as I have had opportunities of judging from observing the practice of many in private cases, as well as the plans pursued in other hospitals, and making a fair trial of them, 1 am convinced that no general plan now in use is so well adapted to the condition of the patients, and to the other circumstances of the Park hospital, as that at present pursued. Whatever may have been Mr. Baird's success with the tobacco injection in Newcastle, and that of Broussais at Paris, of using ice as an internal remedy exclusively, a fair trial has shown that they are not suited to the epidemic prevailing at New-York. The plan pursued at Greenwich rests upon the same principle as the one adopted in this hospital, viz., to bring the system under mercurial action ; and the only causes I can conceive why the same results have not followed its use, (for the prescriptions are exactly alike,) are, a building less favorable for the action of mercury on the system, and a more depraved class of patients. The hospital is a stone fireproof building, with marble floors in the first story, and brick floors in the second, and consequently a continual sensation of coldness and dampness is experienced, even by the medical attendants. I was told to-day by one of my assistants, that every one engaged in the medical department had been affected with cramps in the lower extremities: this he attributed to standing on the brick floor. You are already acquainted with the fact that several of our nurses have sickened, and some have died. I believe that scarcely one has escaped the premonitory diarrhoea. The greater frequency of attack among the nurses may in some measure be ascribed to the larger number of patients, and consequently the greater amount of duty at night. 

Eie last inquiry embraced in the resolutions of the Spe- Medical Council is, Whether the Cholera is always ;ded by diarrhoea ? Particular pains have been taken 



81 

to ascertain that fact ; and in every case but two where an intelligent account of the patient could be given, we have found that it was preceded by a diarrhoea generally of two days' or longer duration: in one instance the patient declared that he was well till within one hour of the attack, then was seized with a looseness, afterward followed by watery discharges and vomiting. 

II had almost forgotten to state in reply to one of your |uiries, that I have not observed any marked difference the character of the disease since its commencement, has been supposed that the consecutive fever a few days st has been accompanied with more severe symptoms of (animation, and that reaction was more sudden and vioit. Two cases in the same ward, received about the same c, were, as far as we could judge, premonitory symptoms. 11 o'clock A. M. in a fair way of convalescence, and at •, M. seized with delirium ferox ; the one actually jumped ; of the window, and the other endeavored to follow him : y were bled ad deliquium, and a large anodyne adminissd, cupping glasses applied to the temples, and nauseating es of tartar emetic administered. Both cases have terlated favorably, and have been discharged cured. 

I[ stated in the commencement, that some of my statistics st be general. From examining the register I find that persons have died within six hours after admission, and within twelve ; — that taking the list, 78 cases recorded, id I think it will give a pretty fair representation of the ole,) 47 of them are marked as cases of collapse ; the laining 31 include all others, whether premonitory or the t stage, together with two cases of epilepsy. 

Before I close this report I would ask the advice of the Council whether it would be proper to have stoves placed in the wards to correct the dampness arising from the peculiar construction of the building. 



82 

tn justice to my assistants, I ought to state, that at the 3 of my appointment, I found the same general plan sued by them which. l have seen fit to adopt and conle, with occasional variations. 

All which is respectfully submitted. 

Peter C. Tappen, M. D., 

Physician to the Park Hospital. 

To the Special Medical Council of the Board of Health. 

Park Hospital, August 31, 1832. 

Gentlemen, — I have received your letter requesting me to transmit any matter in relation to Cholera additional to my former report. Before 1 commence giving a detail of the treatment now pursued at this hospital, it is necessary to state, that on reviewing the document which I presented to the Special Medical Council on the 25th ultimo, I find that I have no reason to change my views of the nature or character of the disease, and consequently, have pursued the same general plan of treatment there detailed, — experience, however, has since enabled me to judge more correctly of the particular agency of some remedies in treating the complaint, of their effects in modifying the actions of each other, and of particular instances in which they may be useful, and when they are hurtful. I shall very briefly describe the general plan now adopted and pursued in the Park hospital, and afterward make some remarks on the use of particular remedies. 

The premonitory symptoms have been treated in the same manner as was mentioned in my former report, and the result has been uniformly successful. The fact tbat four of our nurses have sickened and died of Cholera, who were first treated for the premonitory symptoms, does not at all invalidate the statement I have made, because, in every 



83 

Ence, they have been relieved, and again relapsed in equence of some imprudence, either in returning too to the performance of duty, or, by indulgence in imer food, or from intemperance. 

When the first stage of Cholera is fully formed, but has not yet assumed a manifest tendency to run into collapse, I rely principally upon calomel in large doses (from aj to 3ss repeated every hour, or two hours,) at the same time I use such means as are best adapted to preserve or promote the general heat of the system, — heated sand in bags applied to the extremities, and friction with the dry hand, are generally sufficient. I have laid aside the use of opium in this stage of the disease, except in those cases where the nervous system is much irritated, or where it is accompanied with spasms, —in these latter cases I also employ friction, with stimulating substances, as capsicum in all its forms, mustard, camphor, and whatever will speedily act upon the skin. I continue the calomel, diminishing the doses as soon as I perceive any increased action in the system, and discontinue it when bilious stools are discharged ; afterward a dose of castor oil or Seidlitz powders establishes the convalescence. In this stage of the disease, if the system is plethoric, a small bleeding may be proper. Some patients have been received into the hospital and cured, who were bled before admission, but I have seen no case where I thought bleeding necessary. Diet and regimen now are all that is necessary to establish the cure. 

When the disease is approaching to collapse, in addition to the above treatment, I employ the means for restoring heat more actively, and give ice freely, directing the patient to chew and swallow it as fast as possible ; it is found to cause reaction when thus given more speedily than any other remedy I have seen employed, and it has the additional advantage of being very grateful to the patient, and 



84 

is also one of the most effectual means of allaying thirst and relieving sickness at the stomach and vomiting ; where there is great oppression in the region of the stomach, with tenderness, I apply cups or leeches and follow it with a sinapism. 

In some instances I trust to either remedy alone. When the warmth of the system is fully restored, I either discontinue the ice altogether, or administer it in diminished doses, or give the ice water in small quantities merely to allay the thirst. I pursue the calomel treatment as before. 

If collapse has taken place before I see the patient I give an injection of hot water and brandy ; one pint of the water to half a pint of brandy, with the addition of 3j to 3ij of laudanum if accompanied with spasm; and sometimes 1 substitute for it or give in addition a mixture composed of 3j of Sulph. Ether., 3ij Spt. Amon. Arom., and 3j Tinct. Opii. in half a gill of water. After the effect of this diffusible stimulus is seen in the system, I make no further use of it, but rely upon the other remedies for producing permanent effects. In addition to the internal use of calomel, I consider the application of mercurial ointment combined with camphor and capsicum, a valuable auxiliary ; but from repeated trials and comjKirisons with the internal use of mercury, I am of the opinion that it has not so powerful an action on the system as ice and calomel. 

In my former report I remarked that the consecutive er was often attended with local congestion, for which eding, both general and topical, had been employed. I reover related two cases in which it had been very ively used with decided advantage : further experience confirmed the propriety of this course, and has shown t the success is proportioned to the promptness and bolds with which blood had been drawn. Opium may now given with decided advantage : by its action on the 



85 

nervous system irritability is allayed, and reaction prevented. After bleeding a patient ad dcliquium, 3* to 3i of Tinct. 

Opii. should be given. It is of great importance in the treatment of congestions of the brain and lungs, that the head and chest be elevated at least 45° from the level ; and were I ever again to have the charge of a Cholera hospital, I would procure some inclined planes to serve the purpose of bed chairs. 

The active stage of the consecutive fever sometimes is subdued, and symptoms of local congestion still exist : in this case I have found the most successful plan of treatment to consist in topical depletion, with such general remedies as are suited to the typhoid stage of our autumnal remittents. I have generally used Carb. Ammon. suspended in mucilage gum Arabic, administered in small doses ; during convalescence from this stage of the disease it is of the highest importance to guard against repletion : I believe that it is the most frequent cause of relapse. This general plan I have adopted in the treatment of my private patients : they are a class of people for the most part strictly temperate, and none very intemperate. Several who have come under my care were completely collapsed ; and all, with one exception, treated on this plan, have recovered. The unsuccessful case was a woman upward of fifty years of age, and had been treated with the nostrum of the Fire King nine hours before I saw her, and died within three hours afterward. If the constitution is not injured by intemperance, I consider the disease as manageable as our ordinary cholera morbus. 

Before I make any remarks upon particular remedies, it may be proper to state that the cases which I have witnessed have led me to adopt the opinion of Dr. Kirk of Greenock, in relation to the pathology of the disease, and that I have very little to remark in addition to what he has written on 

12 



86 

¦relative value of the remedies which have been employed neans for treating this epidemic. 

Bleeding. — I have before stated that I have never seen a case where I thought bleeding necessary in the early stage of the disease, although I can conceive that such cases have existed : but many cases have come under my observation in which bleeding has had a decidedly injurious effect. Many patients have been sent to the hospital who just previous to an attack were excited by debauch and large quantities of ardent spirits, then bled freely by some physician : the consequence was, that the patient very soon sunk into a state of collapse ; whereas, had they not been bled, I believe that many might have been relieved by administering alkalis. But while I place very little confidence in bloodletting in the early stage of Cholera, I consider it an invaluable and indispensable remedy in the congestive stage of consecutive fever. 

Opium. — Without inquiring whether opium is a stimulant or not, it is sufficient to notice its effects in the treatment of this complaint. With many others I entertained high expectations of its efficacy in relieving spasms and directing the specific action of mercury by retaining it in the system: but from careful observation I am satisfied that it is only useful in those cases mentioned in the general plan of treatment ; that its general employment is hurtful, and should as far as possible be avoided. By comparing the cases treated with opium and calomel with those treated by calomel alone, I am led to conclude that it has a strong tendency to predispose to congestion of the brain : and I do not conceive that it need be given with a view of retaining calomel in the system. I very much doubt whether it has any such effect. When employed in large doses after venesection in the consecutive fever, I esteem it a very valuable 



87 

Mercury. — I consider mercury the most important agent that has been employed in treating the disease as it has appeared in this city ; and the preparation which I have most successfully used is calomel. I would not venture to give a decided opinion as to its modus operandi. I am inclined to the belief that it is chiefly useful in changing the secretions of the intestinal canal, and thus counteracting the morbific effect of the atmospheric poison, whatever it is. I do not think it necessary in every case to saturate the system, nor is ptyalism an indispensable effect. A large proportion of recoveries have been without salivation : if it be employed until bilious discharges from the bowels are procured, it is sufficient, and may safely be discontinued. Calomel does not run off by the bowels in this disease ; I have never known it to increase the frequency or quantity of the discharge, and it produces its specific effects on the system as speedily when used alone as when combined with opium : it moreover never increases, but rather diminishes the irritability of the stomach. To use it successfully, it must be administered in large and frequently repeated doses. 

Purgatives. — This class of remedies can only be employed in the premonitory stage ; laxatives, however, are often necessary during the state of convalescence. I have generally used castor oil and Seidlitz powders : the Seidlitz powder is particularly useful where the patient voids a greenish matter, resembling water in which spinage has been boiled. 

Emetics. — After making trial of all the different emetics which have been recommended, I confine myself to the solution of muriate of soda ; one tablespoonful dissolved in a pint of lukewarm water, administered at one dose, very effectually relieves the stomach when oppressed with the kind of matter noticed under the last head. 

*"¦ • | * iH '* icttumsj Di uuosius two leciui es on v/noiera. 



88 

I determined to use ice, and felt a degree of confidence in its efficacy which I had not given to any new remedy. I made trial in several collapsed cases after the manner directed by him, and finding that it did not answer my expectations altogether, abandoned its use for a time ; but recollecting that it produced a temporary revival, and appeared to be a very powerful agent in restoring heat to the body, and, moreover, that it was very grateful to the taste, and efficacious in relieving thirst, I determined to make further trial of it in conjunction with calomel and external heat, and it has answered my most sanguine expectations. I believe that where temperate persons are the subjects of the disease, or where ardent spirits are used sparingly, ninety-nine out of one hundred may be cured, even if collapse has just commenced ; and that when collapse is advanced, it affords to the patient the best prospect for recovery. To remove particular symptoms, other remedies may be used with great advantage, but I consider this as the best general plan. 

Brandy. —In regard to the propriety of brandy as a remedy in this complaint, I perfectly coincide with Dr. Kirk in the opinion he has expressed, and 1 shudder when I see the cup of brandy at the bed-side of the patient. I would restrict its use to the condition noted in the general 

I'amphor. — This article may be employed with advan:in the treatment of Cholera. Of the camphor treatit, as it is called, in which very small doses uncombined i any other medicine arc used, I will not express an lion. Very few cases have fallen under my observation. 3 were treated upon that plan in the hospital, and ough reaction had taken place when I first saw them, ' both died in the stage of consecutive fever, with conion of the brain : whether, if prompt measures had been 



89 

used to meet these symptoms they would have terminated differently, I cannot say. I think that it may be advantageously used as an auxiliary to other remedies when prescribed on general principles, but I have no confidence in its virtues as a panacea. 

I Tobacco. — From the high commendations which this icle had received from Dr. Kirk, and the apparently orable testimony which had been given of its remedial ivers in the hospital at Gateshead, I determined to make il of it here, but was disappointed in every instance. It j been administered in nine cases — seven were positively ured. The other two were for a short time revived, but m collapsed again, and finally died. 

I External Heat. — This is an indispensable remedy in the atment of Cholera, but the agents employed may be coned to a very limited number ; after making trial of the rious measures recommended, I prefer the simple method enclosing heated sand in bags, and placing them in conit with the patient. Whatever means are used, a prefer;e should be given to dry rather than to moist heat. 

ifnfusion of Saline Solution. — This remedy has been emyed in the hospital in seven cases. From its effects on se, I do not feel warranted in expressing a decided nion ; the patients were all in some measure revived by and for a short time appeared benefited, but its effects re transient. 

tince reading Dr. Wm. Stevens's paper on the internal of saline remedies in malignant diseases, I have thought two plans might be advantageously combined. I think subject worthy of consideration. 

Non-Purgative Salts. — Only two days before I received an order from the Executive Committee to receive no more patients into the hospital, I commenced a series of experiments with a view to ascertain the value of this remedy, 



90 

which had been so highly commended by Mr. Wakefield for its success in the treatment of the prisoners in Cold Bath Fields Prison ; I had administered it to three persons, all of whom have recovered, but none were so severe as to enable me to draw any satisfactory inference. Enough, however, was seen to make it a subject of interest. 

I fiction. — It is very questionable, whether this remedy been productive of most good or evil ; its indiscriminate doyment I think has done much mischief. The fatigue srienced by a four hours' rubbing from two stout men, the necessary exposure of the surface of the body to cold external air must be injurious ; but it has been iloyed in cases where spasms have been severe with lifest advantage. I would then say that used as a means external heat it is very inefficient, if not hurtful ; for relieving cramps or spasms it is a valuable remedy. 

linapisms. — The application of mustard to the surface lieve has been generally approved ; but great diversity pinion prevails as to the extent to which it ought to be . I have tried both modes : I have almost covered some :nts with it ; in other cases I have confined its applicato the region of those parts which were the seat of jestion ; and I have come to the conclusion that in the r cases it may be profitably employed, but, in the er, its use is superseded by the means for restoring mentioned in the paragraph under that head. 

STATISTICAL TABLE. 

Eie Park hospital was opened for the admission of nts on the evening of the 4th of July, and continued xeive them until the 22d of August; since which by an order of the Executive Committee of the 



91 

Board of Health, all applicants have been sent to the Crosby-street hospital; during that period five hundred and ninety patients have been treated, of whom 

353 were Men, 222 „ Women, 8 „ Boys, ) 7 Gi Is \ un " er y e a r s of age. Of these, 515 were white, and 75 blacks. 

Of these 590 11 were between 1 and 10 years. 49 „ „ 10 „ 20 178 „ „ 20 „ 30 174 „ „ 30 „ 40 91 „ „ 40 „ 50 53 „ „ 50 „ 60 28 „ „ 60 „ 70 G „ „ 70 „ 90 These were Temperate. Intemperate. Very Intemperate. 102 252 236 

Prcgonitory gtagc Ap g chin g Collapse Advanced 19 | 193 | 132 | 129 j BT~ Collapsed, with violent spasms, ----- 36 Total. Cured. Died. 590 T~ ~312~ ~|~" 278 Approaching and Con- ~ , _. , firmnd Collapse. CureJ - Dead. 342 145 197 



92 

Eke places of their nativity, as far as could be ascerd, were as follows :—: — 

America, 153 Blacks, 75—228 England, 52 Scotland, 23 Wales, 2 Ireland, 204 France, 5 Germany, 10 

Switzerland, 3 Norway, 2 Sweden, 1 Holland, 1 Italy, 1 China, 2 Africa, 1 Unknown, 55 

105 Patients came from the neighborhood of the Five nts. 52 From on board of vessels, (sailors, &c.) 

Peter C. Tappen, M. D. 

Physician to the Park Hospital. 



93 

DOCUMENTS, &c. 

tT. VI. — Report of the Physician to the Hospital in Rivington-strect. 

EChe physician of the Rivington-street hospital begs leave :>ectfully to submit the following report to the Special dical Council : — 

The necessary duties required in opening a hospital, with nurses without experience, with an insufficient supply of the necessary material for the comfort and accommodation of the sick, and the prompt and incessant attention which a large number of cases in a state of collapse urgently required, atForded no time to record a correct history of the symptoms and treatment of the first cases. 

Pince the hospital has been well organized, and a suffit medical corps and well appointed nurses have been ined, a correct history of every case and the treatment sued has been carefully preserved. 

liVe may remark that a large number of the poorest class Irish live in the vicinity of this hospital ; many of them c for years (as they themselves confessed) been almost ly intoxicated. They reside in small rooms, frequently jack buildings, crowded together in the utmost degree of i and wretchedness. From one house, called Stagg'g w, we received about 25 of this class : not unfrequently wife came in a state of intoxication with her dying husid to minister to his wants, and was afterward brought 

1.-J 



94 

I nth the same disease. Walnut-street, the receptacle the lowest class of prostitutes, is also in our vicinity, i susceptibility of this class was increased by the corned influence of filth, crowded rooms, irregular and roper diet, intemperance, and the debasing vice to which y were addicted. 

Many persons who had lived in this vicinity for years, and were daily seen in a state of intoxication, constituted another class, and were our earliest patients. These were dying when brought in, and very soon expired. We cannot well convey the impression produced on our mind by the rapid course of the disease in two persons of this description. They were admitted while we were making our afternoon visit. They had been seized within three hours ; but their pulseless wrists, cold, clammy and wrinkled hands, cold tongue and breath, and hippocratic face, conveyed no uncertain prognosis of their fate. We found at our evening visit, made a few hours after, that they had both expired during our absence. 

linother class of persons whose liability to this disease very strong, were the hard-working women, whose stitutions had been broken by years of incessant toil, pled with the privations to which they were frequently lected. Many of this class were also addicted to intemmce. 

tit a more interesting class of sufferers, and in whose If our sympathies were strongly excited, were those for months and often years had endured the sufferings chronic disease. These persons fell an easy and often nconscious prey to the fell destroyer. No language adequately describe the impression produced on our as we entered the room of a private patient of this . A beautiful young married woman was sitting on 'hair with a lovely child by her side. She had felt, as 



95 

I supposed, slightly indisposed for a few hours previously: ight diarrhoea without any vomiting, and a great sense of ikness were her only complaints ; but her eyes were even i deeply sunken in their sockets, every feature of the s was retracted., the pulse was just perceptible, and the 1 and tongue were cool. The united efforts of a respect; physician with my own could not prevent a fatal teration, which happened a few hours afterward. A numof cases have been published of its terrible havoc in le families : a remarkable example fell under our obation: — the wife's mother, the husband and wife, the servant woman and uncle all died within four days. 

Our earliest experience in the treatment of this disease commenced with the last stage ; and the advice of the most distinguished European and Asiatic physicians was faithfully pursued with little or no success in the collapsed cases. For the purpose of restoring warmth to the surface we employed hot blankets, bottles filled with hot water, hot sand bags, the hot air bath, and frictions with the hand or stiff brush : hot toddy, the carbonate of ammonia, sulphuric and phosphoric ether were administered to revive the action of the heart and arteries : cataplasms of mustard, Cayenne pepper and hot vinegar were applied to the chest, bowels and extremities, to direct the current of blood from the internal to the external vessels : hot stimulating injections in large quantities were also frequently given to impart warmth to the cold body. The vomiting was allayed with anodynes ; the tinct. of camphor, ice, and the effervescing draught ; and the purging was checked by anodyne injections and suppositories of opium. In a few cases in the early stage, while the pulse was distinct and full, venesection was tried till the pulse faltered, or florid blood flowed from the vein ; a full dose of laudanum and sulphuric ether was given immediately after in hot brandy toddy ; and a 



96 

similar dose with the tinct. of camphor was thrown into the bowels and retained by pressure ; hot blankets were carefully wrapped around the patient, and strong stimulating cataplasms applied to the bowels and extremities. The practice was recommended as singularly successful by a respectable physician in case reaction ensued. Large doses of calomel were designed to have been given, but in these cases reaction did not take place, and the patients sunk with singular rapidity. The tobacco injection was tried in three cases, with minute attention to the directions of Dr. Kirk. It was interesting to feel the pulse return at the wrist and acquire some force; but this pleasing improvement was of brief duration, the pulse soon began to falter, and death soon followed. To produce speedy vesication we have tried boiling water in a few cases, as has been advised. We soon abandoned this remedy, because we derived no benefit from it, and its application produced great agitation in the mind of the patient. We have produced very speedy vesication with a plaster made by dissolving the powder of the Spanish flies in strong acetic acid. 

We had now made every effort to recover our patients from the collapsed condition by the different modes recommended by the Asiatic and European physicians. Calomel had been tried in large and small doses, in combination with opium, and uncombined. The various means enumerated above had been most faithfully applied. The hot air bath had been tried in a large number of cases. We confess that we were greatly disappointed with the effect of this remedy. Dr. Armstrong had recommended it in the strongest terms of commendation in the extreme form of congestive fever. He remarks, that he has seen a patient whose skin was cold, pulse scarcely perceptible, and whose muscular powers were entirely prostrated, raised from this most alarming condition, and placed in a state of compar- 



97 

Ie safety in one hour by its magic influence. It liad eived the united recommendations of many excellent ters on Cholera ; and yet, after a faithful trial, we felt ur duty to lay it aside entirely, as a remedy of doubtful priety. Its effects were to warm the skin, but not raise the pulse. The perspiration was made to flow, rather a fluid exuded from the skin, but the awful iression which was sinking our patients into their graves i not alleviated. On the contrary, this very perspiration eared to act as an additional cause of exhaustion. 

Kn some cases a more favorable effect was noticed, and seemed to be prolonged, but the deadly grasp of the iless enemy could not be loosened by its power. 

We had read previous to the appearance of this disease in this country, the interesting Essays from the pen of Dr. Minor, recommending a mode of treatment which had been found eminently beneficial in the sinking typhus and spotted fever, which had from time to time invaded certain portions of our country. Dr. North, who had obtained so much distinction for his able Essay on the same subject, in one of his letters, had recommended a practice nearly similar. While we were engaged in the treatment of some very bad cases of collapse with the hot air bath, we were honored with a visit from Dr. Bigelow, and the other gentlemen of the deputation from Boston. They thought that the many points of similarity to this disease in the exhaustion which puerperal women suffer frorn> after severe hemorrhage, should induce us to make trial of the mode of treatment pursued in such cases. A few cases were accordingly treated with large doses of opium and brandy ; and no little solicitude was felt in obtaining the desired success from this treatment, which had been emphatically denominated the American practice ; but we are compelled to record our disappointment and mortification. 



98 

The use of small doses of camphor was tried in a few cases. In one case the pulse rose, and some warmth was restored ; the cramps returned in the limbs, and we were encouraged to hope that these favorable symptoms would continue ; but the powers again became depressed ; the remedy did not again revive them, and other stimuli were then tried with no better effect. 

|\ppalled by the fearfulness of a disease, which an illusius French author has justly described as commencing assaults with death ; — feeling that we had an enemy to :ounter whose first thrust carried a poison to the heart 1 corrupted the blood at its fountain ; — having proved utter inefficiency of all the means which the art had lerto supplied, — we were literally thrown upon our own Durces. 

We had known some severe cases of acute diseases which had not been controlled by the ordinary remedies, and in which the symptoms of dissolution had become manifest, to be relieved by salivation induced in a few hours by the inhalation of the fumes of mercury. These fumes were conveyed to the lungs by a flexible tube attached to a conical tin vessel which contained a stand on which a bar of hot iron was placed ; 10 grains of the grey oxyde of mercury were thrown every few minutes upon the bar, and the fumes passed through the tube into the lungs of the patients. Patients have been rescued from the jaws of death by this remedy. They were salivated ; the symptoms of death disappeared, and recovery soon followed. The profession are indebted for it to Dr. Jackson of Northumberland, Pennsylvania. 

I 'his is a disease in which the symptoms of death exist at time the patient first applies for medical aid. The blood left the superficial vessels and returned to the heart large vessels. Its decarbonization is prevented by the 



99 

ol the lim^rs «\n < l the loss ox nervous intlticDCC* This condition is proved by the blue color and coldness of tl>e skin. The remedy answers many indications. It acts promptly. It will equalize the circulation, remove the congestion of the lungs, and restore the nervous influence. Soon alter this remedy was thought of, two or three cases were placed under its influence, and the usual means of restoring warmth and action on the surface were combined with it, but the hour of dissolution was too near at hand. One died in an hour, the others in four hours. They did not appear to be at all incommoded by the use of the remedy, though the restlessness of their dying condition interrupted its application. On the following day we were informed that Dr. Roe, the ingenious and distinguished physician of the Greenwich hospital, had obtained the same results from rubbing the strong mercurial ointment into the surface of the body generally, and that salivation was obtained after five or six hours' use of this remedy. Any further experiments were now unjustifiable, and the remedy which had been found so successful in that institution, and had secured for its projector a distinguished reputation, and the gratitude of the community, was immediately adopted in this hospital. 

ISo many desperate cases have been brought here for atment, that the application even of this remedy was md, in many of the first cases in which it was tried, successful, and our devoted and faithful assistants were posed to abandon this remedy, also, as inefficient ; but exhorted and encouraged them to persevere, and their nfidence in its powers, after many trials, was secured, very desperate cases, we have made up our own minds subject our patients to the combined influence of merry applied both by fumigation and friction. 



100 

We shall now present a few cases from our record to illustrate some interesting points in the disease, and the effects of remedies. The following case is related to show the effect of bleeding in a constitution uninjured by bad habits before collapse had taken place. 

Henry Decker, aged 19, by occupation a farmer, of good constitution and temperate habits, was admitted the 9th of July. He had arrived in the city from the country on the 4th instant, in good health : he continued well till the morning of the 9th, when he was seized with moderate diarrhoea ; walked a short distance to the hospital and onty complained of slight pain in the bowels on his arrival. He appeared so little indisposed at this time, that the assistant physicians at the hospital were unwilling to receive him. While they were deliberating he vomited the rice colored fluid ; they then placed him on a bed, bled him till the pulse began to falter, gave a dose of laudanum and ether, administered an anodyne injection, with some Tinct. of camphor and brandy, wrapped him in warm blankets, and applied strong cataplasms of mustard, Cayenne pepper, and hot vinegar, to the abdomen and extremities, and gave him hot toddy in small quantities for his drink. His pulse fell rapidly, accompanied with a general sinking of his vital powers ; and he died four hours and a half after the first accession of the diarrhoea. A few days afterward another case with very similar symptoms was treated in the same way and with the same effects. Such experience created the impression, that however successful the practice of bleeding may have been in other places, it did not suit the disease as seen in this hospital. 

E experienced physician in a neighboring village has, are informed, successfully treated the disease by H after U. S. ; 3to 5 grs. of Tart. Ant., 3t05 of opium, calomel, and 15 of jalap, are given immediately after 



101 

E bleeding. The details of his mode of treatment, with is, we hope will be presented to the public. 

I The following case shows the effect of the stimulating in in a collapsed patient. Mary Pitney, aged 56, of iknown habits, was admitted on the 9th of July, with the mptoms of Cholera in a state of collapse; she had had irrhrea for some days. The use of stimulating cataisms, hot blankets, and hot sand bags, with moderate antities of stimulating drinks, and calomel and opium in )derate doses often repeated, restored warmth to the in, and force to the pulse, checked the morbid evacuans and finally produced healthy secretions. She was charged cured, on the 15th of July. 

KThe following case is introduced to show the rapid prosss of the disease when no premonitory symptoms had 

Charles Fitzsimmons, aged 30, of unknown habits, was brought into the hospital on the 10th of July, an hour or two after being seized with Cholera : he was already cold and pulseless, his eyes were sunken, and countenance contracted, extremities corrugated, skin blueish and breath cold. He was immediately stripped, clad in a warm flannel shirt, enveloped in hot blankets and placed in bed, stimulating cataplasms were applied to the abdomen and extremities, and bags of hot sand placed around him. An anodyne of laudanum and sulph. ether, tad composed the stomach, and small drinks of hot brandy toddy were given at short intervals; 10 grains of calomel was also directed. The patient continuing to sink, the hot air bath was applied in the usual way with some apparent mitigation of the urgent symptoms ; the skin was warm and the pulse could be felt : an exudation now took place from the skin, the pulse again became imperceptible, and the vital powers declined : diffusible stimuli were now given in moderate quantities 

W 



102 

but in vain. He died the same day five hours after his admission. 

I The following case presents an exemplification of the i effects of exercise while the system is enfeebled, during avalescence. Timothy Harley, aged 40, of intemperate bits, was seized with the symptoms of Cholera without y previous diarrhoea on the 12th of July, on the 13th the isms and other symptoms were relieved and he took ne exercise ; this exertion was followed by the symptoms Cholera, collapse immediately ensued, and he died five urs after his admission to this hospital. 

The subsequent case illustrates the good effects of the combined plan of moderate stimuli, with calomel and opium, in a very bad case. 

Mary Cunningham, aged 32, of very intemperate habits, Is received from Stagg's Row on the 1 3th of July, in the ipient stage of collapse ; she was directed to take five ins of calomel, and half a grain of opium every hour, h moderate quantities of brandy. After the sixth dose the opium was omitted, and the calomel continued till the healthy secretions were restored. She was discharged cured on the 18th instant. 

Small doses of the tincture of camphor have been found very useful in allaying the irritability of the stomach. Its beneficial effect is evinced in the following case ; and the treatment which has been found successful in the congestive fever is also illustrated. 

Em. Wallace, aged 33, of intemperate habits, was add on the 13th of July, with Cholera, after a diarrhoea of two days' continuance. The vomiting was urgent, and the saturated alcoholic solution of camphor was given in tdrop doses after every ejection : the vomiting was relieved, and five grains of calomel with half a grain ium was given every hour \ an anodyne enema was 



103 

len at the same time, and checked the discharges from the vels. After the fifth dose the opium was omitted, and calomel given alone. The symptoms of Cholera were v relieved, but symptoms of congestion supervened ; jding from the arm, blisters to the neck and epigastrium c resorted to, and he was freely and repeatedly purged i calomel and aloes pills. The congestive symptoms c now removed, but those of pneumonia followed, for eh he was treated, and was discharged cured the 4th of tember. 

11 some few cases, the offensive sordes and the bilious etions observed in the matters ejected, indicated the sssity of a remedy for their removal. Warm water and were found in such cases efficient and mild, as in the iwing case. Cornelia Davenport, aged four years, was itted on the 14th of July, with vomiting, purging, and nps. The matters ejected were tinged with bile ; warm ;r and salt aided their ejection and quieted the stomach; p which pills of calomel and camphor were given for w hours, retained on the stomach and restored the thy secretions. She was discharged cured on the 19th 

In the following case, Cholera was induced in a wife vatching with her husband. We may remark that all assistant physicians and medical pupils, and many of nurses, were seized with symptoms of this disease, with iter or less severity. The prompt attention they ;ived, soon controlled it ; and we take great satisfaction tating that all have completed their duties, after their aordinary exposures, in the enjoyment of good health. 

Mary Ann Wallace, aged 19, was seized with diarrhoea on the 13th of July. On the 14th the ordinary symptoms of Cholera ensued. She complained of much pain in her hpn ri j» 11(1 Wf Q Q VrtlYll fltl O* *J Vfcl 111 1 i~kl 1 C fl ¦ 1 1/1 A *¦» /¦» *¦* a4*s% *\£ 



104 

fac was given ; a considerable quantity of bile was ted, and the pain in the head was much relieved, tiphorated oil was rubbed briskly on the legs, and oved the cramps. After the stomach was quieted, five ns of calomel were given every two hours, till the secres were changed ; and the patient was discharged cured 

I 'he influence of the mind in counteracting the power of licines, and producing a fatal result, when a recovery lid have been, probably, obtained under more auspicious umstances, is presented in the subsequent case. Ellen nch, aged 38, of temperate habits, was admitted July I, after a diarrhoea of two days, with vomiting, purging, cramps. She was suffering from great distress on aunt of the death of her husband, who had died out of house a short time prior to her attack, and apprehended same event for herself and little daughter, who had been brought in with her mother. The ordinary remedies were tried without avail, and she died on the 15th. 

I^ases are recorded on our book, in which cherries, pine les, green peas, and salt fish, acted as exciting causes. ill these cases, an emetic of ipecac was prescribed to ;vc the stomach, and they did well. 

In one case, the disease was induced by drinking largely jold water while the body was overheated. Collapse ensued before the patient was brought to the hospital, he died soon afterward. Sleeping on wet timber proed the disease in another person. 

The folowing case will present an idea of the plan of treatment adopted after the mercurial frictions were introduced : — 

Adam Orr, a laborer, aged 30 years, of intemperate habits, was seized with diarrhoea on the 11th of July, and with the symptoms of Cholera on the 17th. lie was 



105 

admitted on the same day at 3 o'clock P. M. The tongue and surface of the body were cold, countenance sunken and livid, extremities corrugated and damp, pulse very small and feeble, vomiting and purging were frequent. The matters discharged resembled rice water — great thirst. The patient was clad in a flannel shirt, placed in bed and rubbed half an hour with the camphorated mercurial capsicum ointment. Ice was given to allay the thirst and irritability of the stomach. These were relieved in about two hours ; 3™ of calomel was then given. At 7P. M., the frictions were repeated, and 333 of calomel again directed. Hot sand bags were applied to the feet. The patient continued cold and feeble ; small drinks of hot toddy were directed, and an enema of hot water and brandy administered. 9P. M. the patient is now quite as restless ; pulse still feeble, and surface cold ; another 3ss of calomel wag taken, and another enema of hot water and brandy administered ; toddy and sand bags continued. 1 1 A. M., patient better ; surface warmer ; pulse rising ; omit the toddy, and give warm water. 18th, IA. M., reaction fully established ; surface warm ; pulse full and strong ; countenance more natural ; tongue a little furred ; continue warm water. 3A. M., patient continues as at the last report. 7A. M., the same. 9 A. M., pulse still full and strong; slight pain in the head. c. c. ad tempora. Ice applied to the head, and sinapisms to the feet ; 4 pills of calomel, aloes and scammony directed. IP. M., head relieved ; some pain in the chest; respiration slow and laborious; pulse full and strong; pills had not operated. Injection of senna and manna. Jxiv of blood were drawn from the arm. SP. M., medicine has operated ; stools are dark; symptoms of the chest and epigastrium not relieved ; ft take 4 pills calomel, aloes and scammony ; apply a blister to the chest and epigastrium. 



106 

tM., enema given and operated : stools still dark. 7 P.M., alism fully established ; symptoms of debility. 20th, iptoms of exhaustion increase ; diffusible stimuli and aw root. He survived till the 22d, when he died. 

the following case was treated with the frictions, without internal use of mercury : — 

I James Graham, aged 31, was seized with the symptoms Cholera on the 17th of July, and admitted the same day the stage of collapse. Frictions with Dr. Roe's ointnt were applied in the usual way every four hours till 22d, when ptyalism was established. Symptoms of laustion succeeded, and he died on the 24th. 

Ethe following case, the patient was restored from the of collapse, congestive fever, and inflammation of the 

Michael Bryan, aged 52, of intemperate habits, was brought to the hospital in the stage of collapse. Reaction was brought on by the combined influence of mercurial frictions and large doses of calomel. Symptoms of congestion now ensued, for which he was freely depleted, and which were relieved. Pneumonia then followed, but was also cured by appropriate treatment. He was discharged cured on the 29th of August. 

The following case was treated with camphor. — Thos. McCoy, aged 38, of intemperate habits, was admitted on 823 dof July, in the stage of collapse. The symptoms Cholera had appeared on the preceding day. He had en no remedies, and for that reason we thought it a good case to try this plan. The vomiting was urgent at BA. M. : 3j of a saturated alcoholic solution of camphor was mixed with a pint of warm water and allowed to cool ; gw was given every half hour, and sinapisms were applied to the abdomen and extremities ; bags of hot sand were laid around 



107 

the patient, and he was well covered with hot blankets ; 3ss of cold water was allowed for drink at short intervals. This treatment was diligently pursued. The vomiting was relieved after a few doses of camphor were taken ; the urgent thirst subsided after four hours, and the patient was tranquil ; no reaction followed ; the voice sunk to a whisper, and the patient died at 3 P. M. on the 23d instant. 

In the following case the symptoms of collapse succeeded the treatment adopted for the relief of inflammation. — Jno. Bowers, aged 43, of intemperate habits, was brought to the hospital with vomiting, purging and cramps, on the 23d : he complained of great thirst, the pulse was hard and quick, and he had severe and constant pain in the epigastrium. 3xvi of blood were drawn from the arm, and a blister applied to the precordia. Ice was given to relieve the urgent thirst. The pulse was improved, and the pain relieved by the bleeding. A dose of calomel was given to change the secretions, and the purging and vomiting had ceased. On the 26th the symptoms of collapse very unexpectedly took place. The usual treatment was pursued. On the 25th reaction had taken place, and the patient complained of pain in the head : cups were applied to the temples, ice to the head, and four pills of calomel, aloes and scammony were taken. On the 26th the pain in the head was removed, but the respiration had become slow and laborious, and there was some Eor : a blister was applied between the shoulders, and patient was purged with inf. senna and manna. On the i the patient was worse, and on the 28th he died. 

In the following case of collapse the patient was cured. — Eliza Church, aged 27, of temperate habits, was seized with diarrhoea on the 30th of July, and with Cholera on the 31st : she was admitted in the stage of collapse at 7P. M. of the same day. The frictions were applied, and 25 gtt. of black drop were given to relieve the vomiting, which 



108 

nppeared to be brought on by Sg of calomel, taken soon after admission: at 9 P. M. the vomiting continuing, the black drops were repeated at lA. M. Ist Sept., the vomiting was relieved, 3j of calomel was given, and frictions repeated : at 5 P. M. another scruple of calomel was taken : at BP. M. complete reaction had taken place : she complained now of dizziness in the head and pain in the epigastrium, and was bled. 2d, 7A. M. the symptoms were relieved by the bleeding : a dose of oil was taken in the afternoon, and followed by an enema. 3d, patient complained again of fulness of the head, and was inclined to stupor: c. c. ad temp. :dj of cal. : stupor continued : the scalp was shaved and a blister applied to it. The symptoms were relieved by these means, and the patient was discharged cured on the 10th. 

I^he following case of collapse was seen in its lowest ;e by the Professor of the Theory and Practice of the lege and the Physician of the Park hospital : they lght he would not then survive a few hours. — George Huntless, aged 13, was seized with diarrhoea on the 18th of July, and Cholera on the 30th. He was received into I hospital on the Ist of August. At 3P.M. in the coled stage the frictions were applied, and 10 grs. of cal. c given: 10 P. M. repeated the frictions, and gave a iple of calomel. 2d Aug. 9A. M. reaction had taken c, and there was congestion of the brain ; bowels are gish : c. c. ad temp, calomel and aloes pills. 3d Aug. icine operated moderately ; the body and tongue rather ; pulse feeble : warm toddy in small quantities ; the ;t carefully watched. Aug. 4th, body warm ; more or; some distress in the head ; bowels slow: 10 grains of calomel and 15 of jalap were administered and operated, but stupor continued : blisters were applied to the shaved scalp and the inside of the thighs sth nain in the pnicastriurr 



109 

I which he was leeched with only partial relief: emp. lie. epigastric, calomel and aloes pills. 6th, patient still pid ; fever of a low typhoid type ; fuliginous sordes on teeth; emp. vesic. to the nape of the neck; stimulating tment to the blistered scalp ; wine whey. 7th, sympis more favorable ; continue the whey ; Mist. Rhei. 3ij ; ph. Pot. I] ; Aq. 3>v Sss 3in die. Bth patient improving ; itinue the remedies. 9th, patient improving, but still ' : he continued to improve till the 12th of August, when integuments of his legs inflamed and sloughed ; an. tinate ulcer followed. He was discharged cured 29th (Vugust. 

TABULAR VIEW. 

Total Number. Males. Females. 410 ~~p 191 nr us Total. Cured. Dietl. 41 6~ 231 179 

Premonitory Stage. 

Diarrhoea previous to the Attacked without pre- .-. ? . attack of Cholera. vious symptoms Could S lve no account - 

340 | 38 | 32 InfpmnpratP Temperate. Unknown. intemperate. Adults. Children. but probably intemp. 184 ~~| 85 I 59 J~ 84 Symptoms. Purging and vomiting. ™* Collapse. 139 ~T~ 104 ~F~ 167 

15 



110 

Of those admitted prior to collapse there died of Consecutive Fever. Delirium Tremcns. Chronic Disease. ~TB~~ 2 2 

I Cured after Collapse, mcl in large doses, diffusible stimuli, hot and stimulating applications, - 24 mcl Mercurial Caps, and Camph. ointment, mcl and various stimulating embrocations, - 19 Total 70 

Khe calomel in these cases was given in doses of 38*. 

Bhe following table will exhibit the number who died in 12 hours after admission. 

Ist hour, 5 2d „ 3 3d „ 12 4th „ 17 sth „ 9 Gth „ 14 Total 

7th hour, 13 Bth „ 6 9th „ 8 10th „ 6 11th „ 8 12th „ 8 109 

When it is considered how impossible it is to combat a disease which destroys life within from one to twelve hours after application is first made for medical aid, we cannot wonder at the awful mortality of this disease. 



111 

The subjoined tables will show the ages of our patients. 

t Males. Females. Total. i 1 month to 1 year 14 5 From 1 to 10 years 25 17 42 „ 10 „ 20 15 26 41 „ 20 „ 30 40 76 116 „ 30 „ 40 50 52 102 „ 40 „ 50 33 33 66 „ 50 „ 60 11 10 21 „ 60 ?70 6 5 11 „ 70 „ 80 0 2 2 „ 80 „ 90 1 0 1 Total - - 182 225 407 

Ehe following table contains a statement of the countries re they were born. 

Natives of America, 214 Ireland, 81 I England, 17 Scotland, 3 Germany, 7 Portugal, 1 Nova Scotia, 1 

Finland, 1 Barbadoes, 1 Norway, 1 Jamaica, 1 Switzerland, 1 India, 1 

All which is respectfully submitted. 

Marinus Willett, M. D. 

Physician nfthe Hospital. 



112 

DOCUMENTS, &c. 

t. VII. — Report of the Physician to the Cholera Hospital at Corlaex's Hook. 

Cholera Hospital, Corlaer's Hook, 

September 15, 1832. 

I The subscriber, physician to the Cholera hospital establed at Corlaer's Hook, respectfully submits to the ecial Medical Council, and through them to the Board Health, the following report : — 

I Phis hospital was opened on the 18th July, 1832, and to present time (loth Sept.) there have been received 281 ients. The building provided for the purpose was a two •y wooden edifice, 50 feet long and 25 feet broad, pleatly situated on the East River, and open to the southerly breezes, by which it was ventilated. The hospital was an old work-shop, and when first opened for the reception of patients, it was without a sash or pane of glass to the windows, and the weather boards and doors were full of cracks and crevices, through which the winds and rain were freely admitted. It required several days before it could be made I it, clean and comfortable, as two carpenters only could induced to work among the sick and dying. For the t few days after opening the hospital, there was much irregularity, noise and confusion from men engaged in whitewashing the interior of the building ; from carpenters at work inside and out; and from the press of patients received, dying, and in agonies with cramps and vomiting. 

The building was taken in haste, and patients were sent to it before there were any fixtures, comforts or conveniences 



113 

for the physicians, the attendants, or the objects of their care. The first week was accordingly one of hard duty and severe trial, and in that time 62 patients were received, of which number 26 diedj; some immediately after admission, and 3 others were actually sent in dead. 

Order and regularity succeeded, and the change was beneficial to all concerned, and recoveries began to take place. From thence the cures became more numerous than the deaths, and there has since been a constant gain upon the dead list, so that the deceased now bear a proportion of about one-third of the whole number received, or 33 per cent. This would be a great mortality in ordinary cases of disease ; but when all the circumstances are taken into consideration, it is gratifying that the mortality has not been greater. Here we had to contend with a disease to which we were unaccustomed, whose career was rapid, and whose character was malignant ; attacking with violence persons of irregular and intemperate habits, many of whose constitutions were previously destroyed, and some of whom were in the last, stages of the disease when received ; and they only added to the obituary list without an opportunity given to the physicians of exercising their judgment or skill. 

The following statement gives a tabular or statistical view of the daily reception of patients, and the discharges by cures and deaths, to the closing of the hospital on the loth September, 1832. 



114 

DAILY REPORTS. * ti ¦ ¦ 1832. | ..| J 1832. J .I ¦ t i 1 li JSJ IS Brought over 179 69 92 July 18 8 2 0 G August 17 4 1 2 19 19 10 4 0 12 18 5 0 4 20 20 14 9 1 16 19 3 1 4 18 21 5 3 0 18 20 6 0 2 22 22 11 3 5 21 21 4 1 3 22 23 9 3 4 23 22 3 1 3 21 24 5 2 3 23 23 5 1 4 21 25 5 1 3 24 21 4 1 3 21 26 9 3 3 27 25 3 1 4 19 27 11 3 5 30 26 8 2 2 23 28 5 5 8 22 27 2 0 2 23 29 8 2 8 20 28 5 0 3 25 30 5 4 5 16 29 C 1 4 26 31 5 1 8 12 30 4 1 4 25 Aug. 15 4 5 8! 31 8 0 3 30 2 4 2 2 8 September 1 12 2 27 10 apphcat'ns refus'd 33128 2104244 do. 4 3 1 0 10 3 3 1 2 24 4 to. 5 4 0 1 13 i 4 0 3 1 26 3 do. 16 733 14 5221 25 4 do. 7 5 2 3 14 6 0 1 3 21 4 fa 8 6 1 2 17 | 7 2 1 4 18 3 do. 9 3 2 5 13 8 2 1 0 19 5 do. 10 1 1 1 12 9 3 0 3 19 2 do. 11 6 2 2 14 10 2 0 3 18 1 do. 12 2 0 2 14 11 4 1 1 20 2 do. 13 5 1 2 16 12 2 0 1 21 0 do. 14 2 2 1 15 13 1 0 8 14 3 do. 15 5 1 7 12 14 3 1 7 9 0 do. 16 8 1 1 18 15 0 0 9 0 4 do. Carried Total admis — forward 179 dO 92 mons - 281— 19 Total deaths - 93 Total cures - 1881 



115 

From this statement it will be seen that the total number received into the hospital from the opening thereof on the 18th of July to its closing on the 15th of September, a period of sixty days, has been two hundred and eighty-one, of which number ninety-three have died and one hundred and eighty-eight have been discharged cured. 

I 'he total number received in July, from the 18th to the of the month, was one hundred and ten ; of which fortydied, and fifty-three were cured, leaving twelve in the )ital on the Ist of August. 

In August one hundred and forty patients were received, of which, and the twelve remaining on the last of July, there died thirty-six, and there were cured eighty-six, leaving in the hospital thirty patients on the Ist September. 

On the last day of August an order was received to admit no more patients, and close the hospital as soon as those remaining could be dismissed cured, or sent to the convalescent hospital. Notice was accordingly given and posted in front of the building. From that time the daily reports ceased. In the succeeding twenty-four hours, ten applications were made for the admission of patients, and refused, some of them being very urgent. Having inquired of the Executive Committee of the Board of Health for further instructions, directions were given to receive those cases which were violent, in a state of collapse, or in a destitute condition. 

iie result of these orders was, that in fifteen days, fortypatients were refused admission as noted in the preg statement, they being directed to apply to the tal in Crosby-street, the only one intended to be kept ; and in the same time thirty-one were received in the tal at Corlaer's Hook, of which number a majority violent and severe cases, and ten of them died. Had 'hole number of rejected applications been received 



116 

it is probable that the greater part of them might have been cured, and the proportion of deaths diminished. The average mortality, however, is less than one third of the total number of patients admitted. 

fhe greatest number of patients received in one day was teen, and this occurred on the 20th of July, on which there were nine deaths. 

Ehe greatest number discharged cured in one day was t, and the same number was so reported on the 28th t and 31st days of July. 

irhe greatest number received in any one week was y-two, from the 18th to the 24th of July, and in the le period the greatest mortality occurred, the deaths mnting that week to twenty-six. 

K'he greatest number* dismissed cured, in any one week, forty, from the 25th to the 31st of July, and in the c period nineteen died. 

The persons received have been classed according to 

their habits into, 

3. Irregular, 4. Uncertain or unknown. 

1. Temperate, 2. Intemperate, 

I. The first class, the temperate, was composed of those o professed themselves to be such, and where there was evidence to the contrary the habits were so noted ; but hese there was subsequent evidence that the truth was always told. Of the professedly temperate, ninety sons have been received. 

Of which number there have died, . 18 „ cured, 90 

I. Of the second class, the intemperate, there have been ived one hundred and forty-seven. 

Of which number there have died, 55 cured, 92 



117 

3. The third class, the irregular in their habits, may be united with the second, as some were subsequently ascertained to be decidedly intemperate ; but as the habits of these have been entered on the register as irregular, the distinction is preserved. Of the irregular twenty-six have been received. 

ff which number there have died, 7 been cured, 19 

4. The fourth class, whose habits were uncertain or unknown, was mostly composed of those received in a dying state, or unable to give an account of themselves, Kof those in this class who recovered, subsequent iry was neglected from the pressure of other busi. They may generally be considered as intemperate, teen of this class were received. 

Cch number there have died, 1 1 „ been cured 7 — _!! Total received, 281 

I Of the whole number received into the hospital, there re, Whites, . . . 241 Blacks, ... 40 — * 8 ' Of the Whites, died, . 79 " were cured, . 162 Of the Blacks, died, . 13 were cured, . 27 281 

[6 



118 

¦^he number of each sex admittted, was bllows : — 

Of Males, . . .128 Females, . . . 153 281 Of the Males, died, . . 49 n « were cured, . 75 " Females, died, . 44 were cured, . 113 

K)f the females, twexty-six were prostitutes, from Wal-street or its vicinity, of which number five died ; to eh may be added two old bawds. 

thildren, under 14 years of age, have been admitted to number of twenty-five. 

Etale children, . . . 12 emale children, . . . 13 f the Male children, die-d, 2 " " " cured, 10 " Female " died, 0 f" " cured, 13 

The patients admitted, were natives of the following countries, viz. — 

The United States, . . 131 Ireland, .... 64 Other parts of Europe, . . 31 Flacks, .... 40 nknown, . . . 15 281 

Ehe sick received and treated at this hospital were of all , from 2to 85 years ; and they were cured or died, as :d below : — 



119 

died, ... 2 were cured, . . 23 Of persons from 14 to £0 years, died, . . 2 were cured, . . 7 Of persons from 20 to 30 years, died, . . 24 were cured, . . 60 Of persons from 30 to 40 years, died, . . 28 were cured, . . 60 Of persons from 40 to 50 years, died, . . 19 were cured, . • 28 Of persons from 50 to 60 years, died, . . 6 were cured, . . 6 Of persons from 60 to 70 years, died, . . 9 were cured, . . 5 Of persons over 70 years, died, . • 1 was cured, . . 1 Total number received 231 



120 

I The deaths have amounted to ninety-three, being rather ! than one third of the whole number of patients received. )m the list of sick, there may be deducted six persons, eived under pressing circumstances, which were not es of Cholera. These were, one case of dropsy, with M'der of the bowels ; two cases of pulmonary affection, :of which proved fatal ; one of stupor from a fall, brought at midnight, and which terminated fatally ; one of a ere contusion, received by order of one of the Aldermen ; and one of a child supposed to labor under a consecutive fever, but which broke out with measles, (Rubeola,) after it was received. With these exceptions the mortality by Cholera will still be less than one third, as will be seen by the following summary : — 

Received of Cholera patients, . 275 of other diseases, . 6 Died of Cholera, . . 91 " of other diseases, . . 2 Cured of Cholera, . 184 " of other diseases, . . 4 281 

The proportion of deaths was least in children, who may be classed among the temperate. Of the professedly temperate, one in five died ; while of all the other classes, nearly one half were swept away by the pestilence. The mortality was greater in males than in females, being more than a third in the former, and less than a third in the latter ; in negroes about one third, and in white persons rather less than one third of the whole number received of 





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I and 70, more than one half. Of the aged persons who i, two had their arteries in both wrists ossified, rendering pulse scarcely perceptible. 

Krom the obituary list, it is ascertained that the disease ed fatal at the following periods : — 

Died shortly after reception, in less than one hour, . . 6 " in one hour after reception, 1 " in two hours, " 4 " in three, " " 2 " in four, " * 2 ¦ in five, " " 3 " in six, " " 2 " in seven, " M 2 Died the same day, in less than twentyfour hours, . . 24 Died the next day, in twenty-four hours or more, . . 19 Died in two days after reception, 1 2 " three, " 3 " four, " 4 " five, " 6 " seven, " 2 " twelve, " 1 Total number of deaths, 93 

From this statement of facts the Special Medical Council will obtain an answer to their inquiry as to what days the disease most usually terminates fatally. The greatest number of deaths occurred in this hospital on the first and second days of the disease. Of the protracted cases which terminated in dissolution, several persons, whose constitu|>ck 



122 

of the disease, sunk into a state of inaction ; and y died of delirium tremens or mania a potu, after tht olera was cured. Other protracted cases were pro:ed by a metastasis, or change of morbid action from the mach and intestines to the brain, liver, or lungs, where lgestion took place, while some lingered in a state of mustion, and died in a typhoid state, without power to Tcome the prostration produced by the previous disease. 

I The admissions may be arranged in the following manr, as taken from the hospital register : — 

Admitted in a state of collapse, Admitted with puking, purging, and cramps, ... 99 Admitted with puking, or purging, or both ; but without cramps, and with the milder forms of Cholera, 78 Admitted with other diseases, 6 Total admissions, 281 

Of the cases noted when admitted as not being in a state of collapse, a number sank into that condition soon after being admitted, thereby adding to the number above stated. Several strong and well marked cases will be presented in the course of this report, of persons sunk into that last and most dangerous, and generally fatal, stage of the disease. 

K/mptoms of the Disease. — The malignant Cholera ars to be a violent disease of the primae vise, or stomach and intestinal canal, into which the fluids of the body are turned ; and the discharges, therefore, both upward and downward, though not always attended with pain, if left unheeded, bring on that stage of the disease which has been denominated the state of collapse ; in which the countenance chancres the eves express a peculiar sensation ot 



123 

anxiety, the pulse sinks, the extremities become cold, the fingers corrugated, a cold clammy sweat supervenes, cramps attack the extremities, the voice fails, and a cold breath, and cold tongue, give indications of extreme danger, and of a speedy and fatal termination to the disease. 

Premonitory Symptoms. — The violent forms of the disease are most usually preceded by forewarning, or premonitory symptoms of a milder character, which, in ninety-nine cases out of a hundred, may be cured ; but if neglected, may suddenly and unexpectedly advance to a more dangerous stage of the disease, and terminate fatally. The most usual of the premonitory symptoms, are simple looseness of the bowels, with or without pain, and which sometimes continues several days, though at other times only a few hours, without becoming dangerous. Borborygmi, or rumbling in the stomach and bowels, with pain or sickness at the stomach, sometimes occur as premonitory of malignant Cholera ; and they precede vomiting, or looseness of the bowels, or both. 

Essential Symptoms, — The essential symptoms of the epidemic Cholera, as they occured to the observation of the subscriber, are purging, or puking, or both. Vomiting sometimes occurs as the first symptom, but the disease most usually commences with evacuations from the bowels. These may be in the commencement, the. natural contents of the intestines, or in vomiting, those of the stomach. But in the progress of the malady, the discharges, up and down, become copious and thin, with little or no fetor, and often without pain, looking like dirty water, or the washings of dirty rice, and containing portions of flocculent matter, as though the fibrins of the blood were separated into shreds and floating in the watery mass. When these loose evacuations from the bowels become involuntary, the patient sinks without a hope of recovery. 



\ 

124 

\ 

I The vomiting may be moderate, and yet the patient die n the copiousness of the other evacuations, and the ence of the cramps which occur in most of the fatal 2s. The irritability of the stomach is sometimes very it, attended with distress, pain, burning heat and thirst, ;n the desire for cold drinks is urgent, and they are cted soon after being swallowed, with additional quansof fluid. In such cases other drinks or medicines proe the same effect. 

Cramps attend some of the milder cases, and are not I:essarily fatal. They occur most usually in the extremii, sometimes in the stomach, and external parts of the ly. When violent, they keep the patient in agony until strength is exhausted, and the sufferer sinks into a state torpor and death. Some have passed into the stage of lapse and died without cramps, remaining for some time a state of cold insensibility denominated the Cholera Asphyxia. 

Premonitory symptoms do not always occur. — Premonitory symptoms are sometimes wanting, but such cases are not numerous, and the patients are then attacked with violence from the operation of some exciting cause, and the disease runs rapidly its fatal career. A few such cases have been admitted into the hospital at Corlaer's Hook, of which the following are instances. 

CASES. 

1. One patient by the name of Tredwell Platt, aged 38 years, a wheelwright by trade, and of intemperate habits, was admitted into the hospital at 9 o'clock in the morning of the 23d August, and died at 10. He was well the day before, worked at his trade till night, ate a hearty supper, of which cucumbers formed a part. He had before eaten ? rift ryi \v\ i\\ 1 fY"» T")l] Tlif V AYlfl fnOllO^nt np f*Oll If 1 *A Cffk Ifl I fIU li 1 ( '"'* \- 11 J > 1111 1 1 1 1 1 Li 11 1 1 j j Allvl IMUUgUL Iv LUUIU 9 will ** o 



125 





Pvent to bed well, and alter midnight he was I with violent purging, rapidly succeeded by i and collapse, in which state he was sent to the morning, and died one hour after having and about eight hours after the first 

2. William McMennomy, aged 30 years, a carpenter, of temperate habits, was received on the 13th August, at 8 o'clock in the evening, and died in four hours. He had no premonitory symptoms, was taken that day, and rapidly sank into a state of collapse. His disease was induced by drinking a pint of sour cider when overheated. 

I. Catharine Gyle, aged 36, mantua maker, of temperate its, was as well as usual on the morning of the 30th just, when she ate pickled cucumbers at breakfast, eh soon brought on violent diarrhoea and vomiting. She admitted into the hospital at 9 o'clock the same evening state of collapse, and died next day, notwithstanding mercurial frictions and other remedies, which had no st in rousing her from a profound torpor, a cold insenity without cramps, a strongly marked instance of ilera Asphyxia. 

I difference between common Cholera JYlorbus and Malignant dera. — These are both affections of the stomach and stines, and may therefore be considered as modifications tie same disease ; but nothing like the late epidemic and ignant Cholera has occurred to my notice in twenty-four rs' practice. Several cases of cholera morbus of great ence are related in the medical journals,* as having jtofore occurred in this country as parallel to those of late epidemic Cholera; but as they are few and solitary, 

? See Bushes Med. Chirurg. Bulletin. 

17 



126 

tr must be considered as sporadic cases of extraordinary ignity. 

The common cholera morbus prevails annually, most usually in warm seasons, during the months of July, August and September, and is attended with puking, purging, and griping pains in the stomach and bowels. The evacuations are bilious, and the vomiting of green bile is evident to the sight and taste of the patient. 

In the malignant Cholera, bilious discharges are wanting, and the evacuations up and down are thin and watery, and without fetor, although there may be food and feculent matter in their commencement. The liver and kidneys appear to be torpid in their ordinary secretions, while the fluids of the body are determined to the intestinal canal, and ejected up and down in the form of dirty rice-water. 

B Cramps attend both forms of disease, but they are more lent and fatal in the malignant form. 

I The epidemic Cholera generally commences with mild nptoms, and suddenly changes its character, running into a state of collapse, often attended with cramps, though sometimes not. 

Ehe common cholera morbus commences with violence out premonitory symptoms, and seldom or never tennis with the symptoms of the last stage of the malignant 

I Malignant Cholera differs from Spotted Fever. — The )tted fever of this country has been stated to be the ne disease as the malignant Cholera. If this be the case, :n the latter is not a new or unusual form of disease the United States. It is true that Dr. Elisha North, an linent physician of New London, and one of the principal iters on the spotted fever, gives a tabular view of the nptoms, in which he has the cholera morbus form of >tted fever. With a view to determine how nearly the 



127 

two diseases were allied, I have looked in vain for petechia? or spots, which often accompany and characterize the spotted fever, and I never found them in cases of malignant Cholera, except where they had been produced by sinapisms, or the frictions with capsicum. 

Kn malignant Cholera the primae viae are the principal seat the disease, and puking and purging essential symptoms he commencement. 

In spotted fever, " the brain seems to be the part most affected," and " the first passages are not the parts on which the causes of this disease principally act."* 

I Sudden Changes in Malignant Cholera. — The changes this disease are very sudden and striking. From an )arently slight attack the pulse suddenly sinks, the counance becomes haggard and anxious, and the other nptoms of collapse rapidly succeed. The disease has :n distinguished by writers on the subject into several *es, but they are not so evident in practice as in theory, stages gliding into each other imperceptibly, rendering ifficult to draw the line of distinction, except in the last I generally fatal stage. 

In some cases which have terminated fatally, the symps characterizing the collapsed stage were all present, in others the blueishness, sunken cheeks and loss of :e were not so evident ; and where the cramps were eradded, it frequently happened that the voice was ing, and raised in groans and screams, expressing the ny of the sufferer. Aphonia, or loss of voice, has urred where the patient did not sink into collapse, and overed. In the latter period of collapse the pulse is ;n imperceptible at the wrist or temples an hour or more vious to dissolution. The cold tongue, though always 

? See North on Spotted Fever, pp. 56 anil 57. 



128 

observed in the cases that have proved fatal, yet is not necessarily a fatal symptom, though a dangerous one, as it has been observed in a number of cases that have recovered, and in some that were collapsed, or on the verge of running into that state. 

I Phis malignant form of Cholera was sometimes checked medicine, and immediately changed its type, producing letermination to other parts, or a transfer of morbid on. This would also happen spontaneously, when the in, the lungs, or the liver, would be the organs upon eh the diseased action would fix itself, followed by what been called a consecutive fever. 

Cases of Collapse. — Of the cases of collapse several strongly marked ones have been cured. 

1. George Nortican, a negro, twenty-two years old, of Kperate habits, was received on the 23d and discharged id on the 31st of July. Previous to admission he had passed rapidly through the earlier stages of the disease, and when admitted he was completely collapsed, being universally cold, with a cold tongue, covered with a cold sweat, pulse scarcely perceptible, and incessant cramps. 

I ""he treatment consisted in having him stripped and bed dry, bags of hot sand applied to his body, and two l kept assiduously employed in rubbing his extremities i the camphorated mercurial ointment, in which red per was incorporated. This friction was continued ifully for three hours or more, when the pulse rose, the nps abated, the heat returned, and he was then left ered with blankets, and the hot sand bags around him. medicine was introduced into the stomach until the next day, when a mild cathartic was administered. Mercurial purgatives were subsequently given. 

Khe result of this treatment was favorable. The stomach left undisturbed with medicine until it could be taken 



129 

Ehout being rejected. In four or five hours the merial fetor was perceptible in the breath, and next day the ient was salivated, though not violently, and from this gradually recovered. When discharged he was sent to convalescent hospital. 

12. A second case of collapse still more violent than the needing was also cured. Eliza Mitchell, a black woman, intemperate habits, twenty-two years old, was received the 4th and discharged cured on the 28th of August, 32. 

I When admitted she was in a more advanced state of lapse than the preceding negro (Nortican.) The feeble se, the cold extremities, cold sweat, cold tongue, were same as in him ; but she had in addition burning heat at stomach, thirst, vomiting, and cramps so violent, that h her constant agitation, it was impossible to keep her ered, and the hot sand bags properly applied. Though ing- cold to the attendants, she felt herself a sensation of t, and the blankets were kicked or flirted with the hands :on one side, and then on the other. Her screams, sed by the cramps, kept the whole hospital disturbed several hours. 

IPhe mercurial friction with camphor and pepper was duously applied to the extremities and chest for four irs in succession, when the cramps ceased, and being ered up, hot sand bags were applied all around her. ring the friction, when she was very thirsty, small pieces cc were given, which were kept in the mouth, and when Ited the water was swallowed and retained. She asked other drink, and mint tea was given in small quantities ; was sometimes rejected, and at other times retained, ood by and saw both the ice and the tea administered, medicine was given until the cramps and irritation of stomach were allayed. She was evacuated the next 



130 

day with calomel, and her feet, which continued cold, were bathed in a hot decoction of capsicum (red pepper.) 

(This treatment resulted in a salivation, which com:nced next day, and became very violent, and required 2 application of a blister to the face to check it. The nds of this patient continued of an icy coldness for several ys, with some irritability of the stomach, over which a ster was applied. 

E^his was also a case of second attack of the same ase, and which will be again noticed with others who c had Cholera more than once. 

13. Charles Moore, aged 31, a sailor, of intemperate habits, s received at three o'clock in the morning of the 7th August. Me had drunk freely of cold water the day 'ore, while in a state of perspiration, and was taken with imps in the evening. When received into the hospital had violent vomiting and purging, cold extremities, ble pulse, and dizziness of the head, with dilated pupils, is patient was not sunk so low into a collapsed state as two preceding cases, but his condition was such as to ider his recovery very doubtful. 

I-II -I is treatment consisted of the stimulating mercurial tions, dry heat, and sinapisms to the epigastrium. His nach rejected cold water, but retained brandy and lanum. Calomel purgatives were given after the sto)h became retentive, and it was subsequently exhibited mall doses. He was also twice cupped at the temples, ice was applied to the head for several days in succesl, to relieve the determination to that part. This patient recovered slowly ; his pulse continued feeble, and his extremities cold, for a number of days. His skin was washed with warm soap-suds, to remove the grease of the unguent, and then he was washed with a hot infusion of DtiDDPi* no f*ontiniif*n to 11 Inirf*i*1 nirf*i* * < ?? 1111 1 1 fiiq f*si^p vfir"C*d 



131 

lon a typhoid state, with feeble pulse, loss of appetite, j prostration of strength. Added to these, there was a ronic irritability of the stomach, attended with nausea, kness, and sometimes vomiting. Congestion finally took ice in the lungs, and he was one day relieved by vomit; blood, which again occurred a few days after. Small jes of calomel with ipecacuanha were given, and he was ice cupped on the chest, with great relief. His subseent improvement was gradual, and he was finally disarged from the hospital on the 7th of September, restored the first place from a state of collapse, then of determition to the head, and afterward of determination to the 

11. Wright Tucker, aged 30, a sailor of regular habits, i received on the 27th of August, and discharged cured the 6th of September. He had diarrhoea several days vious to the 26th, when vomiting commenced ; and when nitted on the 27th, he was in a state of collapse, with niting, purging, and cramps. His pulse was feeble, his remities cold, tongue cold, face cold, and covered with old sweat. 

i Mercurial frictions, dry heat, and a sinapism to the pit of ; stomach, were applied. Mint tea was given to drink, hen his stomach was thought to be sufficiently retentive, een grains of calomel, with one of opium, were given at lose. This was followed next day by a mild cathartic. 

I Several other cases of collapse were cured by a similar :atment, viz. a persevering application of the stimulating :rcurial frictions, dry heat with bags of hot sand, mustard ultices to the stomach, and mercurial cathartics, with or thout opium, when the stomach became retentive. In jse and other cases where vomiting was violent or freent, care was taken not to disturb the irritability of the stric organ by frequent doses of medicine, but to suspend 



132 

its use until external frictions, sinapisms, blisters, or cupping at the pit of the stomach, had removed its irritability, for which cupping has been much and beneficially employed. To arrest the discharges from the bowels injections of starch and laudanum were very efficient. 

Ji case of Collapse Cured, but terminating fatally in congestion of the brain. — The following was considered by all the medical attendants as an interesting case of recovery from extreme collapse, when a secondary or consecutive fever followed, with a determination to the head, and destroyed the patient. 

I Nancy Robinson, aged 19 years, a prostitute from alnut-street, was received on the 3d of August. She was taken that morning with violent vomiting, purging, and cramps ; and when admitted into the hospital these continued, and she was sunk into a complete state of collapse, with pulse scarcely perceptible, cold skin, cold tongue, blueness of the fingers, eyes, and lips ; burning heat at the stomach, great jactitation or tossing of the legs and arms, and though cold as a frog, and covered with a cold perspiration, she could not bear the bed clothes upon her, complaining of a sense of heat. 

The mercurial frictions were assiduously applied to the extremities, dry heat to the body, and warm peppermint tea given as a drink. The latter, though in small quantities, was sometimes rejected. She was also cupped at the 

These means were effectual in restoring the pulse, relieving the cramps, and raising the patient from her extreme state of collapse, so that next day she was comparatively easy and able to take and retain a mercurial cathartic. A remarkable coldness of the hands, (though heat had returned to other parts,) and a livid appearance of the lips, continued for several days, when a determinaiion 



133 

to the head took place, and the pulse and skin rose to a febrile quickness and heat. Sleepiness and stupor ensued, and notwithstanding bleeding, cupping, purging, blisters, and ice to the head, she sunk and died on the sixth day of the disease. 

I Congestion of the Brain. — The symptoms of Cholera ving been arrested in two children, both males, and both *cc years old, a secondary fever followed, and they died >m congestion of the brain ; one on the second, and one the seventh day of the disease. 

Two negro women, also, had secondary fever and determination to the brain, and both died ; one on thejifth, and one on the twelfth day after reception. 

I Two white women recovered from a state of congestion the brain, by bleeding, cupping at the temples, blisters d ice to the head, and drastic cathartics ; one child, also, :overed from this state by the application of leeches to i temples, ice to the head, and cathartics. 

t Congestion of the Lungs. — A determination to the lungs Ie place in four instances ; one in a negro, and three in te men. They all proved fatal, except in the instance Charles Moore, whose case has already been related ler the head of collapse. One of the fatal cases was a te man, who had ossified arteries as before mentioned. 

I'ongestion of the Liver. — Determination to the liver took c in one female, Maria Sullivan, whose eyes and skin irne very yellow, and the yellowness continued to 2ase until it was arrested and removed by the exhibiof calomel in small doses, which lightly touched the s. She has recovered, and was discharged cured on 7th September. Hers was, also, a case of second :k, yet to be noticed. 

Puerperal Cases. — Among the patients admitted into 

18 



134 

t hospital with Cholera, there have been four puerperal ten, two of whom died. 

1. Catharine Riordan, aged 18, of unknown habits, was received on the 25th July. The violent puking and purging brought on premature labor ; she was delivered of a stillborn child on the 26th, sunk immediately into a state of collapse, and died in a t'cw hours. 

I!. Mary Morgan, aged 20, of temperate habits, was vered of a living child before her reception into the pital, where she was admitted on the 16th August in a c of collapse, and died the same day. 

3. Mary Williams, aged 19, of temperate habits, was received on the 22d August with vomiting, purging and cramps. Sinapisms were applied to the epigastrium, dry heat to the body, and calomel with opium given internally. On the 26th she was delivered of a still-born child. She was discharged cured on the 12th September. 

t. The fourth case is that of a negro woman far advanced regnancy, who was cured of Cholera, and sent to the valescent hospital, having escaped abortion. 

Second Jlttacks. — A number of cases occurred of a second attack of Cholera in the same persons. Some of them were rather cases of relapse from indulgence in eating, or irregularity in living after being discharged, and before the stomach and bowels had acquired strength enough to bear the ordinary course of living. 

E'here were others, however, of a character unequivocally ked, where the same person was attacked the second 

I. Letty McGuire, aged 26, of temperate habits, was the first person admitted on the ISth July, 1832, having been attacked the day before with purging and cramps. She was treated with external stimulants, mustard applications and opium internally. This was followed next day with a 



135 

mercurial cathartic, succeeded by a Seidlitz powder, and the patient was discharged cured on the fourth day. 

I For five days thereafter she was employed at the hospital assistant to the cook, and slept at home, some distance m the building. She was then taken more violently than first with nausea, vomiting, and cramps in the legs. On ng readmitted she was treated by the application of dry it, frictions, and stimulating applications to the stomach 1 extremities, and calomel with Dover's powder given Brnally. She was again discharged cured on the 30th y, four days after reception. 

2. Eliza Mitchell, a negro woman, aged 22, of intemperate habits, was admitted the second time on the 4th of August, in a state of collapse, as already related. This second attack was two weeks after her discharge the first time. 

The first attack was preceded by several days of diarrhoea, when vomiting and violent pains in the epigastrium were superinduced by eating boiled beans. She recovered from both attacks, and was discharged cured of the second on the 28th of August, twenty-four days after admission. 

I. Maria Sullivan, aged 30, of irregular habits, was on the 15th of August, having been taken the day >re with vomiting, purging, and pain over the epigasm. When admitted had feeble pulse, cold skin, less ation in the primae viae, but extremely weak, verging on apse. She was treated with dry heat, and sinapisms at pit of the stomach, and calomel with opium given intery. She recovered slowly, as a determination to the liver c place, requiring further mercurial treatment, as already 

B'our weeks previous to her reception in the hospital at laer's Hook, Sullivan had been successfully treated with 



136 

X first attack of Cholera by Dr. Rhinelandcr, in the sby-street hospital. 

4. Catharine Brown, aged 27, of temperate habits, one of the nurses of this hospital, had two attacks of the disease, in both of which she had vomiting, purging and cramps, and from both of which she recovered with the use of such means as have already been mentioned. Before the hospital closed she had a similar attack the third time, and recovered. 

IVickness among the Nurses and Attendants. — Scarcely one of the attendants escaped without symptoms of the ase in some form or other; but as application for mediaid was generally made in season, the cases were soon id. Some of them were slight, and so easily removed the persons continued to perform their duty, and were entered as patients. When the symptoms were more jnt, as in the case of Catharine Brown, (just related,) attendants were directed to go to bed, and were treated atients of the hospital. Only one case proved fatal. 

Samuel Weeks, aged 55, of intemperate habits, was gatekeeper to the hospital for ten days. He sat under an awning during the day, some distance from the building, and slept at home. 

|)n the 7th of August he was taken with vomiting, purgand cramps in the legs, the consequence of neglecting lotice or mention the looseness which had troubled him several days. When taken into the hospital on the •ning of the 7th, his pulse was feeble, surface of the >s and body generally cold, accompanied by incessant it. Notwithstanding the mercurial frictions, sinapisms, heat, warm drinks and mercurial cathartics, he sunk a state of collapse, and subsequently of congestion of head, and died on the fourth day after reception. 



137 

I Another one of the attendants died in conseqence of an cident and not of Cholera. 

John McEvers, one of the men employed in transporting patients to the hospital with the sedan, left there at night, and died at home : the day hefore he had lacerated his finger with a rough nail, and the wound was dressed by one of the physicians of the hospital, and he continued on duty the remainder of the clay. In the evening before going home he complained to some of the attendants, of pain running up his arm from the wound, and talked incoherently. Plis case is not considered as one of Cholera, though it was said to have been so reported. His death must be attributed to tetanus, caused by the wound in the finger from a nail. He was not seen or visited by the physicians of the hospital after he went home, nor was he entered as a patient. 

Patients Injured by JHedicine. — Of the patients admitted, some were injured by the injudicious exhibition of medicine before reception. The following cases may suffice as examples :—: — 

11. Daniel Lomaree, aged 49, of temperate habits, was icked with Cholera on the 23d of July, and was received 3 the hospital on the 24th. Previous to his reception took twelve opium pills, which brought on a high fever, lent pain in the abdomen, with tenesmus and bloody ols. The pain was attended with excessive soreness at pit of the stomach and abdomen, where the least press) gave him distress. 

Warm fomentations were applied to the bowels, and a mercurial cathartic given. Two hours after admission he was bled freely, and the bleeding from the arm repeated in three hours. He was also cupped both on the stomach and bowels. Mercurial frictions were then applied to the abdomen, and calomel was repeated until alvine evacuations 



138 

were freely procured : when this was accomplished the soreness over the body gradually diminished, and the irritation in the intestines with the bloody discharges ceased. On the 28th of July he was sent to the convalescent hospital in Orange-street, and In a few days returned to thank his physicians for their care and attention, which had resulted in his cure. 

E Betsey Segur, aged 30, of intemperate habits, was ived on the sth of August, in a state of collapse, and in five hours. The exciting cause of her attack she d to be from eating a few pears. 

Mustard drafts had been applied to the feet and chest before admission, and she had taken a wine glass full of spirits of camphor. This had arrested the vomiting, but the cramps were violent in her feet, legs, and along her ribs, and the excessive pain and burning heat at the pit of the stomach, were such as to keep her in constant agitation. Hot sand bags were applied but ineffectually, their utility being prevented by constant motion. The mercurial frictions appeared to distress her, and nothing gave any relief but cold water and ice, both of which her stomach retained. The ice was taken with avidity, and swallowed with eagerness. She even said, when a piece of ice was taken from a bowl and put into her mouth, that she could eat the bowl full ; but notwithstanding the attention and care bestowed upon her case, and the use of as much ice as she wanted, she soon became exhausted, and died. 

Immigrants. — Two of the patients were foreigners, who recently arrived from New-Orleans. They were yes of Ireland, a man and his wife, the latter of whom died, as has been related among the puerperal cases, and the man recovered. These are the only emigrants known to have been received into this hospital. 



139 

not having visited the places from which the patients were brought, cannot answer satisfactorily the question as to the greatest number of cases occurring in one house. The following is the only information in their possession :—: — 

On the 22d of July, a man, his wife, and child, were brought to the hospital from 89 Madison-street. The child recovered, the parents died. 

En the 14th and loth of August, a man, his wife, and c children, came from 49 Lewis-street, and all recod. The youngest child was very ill, and was cured of secondary fever and determination to the brain, by bleeding, leeching, and ice to the head. 

On the 2Gth of August four persons were admitted, having been taken from an alley No. 450 Cherry-street, out of which fifteen individuals had died of Cholera. These four having been removed from the local infected district and placed in the hospital, were all cured. 

On the 23d and 25th of August, a man and his three children were received from No. 80 Pitt-street. The man Em a state of collapse, and died in two hours. One of children was in a state of stupor when received, and of consecutive fever. The other two recovered. 

A female was received from Stagg's Row, in Delanceystreet; in an advanced stage of Cholera, and recovered. Forty-three individuals had previously died out of that Bw, which was crowded with persons in the lowest conon in life. 

i Quarantines against the Cholera. — Quarantines for the rpose of preventing the introduction or spread of Cholera, jear to me to be of no utility, except to quiet the minds those who labor under the apprehension of its being con;ious. That they have not prevented the disease from 



140 

Earing in this and other places, present strong evidence y mind of their inefficiencj\ 

I Cholera not Contagious. — One of the reasons for believthat quarantines are of little or no efficacy, in guarding linst the introduction of Cholera, arises from the convicri that it is not a contagious disease. How then, it may inquired, did it happen that in the Corlear's Hook hospione of the attendants died, and that a number of the ers sickened, as well as some of the nurses ? If the jase were contagious, the question might be answered another. How did it occur that others laboring under lal exposure escaped 1 

The fact that some of the attendants sickened, is no proof of the contagion of the disease, because, like all other persons, they were liable to be acted upon by the same predisposing causes, and they were more exposed than others to the exciting causes of fatigue, disturbed rest, and irregularities in diet. Diseases acknowledged as contagious generally leave the constitution unsusceptible of a second attack, but in this we have evidence already related of Ems laboring under the disease the second time, and greater violence than the first. The physicians assod with me in the duties of this hospital concurred in this 

The circumstances of many people in one family, in one house, or in one neighborhood, or range of buildings, having sickened and died, may be accounted for without resorting to a foreign origin for the complaint. This disease I believe to depend upon an atmospheric influence, rendering the human constitution more than usually liable to disorder of the intestinal canal, and this creates a predisposition in all persons under the same influence ; when an exciting cause only is wanting to develope the disease. 11 1 ' ¦ 1111 1 1 itirliil r^t 1111 1 1 *t ¦ s iti t ' ' 1 1 1 1 1 ' ** ' 1 1 1 1 1 fit'i 111/*1 1 1/* ill cf ( ' ¦\ i ''ii t ' t ¦ v nDH 1 1 if* 



141 

Int of rest, anxiety, grief, fear, change of habits, briety, and other agencies, may act as exciting causes, I produce the disease with greater or less violence in. •portion to the force of these causes. And yet so ceptible have we been under this predisposition, that :iting causes of a very trilling nature have produced the ;ase, and such as at other times would not have induced ordinary cholera morbus, or any other disturbance in stomach and bowels. Scarcely an article of diet, or ruit of the season, even though ripe, but has had an ncy in producing malignant Cholera. 

The fact of several persons in one family having this disease may be accounted for by similar indulgence or irregularity. Many families crowded into one house, or one neighborhood, or range of buildings, have sickened, and some of them died, from the operation of similar exciting causes. Where such occurrences have taken place, they have been among the very poor, filthy, and badly provided for ; all of whom being like the rest of the community in a state of predisposition have been acted upon by numerous exciting causes incident to their condition. We may add to these agencies, their crowded, close, and unventilated habitations, which have constituted a confined and locally infected district, in which the prevailing epidemic exerted a greater activity, and carried off many victims. This has been witnessed at 450 Cherry-street, where fifteen who died of Cholera were taken from one alley ; and in Stagg's-Row, in Delancey-street, where fortythree others fell victims to the disease. A healthy person going into such an atmosphere would in ordinary times be fortunate to escape a fit of sickness, and if he had ventured into it during the late epidemic, he might have been taken sick, and Ins sickness assume the prevailing form of disease, not from contagion or personal intercourse with the sick, 

19 



142 

but from the foul atmosphere acting as an exciting cause in one unaccustomed to it. Those who have lived in such an infected atmosphere and escaped the disease, have become acclimated, and unsusceptible of its action on the system. My opinion therefore is, that malignant Cholera is not contagious per se, or by personal intercourse with the sick in a pure atmosphere. 

(he atmospheric influence predisposing to this disease, has irallel in the influenza, or the malaria, which sometimes luces yellow fever in this northern climate. The cvice to our senses in all these cases is an unusual state the season during and preceding the prevailing comnt. 

The last winter was unusually severe and long continued, and the spring was cold and protracted into the summer months, and during the prevalence of the epidemic, which was rife in July and August, these months, with the exception of a (ew days, were cold and uncomfortable, with many showers and cold rains. Such weather in other seasons would not have produced the ordinary cholera morkof the country, which prevails most in hot weather ng the same months. 

Treatment and JWedicines. — At the commencement of the epidemic Cholera in New-York, I had formed no plan of treatment, had laid down no rule of conduct, except the determination not to prescribe for the name of the disease, but to wait until it appeared, watch its symptoms, and then act upon the general medical principle of prescribing pro re nata, or according to circumstances. I felt rather embarrassed at the different opinions promulgated on the nature of the disease, and the numerous remedies recommended in its cure. Some of these appeared to be useful, but which were entitled to the preference experience was 



143 

method of treating a disease which I had not seen was given more at large in a report made to the Cholera Committee of the Medical Society on the 25th of June, 1832. Experience has since convinced me that my judgment at that time was correct, and that I have profited by my decision not to be governed by preconceived theory, nor to be bound to the use of any specific remedy. 

IFhe most useful and practical information which had ne to my knowledge, was given by Dr. J. R. Rhineder after his return from Canada, in a verbal report to oint Committee of the Medical Society, and the College Physicians and Surgeons ; from a statement made to the le Committee by a gentleman who had seen much of disease in Montreal ; and from Dr. Moir, of Edinburgh, 3 was in New-York in June last. With such informai, and the successful treatment of a few cases in private ctice, I commenced duty at the Cholera hospital at rlear's Hook, on the 18th of July 1832. 

The facts in relation to the numbers received, their ages, sexes, conditions, &c, having been given, and the result as to cures and deaths, it only remains to give an account of the medical treatment that has been the most successful, and to designate such remedies as have been useful. 

I The Mercurial Practice. — After the experience afforded two hundred and eighty-one cases admitted into the pital,and many occurring in my private practice during same period, I am satisfied that the mercurial treatment been the most effectual, and the one that can be relied with the greatest confidence. This treatment is both ernal and internal : external by frictions with mercurial tment, incorporated with camphor and capsicum ; and ;rnal where calomel is combined with opium, Dover's ,vder, or rhubarb. These, with the application of dry it, sinapisms, blisters, and cupping, and also restraining 



144 

of the most decided and violent cases of collapse. 

In the administration of calomel internally, it was given in doses of five, ten, fifteen or more grains, combined with one or two grains of opium, or with ten or fifteen grains of Dover's powder. Opium was necessary to allay pain in the stomach or bowels, and to prevent the calomel from passing oiFtoo rapidly. I was much pleased with the operation of Dover's powder in combination with calomel, where it could be given without disturbing the stomach in the earlier stages of the disease. The result of its action was in the first place, to allay pain, from the opium it contained, to arrest the operation of the calomel, and thereby to enable it to exert an influence on the secretions of the liver. It finally tended to produce a warm perspiration, and by such determination to the skin anticipating the influx of fluids to the bowels, and that cold and morbid perspiration which usually followed. Dover's powder could not always be retained, particularly where there was much vomiting, and it was not useful in the advanced or cold stage of the disease. If opium or laudanum had previously been taken, calomel was given either with jalap, gamboge, scammony, or rhubarb, as it was necessary to act with more or less visor upon the liver, and the intestinal canal. Where opium was not required, calomel with rhubarb operated kindly. 

fforcurial Frictions. — Friction with hot chalk was emcd the first week after opening the hospital, but it was abandoned for the mercurial friction. The experii of this hospital is therefore not in favor of friction chalk. We were subsequently informed by Dr. Roe, ie Greenwich hospital, that it should have been com-1 with the mercurial ointment, and would then have more useful. 



145 

than moist heat. Hot bricks, hot stones, bottles of hot water, or hot ashes may be usefully employed in restoring heat where the patient has sunk or is sinking into the cold stage. Hot sand, however, was soon established as the best and easiest method of applying heat, and bags were prepared, filled, and disposed around the patient, to restore the heat of the body and promote a warm perspiration. 

Cupping. — Where there was much vomiting, or great irritation of the stomach, cupping was found with other means to be very effectual in allaying it. With an exhausting syringe, and cups prepared for its application, much more blood could be drawn than by the old method of ratifying the air in the cups by heat. Sometimes the chest and pit of the stomach were rubbed with the camphorated mercurial ointment without the pepper ; the cups were then applied, and if the puking or irritation continued, the mustard poultice was also laid over the part. In all cases of uneasiness, pain or distress in the head, cupping was resorted to with advantage, particularly where there was sleepiness or stupor arising from a determination to the brain. 

I Sinapisms, Blisters. — Sinapisms or mustard drafts were irst extensively applied to the feet, ancles, calves of the i, wrists, chest and abdomen. They were subsequently tted on the extremities as they interfered with the merial frictions, which were found to be more effectual, ients sometimes complained of the pungency of the mus-1, which it was necessary to remove. Where this hapied at the pit of the stomach, the frictions were renewed, itting the capsicum. Blisters were sometimes necessarily I usefully applied to the epigastrium, particularly when re was a protracted irritability of the stomach, arising m a chronic gastro-enteritis. 



146 

I Injections. —To arrest the rice-water discharges from i bowels, injections of starch or arrow root, with laudam, were found to be the most effectual. These were lewed as often as was necessary to produce the desired set, and they answered better than when laudanum or ium was taken into the stomach. Other injections were ployed without advantage. I can give no testimony in or of spirits of turpentine, or infusion of tobacco so ployed. 

Drinks. — I have seen drinks of all kinds, either hot or cold, rejected. Ice water, cold water, mint tea, barley water, lime water, cannot positively be relied upon to arrest vomiting, or to allay the irritability of the stomach when very great ; and yet they are all occasionally useful. Ice itself, when taken into the mouth and swallowed as it melts, has been serviceable in some cases of burning heat at the stomach, but is not to be depended upon in all. I have thought it in some instances to have been injurious. Brandy and laudanum has been found serviceable in some of the cold cases. An infusion of the leaves of the peach tree has in several instances checked vomiting, but in severer cases was ineffectual. Drinks of all kinds, with laudanum, or hartshorn, or peppermint, or camphor, would occasionally be rejected from the stomach, so that after two or three weeks' experience, it was determined in all cases to depend upon external frictions and irritants, to allay the tumult of the stomach, and not to disturb it with medicine until that tumult was soothed or allayed. This course has since been attended with benefit. 

Eimphor. — The internal exhibition of camphor in checkomiting, has been rated, in my opinion, higher than it yes. I have tried it both in the hospital and in private ice, and though sometimes useful, it is not that soveremedy which it has been represented to be. My 



147 

Istants satisfied themselves as to its merits, and after ibiting it in the several modes that had been recomidcd, concurred with me in opinion, and laid it aside i other internal remedies, until external irritation had yed the inward tumult of the stomach, and then we sd upon calomel and other evacuants. Camphor, when jrnally applied, is considered highly useful, either in the n of camphorated ointment, spirits of camphor, or the solution. 

Pepper Stimulants, tyc. — An icy coldness of the extremities sometimes continued for several days, when a hot decoction of red pepper was employed to restore the circulation and heat. In cold extremities, where the patient was verging upon the state of collapse, this kind of stimulus as well as the mustard application, was useful, the parts being rubbed dry and kept warm. 

II r enesection. —In the early stages of this disease bleeding useful in allaying the irritability of the stomach and r els, and with the use of warm diluents inducing a warm spiration, thereby diverting the determination of fluids n the intestines, and arresting the violence of the disease, al bleeding by cupping has already been mentioned as only useful in secondary fever, but in its topical applion to the chest, the pit of the stomach, and abdomen. 

I Cathartics.. — Beside the cathartics of calomel, it was n found necessary to combine drastic cathartics with it, sometimes to a considerable extent before the bowels lid yield, although previously in a very lax state, lere calomel had been combined with opium, the milder liartics of castor oil, magnesia, and rhubarb, or Seidlitz vders, were subsequently administered to prevent the urn from retaining the calomel too long in the system, the early or approaching period of the disease, the preoitory symptoms were sometimes easily removed by 



148 

some of the milder cathartics, particularly after the borborygmi or rumblings in the stomach and bowels were allayed by a carminative draft of hartshorn, peppermint, and laudanum, or a few drops of camphor in solution. In the more advanced stage of the disease, calomel appeared to be the most effectual cathartic. 

IJlsafatida, Ether. — At the first opening of the hospital Lfcetida was freely administered as an antispasmodic, but hout apparent benefit, and was soon laid aside. Ether s also given in a few instances but was not persevered In one case of collapse, far advanced, a fair trial was de of chloric ether, every few minutes, and it appeared have some effect as a diffusible stimulus in raising the se, but its operation was very transient, and the patient ik, although frictions and other means were also emyed in combination with it. 

Autopsic Examinations. — No autopsic examinations were made at this hospital, because there was no separate apartment where they could be performed without exposure. The hospital was open on all sides and in all parts to the intrusion of nurses, attendants, and others. I therefore deemed it prudent not to permit such examinations, and knowing that the popular prejudice was strong on this subject, I thought the reputation of the hospital would be affected by it, and a knowledge of such dissections would operate injuriously upon the feelings of the sick, some of whom would inevitably learn that such examinations were performed, and shun the hospital, or if there, be under dread from such knowledge. 

For similar reasons, I refused to sanction the raising a blister by boiling hot water, as an experiment that would do more harm than good ; and the application of the actual cautery or red-hot iron to the spine of a patient in a col- 



149 

I considered as an experiment which wanted further proof of its efficacy before I could be induced to try it. 

Jlfy Associates. —At the opening of this hospital I was associated for a (ew days with Drs. Rogers, Pollard and Stevenson, with whose attention and assiduity I was pleased. They were succeeded by Dr. C. R. Gilman, and Dr. John Graham. I am indebted to both these gentlemen for the assistance they have rendered me, and particularly the latter for his attention and skill in performing his duty, and seconding my wishes in relation to the treatment of the patients, he having remained with me several weeks after the other retired. My thanks are also due to Mr. Daniel 11. Carpenter, and Mr. Patrick Garvey, who acted as house students. 

Respectfully submitted. 

Samuel Akerly, M. D., 

Physician to Corlaer'e Hook Hospital. 

New-York, Sept 29th, 1832. 





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DOCUMENTS, &c. 

It. VIII. — Reports in relation to Cholera at the Bellcvue Hospital. 

To Walter Bowne, Esq., President of the Board of Health. 

New-York, July 16, 1832. 

IPhe Committee appointed by the Special Medical Counin conformity uith the request of the Board of Health nquire into the origin of the malignant Cholera in the levue Alms-house, reported in part that — 

The first person who died of malignant Cholera, within the precincts of the Bellevue establishment, was a pauper in the main building named Mary Bloomfield. She occupied a bed in the closest corner of No. 19, in the main building. She sickened on the Ist July and died on the 2d. She had not been in New-York for several years, and no person from town had become an inmate of this room for three weeks or more. It is not ascertained whether she had intercourse with visiters from the city. Fifty-four persons were received into the alms-house from the 24th June, to the Ist July inclusive. After her death two other women, inmates of this room, and occupying adjoining beds, who had been in town, also sickened and died, as did the nurse, who, so far as we can learn, had not been in town. 

ro. 19 is a room on the basement floor of the main buildnearly level with the ground. It is 52 feet long, 20 broad, and 9 feet high. 

Eis room has four windows on the north-west side opento a yard — this yard is surrounded by a fence 13 feet which encloses various buildings, in which are lodged 



. j H 7>^,v. meitl r it ¦ r ¦ SELLEVUE Cm rmXion I-;, Id a I U ii 



. ftt 'lit /: , | Ayr ¦ .IP X, Jk gr I- __ ¦ ET3B ft :,,^:ior§l; first / Slcry ,>,,, ¦ 1 J v U -==Wz= Second tflory - j:trt ,—, — O .) Kicm. .1. 1 Bed Ruvm C^, Third Slcry , 

\ 





151 

lipers, sick, criminals, and persons detained for trial, eh window is 4 feet 4 inches, by 3 feet 1 inch, with two idow sashes sliding up and down. 

There is one door only to the room No. 19 ; its dimensions are about 3 feet 3 inches by 7 feet 6 inches ; it opens on the north-east end of the room, into an entry which communicates with the yard on the north-west, with the front of the building toward the river in the south-east, by one door of 3 feet 8 inches by 7 feet 6 inches, and with five other crowded wards. 

There is an open chimney in the room and a fire, by which some cooking is done. The door which opens into the entry, we understand, was. usually kept open, but the windows opening into the yard were kept closed at night ; the heads of some of the inmates, while in bed, being close to the windows, it appeared probable enough, that no one Would allow her window to be open. 

The number of inmates in No. 19, is usually 20 — often more ; we counted 28 bedsteads. The inmates remain in the room during the most part of day and night ; their diet is tea and molasses, (without milk,) and bread for breakfast ; mush and molasses for dinner, every alternate day ; fresh beef and soup for dinner, every alternate day. 

They also further report, that they visited the general hospital at Bellevue, for the purpose of conferring with Dr. Wood, the physician to that establishment. In his absence they obtained the following information from Dr. Morrel, the assistant physician: — That on the 30th of June, 145 patients and 97 maniacs were in that place, (200 yards distant from the alms-house.) The first man with malignant Cholera, Daniel Ryan, aged 48, was admitted into the hospital 3d of July, and he died the next morning. Geo. Elliott, aged 70, was the second. He wa» sent from the alms-house July 3, and died the next day. 



152 

IDrge Riley, aged 51, the third case, had been frolicking ait the city the day previous, came from the alms-house y5. He was convalescent and walking about the ward the evening of the Bth, and died that night, very soon :r drinking a copious draught of cold water. No more sons with malignant Cholera were admitted after this ient. The first patient on the male side of the hospital o was taken ill with malignant Cholera, was Joseph rring, aged 60. He had been there since the 9th of ril with chronic diarrhoea, and was improving, when on 7th of July he was attacked with malignant Cholera, I died the same day. He was in an intermediate ward ween Ryan and Elliott ; but all those wards may be ctly considered as one, for the partition walls do not end to the ceilings ; since which time 34 men patients c been taken with that disease. 

IDatharine O'Neal, aged 30, the first female with maligit Cholera, was sent from the alms-house July 3, and 1 the next day. She had been a few days in the city and jrned June 30. Ann Barnes, aged 52, was the second c, also sent from the alms-house July 4, and died the sth ; more were admitted with that disease after this time, ly Wadock, aged 48, a hospital patient since the 25th of ril, was the first female resident, taken with malignant olera on the night of the Gth of July, and died the next , since which time several female patients have had that :ase. 

Ehe maniacs are separated from the other patients, and ot communicate with them except sent on duty ; and the first case of malignant Cholera among them, was a man who attended as an orderly on the women's apartments, in which 25 of them were, and had been sick with that disease. He was taken ill on the Bth, and died on the 9th of July. Since then two more maniacs have had the same disease. 



153 

(From the above facts it appears that no cases of maliglt Cholera occurred among the 145 patients in the hosil, and the 97 maniacs, before the evening of the 6th of y, six days after its first existence in the alms-house, and until three days after five persons with that disease were nitted into the general hospital. 

We were also informed that at the eye infirmary, (situated at a little distance from the general hospital and almshouse,) there were about 120 patients, mostly children, and that not a single case of malignant Cholera had taken place. No children had been received from the alms-house since that disease had occurred there, and only two from the Long Island Farms, and two from the city. 

Respectfully submitted, 

Jos. Bayley, M. D. 

Board of Health, July 25. 

IPhe Special Medical Council having examined the jrns made to the Board of Health of the cases of the lignant Cholera which have occurred from the Ist to 24th instant inclusive, in the alms-house, alms-house pital and penitentiary, have prepared the following ement as the result of their inquiry. From this they enabled to show the rise, progress and decrease of that ;ase in those institutions ; and from these data, they st some consolatory inference may be drawn in relation its probable continuance in our greatly afflicted city, order to a full understanding of the subject, it is necesy to state, that about 1,447 persons were in the aboventioned institutions on the 30th June, and the present nber is over 900. 

We have divided the twenty-four days into three equal periods of ci iT ht days each as follows •~~ 



154 

From Ist to Bth July, 8 days, - 68 cases. « 9th to 16th « " - 278 " « 17th to 24th " M - 96 « 

And only 22 of the 96 occurred in the last three days. 

I 'he cases at the eye infirmary, at Bellevue, first >rted on the 20th instant ; also, those in the penitenf, Blackwell's Island, and among the children at the g Island Farms, first reported on the 22d instant, havso recently occurred, are not included in the foregoing iber. 

From the above facts we are led to infer, — 

Ist. That in crowded public institutions the ratio of persons attacked is very much greater than in cleanly private dwellings, and if the same inmates continue to live there, without the addition of new comers, the disease generally reaches its maximum in sixteen days from the commencement, and then diminishes daily. 

(d. That in public institutions, a very large majority of ions living, even under circumstances unfavorable for preservation of health, appear to become accustomed n impure atmosphere, and thereby made less susceptiof its influence. 

Id. The disease has prevailed in the city nearly one tth —it attained its greatest height at Bellevue in two ks, and has now greatly decreased there. Our city ms are also more favorable. May we not hope that disease has reached its height, and that it will hereafter me 1 While we cherish this hope, we would at the c time recommend to the inhabitants to persevere in purification of their dwellings, and in the strict enforceit of all the cautions in living, clothing, and sleeping, 

heretofore enjoined. 

Jos. Batley, Chairman. 



155 

To the Special Medical Council. 

Gentlemen, — In accordance with your request, I herein transmit you a full account of the epidemic Cholera, as it prevailed at the Bellevue establishment. But it may not be improper, before entering upon our subject, to exhibit a meteorological table for the days immediately preceding, and subsequent to the breaking out of the pestilence at that place. 

6 A. M. Noon. 7 P. M. ¦cs2c * II * I J J I|2 I I 1 CQr- £ S3 E" £ M Ei £ June 18 28.75 73 calm, thndr 28.73.87 S.W. clear 28.50 WjTSoXf'^l 1!) 28 80 .62 N-.VV. fresh 29.07.69 NT.W. rainy 29.23 .67 N cloudy 20 29.55 57N.W. clear 29.64.74 N.W. clear 29.58 .65 S clear 21 29.68 .67 S.W. clear 39.7ff1.79 S.W. clear 29.64J.74 S W clear 2229.64.66 S.W. 29.56.80 S.W. 29.48.73 S clear 23 29.40 .72 W. clear 29.32.84 N.W. clear 29.20 .78 W. b. N. clear 25 29.38.77 VV.S.W. fair 29.28 .87 S.W. 29.20.79 SSW 26 29.38.74 S.W. fair 29.15.85 S.W. fair 29.00.75 S cloudy 27 28.85 75 S. frcsli 28.75,84 cl'dy. frrsh 28.74 .82! VV. cloudy 28 28.80j.75 W. cloudy 28.75 .81' \ tre 'hc]^ y- \ 28.98 .76 N.W. clear 29 29.40 .68 W.N.W.clr. 29.50 .79) S.W. clear 29.48 .72 S.S.W. clear 30,29.60).72 S.S.W. clear 29.56.811J (mh cw&? w I 29.55 .73 S.S.W. clear 

The first case that occurred at this institution, was one that was brought from without the walls. The following is a detailed account of that, and of the immediately succeeding case, as far as could be ascertained at the time this paper was drawn up. 

loseph Dean, a colored man, aged 16, who had been aged in sweeping the streets of the First Ward of the of New- York, was admitted into the alms-house June 1832, about dusk. No physician saw him at the time, 



156 

I from his own account, he sickened with diarrhoea on 18th or 19th inst., and the man evidently had some ominal pain from his holding his hand firmly pressed on epigastric region. He was placed for the night in room 3, (see the diagram at the end of this report,) but ard morning he was made to lie in the passage just out: the door of the ward. On the morning of the 26th he i sent to Blackwell's Island, and there recovered. No 2r case of Cholera was observed on the Island till July when one case was reported ; and on the 12th, two cases. 

ILbout 1 A. M. of the 26th, while the said Dean was g in No. 3, Richard Bostwick, aged 83, also a black, inmate of the same ward, was attacked with vomiting purging, together with cramps. This man had been in house since 1829, and had not been outside the gate in lonth : indeed it was almost impossible for him to go into yard, as he was laboring under some chronic abdoal disease, of which habitual constipation was the only ptom recollected by his room-mates. They stated that nature of his evacuations while laboring under this new was the following; his dejections consisted 'first of dw slime, then whitish slime, but always thin like gruel;' matter vomited was ' first yellow, lastly green, but thin water.' The physician was not called till too late, he on the 27th. 

The next case that occurred in the alms-house, was in ward No. 9, on June 27, and the next two that were attacked lived in ward No. 19 ; this was July Ist, 1832. — The disease began to show itself in every part of the establishment, no place escaping its ravages, but No. 4, the lying in ward for blacks. 

Khe reports of the daily progress of the disease were c in due form to your learned body, of which the wing is an abstract. 



157 

m ~ « i -a '« w «5 Ja es <D p g 5 « «353 O S O Q X fi >5 U Q BS Brought over 184 139 272 July 62G 0 13 13 July 24 22 3 12 80 7 4 0 5 12 25 10 2 5 83 8 26 1 11 20 2C 14 14 9 74 9 5G 7 2(J 49 27 3 12 1 64 10 42 1 17 73 28 1 21 3 41 11 52 14 24 87 29 1 22 1 19 12 48 16 23 96 30 3 5 5 12 13 34 21 19 90 31 1 2 1 10 14 29 8 24 87 August 14 2 3 9 15 20 9 20 78 2 0 0 0 9 16 21 16 18 65 3 10 2 8 17 20 4 13 68 4 3 4 16 18 14 5 10 67 5 0 0 0 6 19 II 5 15 58 6 0 0 0 6 20 28 12 13 61 7 0 0 0 6 21 18 6 7 66 8 0 0 0 6 22 8 11 2 61 9 0 0 0 6 23 27 3 12 73 10 0 6 0 6 Carried forward 484 139 272 | Total 547 232 315 

Of those 547 cases, there were 

Males. Whites, (Maniacs, 17) 227 Colored, (Maniac, 1) 10 Total Males, - 237 Females. Whites, (Maniacs, 19) 270 Colored, (Maniacs, 8) 40 Total Females, - 310 

Average age of male whites was 42 years ; do. blacks 45J years; average age of all the males 42\ years. Average age of female whites was 37^ years ; do. blacks 333 years ; average age of all the females was 36i, years ; average age of the total 547 cases was 37w years. 

21 



158 

My views of the disease itself, may be comprised in few words. 

Ei predisposing cause must be looked for in the atmose ; its exciting causes are manifold, such as excesses, king perspiration, mental or bodily fatigue, fear> (a powerful cause,) irregularities of diet, &c. 

Its pathology, I conceive to consist primarily in an asthenic action or condition of the excretories of the mucous membrane of the alimentary canal, and that as the disease progresses, this abnormal action of the excretories is transferred, or rather by the laws of continuity affects the mucous membrane, producing a state of hyperaemia. 

Itnd this indeed accords with what is found on dissec, since if you open a choleric where the disease has ted but a few hours, you find a blanched appearance of mucous surface : but if the man has been sick a longer od, you find a greater or less degree of hyperaemia. s is found to hold in a sufficient number of cases that ive opened, to induce me to venture the opinion. Also t aminal tenderness makes its appearance some time r the diarrhoea, never before, and never until it has ted for a period. 

1.8 regards the symptomatology of the disease, my arks are derived from clinical observation, and not 1 books. The following is the most usual order of r appearance, though their occurrence is by no means ilar. 

tt. Diarrhoea of a fluid resembling in appearance rice r. 2d. Sunken eye, with blue areola. 3d. Abdo-1 pains, with cool and livid tongue. 4th. Restlessness, :ty, and vomiting of a fluid resembling the dejections. sth. Cramps, which most frequently subside before, but which often are present after death, or rather after the heart has ceased to act, with blueness of the extremities. 



159 

7th. Death. 

I^ith regard to the premonitory symptoms, (which may ude those mentioned as Ist and 2d,) I have not yet seen ise of genuine Asiatic Cholera, which was not preceded hem sufficiently long for the patient to have adopted ns to mitigate, if not prevent the invasion of the ase. lam aware that this is hazardous language, but ive not yet seen the case, but that I was satisfied a eness has preceded the development of the disease. i stage is of variable duration, it being sometimes only hours, while in other cases it is a month. 

Ehe blue areola about the eye, is a characteristic symp; it is one, by which the experienced practitioner is •led sometimes to warn the inattentive sufferer of his :nding danger. 

K^ith regard to the treatment pursued at the Bellevuc lera hospital, a report has already been made. I therewill not occupy your time with that. 

lor the better understanding of the origin of the Cholera le alms-house, I subjoin a plan of the house ; merely nising that the basement floor is raised about one foot i the level of the yard. 

I nee August 10, Cholera has again appeared, first in 17; but as I was then discharged, and the Cholera ital closed, I make no mention of that in my report, er than this. 

Respectfully submitted. 

Thomas T. Devan, M. D., 

Attending Physician of Bellevue Cholera Hospital. 



160 

To the Special Medical Council. 

Rellcvuc Hospital, August 2d, 1532. 

Gentlemen, — Owing to the illness of our resident physician, and to the want of a person who should have the power to enforce a regular and uniform system of treatment throughout the different parts of this establishment, each one has pursued that plan which suited him, and consequently the treatment has been so various, that in classifying it under two different heads I may not have done justice to all ; nevertheless, since more would be superfluous, i have chosen rather to let it remain : however, owing to this want of uniformity the report cannot be as useful as under other circumstances it ought to be. 

The treatment, I have divided into two kinds — the pathological and the mixed. The first ht-ving been determined on after the careful examination of twenty-three persons dead of Cholera — since then ten more have been examined, which serve to confirm the conclusions first formed. On the 10th of July, they were the following :—: — 

¦St. It is improper to administer purgatives in any stage be disease. 

2d. It is improper to administer large doses of stimulants. 

3d. The copious secretions should not be checked by those remedies which produce hyperaemia of the mucous membrane in their stead, for nearly all these patients die in the end, of typhus fever. 

4th. It is prudent to give opium in small doses. 

Bti. It is not imprudent to give a little brandy in the stage, provided that ice be at the same time administo moderate its effects, and to allay the thirst. 

Gth. External heat is necessary. 

Kl. It is better to rub the body diligently (while the is at the same time applied) with an ointment recomled to us by Dr. Roe, of the Greenwich hospital, than 



161 

I give mercury by the mouth in any form during the cold ge, or even before, if vomiting obtains, for the stomach not then in a physiological condition, and the mercury if ministered will not have its wonted efFect. 

Bth. Patients treated in this way rarely suffer from a consecutive fever which is beyond the control of medicine. Subsequent experience has proved the correctness of this 

Ehether mixed or pathological, the treatment has difin the three different stages of the disease. 

The First, where diarrhoea alone is present. 

E7ie Second, where vomiting and purging of the characitic evacuations exists while the heat of the body still ains natural. 

I The Third, and last, where the two preceding are ompanied by a cold, clammy and blue skin, cramps the extremities, and a very feeble pulse, or no pulse ill at the wrist. 

Pathological Treatment 

First Stage. — This consisted in the administration of blue pill and opium, with absolute diet. If pain was present, leeches to ihe epigastrium and arms, and where these could not be procured, cups to the epigastrium. 

I Phis plan never failed to arrest the disease, in the hands those who diligently pursued it, where the mucous nbrane of the gastro-intestinal canal was not previously :ased. 

I'econd Stage. — Ist. Blood-letting. 2d. Diligent fric¦? with the ointment alluded to above, when persons dbe procured to perform the duty. 3d. Ice to allay thirst. 4th. Small doses of brandy and laudanum if vomiting continues. sth. cups to the epigastrium if c was pain, and the brandy omitted. 



162 

Third Stage. — Ist. Ice to allay the thirst, which is now indeed unquenchable. 2d. External heat. 3d. A continuation of the frictions. 4th. No opium, and frequently no brandy, especially among the children. 

Mixed Treatment. 

I First Stage. — Beside the above treatment, calomel and ver's powders was a very frequent prescription also, uple doses of calomel, and calomel and opium in small es, and all with success. Nevertheless, I believe they asionally did harm. 

tecond Stage. — Ist. Blood-letting less frequent than c. 2d. Calomel and Dover's powder continued. Calomel and opium. 4th. Calomel, capsicum and m. sth. Soda powders. 6th. Scruple doses of caloevery half hour. 7th. Ice. 

Iliird Stage. — Calomel and Dover's powder ; calomel opium ; calomel, capsicum and opium ; carbonate of lonia and capsicum ; scruple doses of calomel every hour continued ; external heat in various ways, ice, ; severe shocks of electricity along the course of muscles to allay the cramps ; also the burning of hoi on the skin. — The first way, the practice of Dr. an ; the second, that of Gardner ; and both lay claims aving been the first to use these means. 

{the foregoing stages I may add a fourth, which very ently obtained with those who followed the mixed nent, and one sometimes very difficult to manage, was typhus fever, of a very malignant cast, and which autopsic examinations was proved to be the conse:e of hyperaemia of the gastro-intestinal canal ; for the i of those dead of the fever, who during life had ited symptoms of compression, did not differ from dead of collapse, where the mental faculties seemed 



163 

Ifectly sound ; only in this, that a more than ordinary umulation of blood in its substance obtained univery in those dead of the fever, but was not always present hose dead of collapse : indeed in one case, which was hild who died of all the symptoms of hydrenaphalus, ept the screaming, there was neither as much blood in brain, or as much fluid in the ventricles as in another d of collapse who retained a sound mind to the last nent ; and precisely the same thing was observed with ard to adults. - 

Eleside the* foregoing, injections of warm water, sometimes regnated with salts, were practised at this hospital in Ive cases, all in the last stage of collapse but one, who was still in the second stage of the disease, and this patient recovered ; all the rest died. 

It is now ten days since her recovery, which was speedy and without consecutive fever. On the eighth day after injection she began to complain of soreness along the course of the vein ; this has increased, and there is still some apprehension of an unfavorable result. 

The first patient was injected at this hospital on the 3d of July, 1832. This fact I should not have mentioned if some persons had not attached some credit to the performance, and been published as the first who performed it in this city. For my own part, I have no hesitation in saying that it is a dangerous measure, and one not calculated to be productive of any very favorable results. 

The steam bath has also been used by Dr. Devan, but without that success which can justify me in recommending it as a good remedy for collapsed cases : in the stage immediately preceding, however, it has undoubtedly been productive of some good. 

Upon the whole, then, the treatment drawn from the pathology of the disease, as understood by Dr. Baker and 



164 

slf, v is the only one lam at present prepared to recomd, and that which I should wish to be practised on ;lf should I get the disease. 

I am, Gentlemen, 

Yours most respectfully, 

Morrell, 

Acting Physician to the Bellevue Hospital. 

REPORT OF COMMITTEE, &c. 

The Committee appointed in pursuance of a resolution of the Board of Health, for the purpose of inquiring into the circumstances which have put a stop to the prevalence of Cholera at Bellevue, with the utmost satisfaction report — That the medical officers of the Bellevue establishment, in all its departments, have taken the most efficacious measures, as well as most fortunate in their results, for enforcing among all the persons under their charge, an undeviating attention to the recommendation so earnestly enjoined by the Special Medical Council, of making known, at the first onset, the forewarning symptoms of Cholera, and of obtaining immediate medical assistance. It is to the good judgment and laudable assiduity of the indefatigable Superintendent, and those medical officers, in carrying the injunctions of the Council into effect, that your Committee attribute, in part, the happy change which has taken place. 

IVo longer confiding to the inmates of the Bellevue estabiment the care of reporting their own illness, the medical cers themselves go round daily, and question every person ividually, and whenever diarrhoea is detected, medical Enent is ordered on the spot. From twenty to thirty cases are prescribed for every day, and it is the imion of the officers that many of those cases, if neglected, d still pass into malignant Cholera. 



165 

The same medical police is observed on Blackwell's Island, and the penitentiary prisoners residing there, are daily paraded, questioned, examined and inspected, and if any are found to present the premonitory symptoms, they receive instant medical treatment. Will it be believed, that all this vigilance, which has only their own safety for its object, requires to be supported by a degree of constraint? 

Coincident with the strict enforcement of this system, the disease has been seen to decline, and at last to cease. 

re are of opinion that one of the causes of its decline also be found in the effect of habitude, the inmates of establishment being in the state of acclimated persons. 

In the building called the fever hospital, containing at sent one hundred and fifty-two patients, the resident sician prescribes for six or seven daily, who are laboring er bowel complaints, and the physician in the almsse for eight or ten, among a population of six hundred, ough the greater portion of those predisposed to dis: of the bowels, have been already carried off by the lemic. 

It appears inconceivable that persons should be so negligent of their own welfare, as to slight this warning diarrhoea, although they have been so often told that it is the first stage of the fatal Cholera. Something like an explanation of it may be found in the fact, that looseness of the bowels is the endemic disease of the Bellevue establishment, as it is of all places, where the inmates are much confined, and always fed with the same food. A slight looseness, giving no pain, and to which they are accustomed, gives no alarm. Thus the first stage passes over unnoticed, and the stage of collapse has begun before the distemper has been recognised. To this circumstance, we must in part, ascribe its fatality at the commencement. An irregular state of the bowels is also a disease that frc- 





166 

quently carries off old and infirm people. It is in some sort natural to them, so that when the poison of the malignant Cholera is superadded, it is not surprising that they should sink rapidly. 

The entire cessation of the disease at Bellevue, without the cause having exhausted itself, in consequence of those measures only of precaution and care, which in like manner and in other places and in other hands, has been so successful when applied in time, is highly encouraging. 

The whole number of the inhabitants of the Bellevue establishment is fourteen hundred persons. 

All which is respectfully submitted by your Committee. 

\V. J, Macneven, 

Jos. Bayley, 

Anthony L. Anderson. 



167 

DOCUMENTS, &c. 

ARTICLE IX. — CASES. 

Sect. I. — Cases of Cholera successfully treated in the early stages. By Samuel Akerly, M. D. 

lOase I. — John Boyd, aged 29 years, a painter, of temate habits, received August 29th in the morning ; was en yesterday afternoon with vomiting and purging, and v has in addition, a full and hard pulse, and violent pain he head, — a threatened determination to the brain. 

Il mustard draft was applied to the breast, his feet were lersed in a decoction of Cayenne pepper, and he was I from the arm eighteen ounces. After bleeding his J was very much relieved, and his stomach became ntive. Fifteen grains of the submuriate of mercury ibined with eight grains of Dover's powder, was then n at a dose, and produced the desired effect of first icing perspiration, and then acting on the biliary secres and the primoe viae. In the evening he was better, next day out of danger ; but he remained on account lebility nine days in the hospital, taking an occasional iartic, and was discharged cured on the 6th September. 

Case II. — July 13th, 1832. A young man about 20 years old, of temperate and industrious habits, in consequence of some irregularity in diet, was seized on the afternoon of 13th July with violent cramps in the stomach, preceded by nausea and sickness without vomiting. The pains were so great as to throw him into agony and a high state of arterial excitement, to relieve which bleeding was 



168 

indicated. I accordingly bled him twenty ounces when he fainted. He was put into bed, covered up warm, and took a large dose of calomel and jalap. Warm sage tea was given him to drink, and a profuse perspiration followed, which continued most of the night. The medicine operated kindly, and the next day he was relieved, complaining of nothing but weakness. 

Case 111. — July 14th, 1832. Mr. J S , aged 49 years, an industrious mechanic and a worthy man, was seized violently on Saturday afternoon, 14th July, at his place of business at Rutgers-slip, where I was called to see him about 6 o'clock, P. M. 

Premonitory Symptoms. — Has been laboring under diarrhoea for several days, with some, but not alarming pains, continuing at his usual employments and taking no medicine. 

fUtack. — On Saturday afternoon had a violent chill, >wed by universal distress and indescribable feelings, iin the head, cramps in the hands and legs. Numerwatery evacuations to-day from his bowels, no vomiting. Is very bad, but says he is not frightened. 

Finding him unable to walk, conveyed him in my gig to his residence. Hands and legs cramped on the way. After arrival examined him more particularly. Eyes sunken, and bluish around them, pupils enlarged, hands cold, fingers bluish, tongue cold, furred, and yellow from the use of tobacco. Pulse moderate. 

Exciting Causes. — Has been actively engaged in business, and perspired much for two weeks past, and to quench his thirst has drank vinegar and water, and occasionally a glass of brandy. On Saturday morning took a glass of brandy and water, and in the afternoon, port wine and water, the latter of which was rejected by vomiting. Having been very thirsty, thinks he has taken, during the 



169 

E, three gallons of water, most of it mingled with vinegar, charges from the bowels to-day, numerous, copious and cry. 

ifreatment. — On arriving at his residence administered following, ft Spts. Ammon. mm. xxv. : Laud. Liquidi. i. xxx. : 01. Cajeput. mm. v. m. These were dropped on ar, mingled with water and taken at a dose. The ient was then bled about twenty ounces, when on being ered up in bed, a free perspiration ensued. Pulse rose r the vein was opened, and.the pupils of the eyes con;ted. The blood had a mottled appearance on the suri, and on standing had a large proportion of serum. Soon sr bleeding had a copious rice-water dejection, having a ht feculent smell. No discharge of urine. 

Applied to the stomach and bowels, a poultice of rye flour and Cayenne pepper mixed with warm vinegar ; hot bricks to the feet and body. By 7 o'clock I had prepared and administered four doses like the preceding of ammonia, laudanum and the oil of cajeput. Gave another at eight, and barley water for drink. 

lAt 9 feels better, but still has some cramp in one leg and it. Is thirsty and has taken some barley water. Has "spired freely since 7 o'clock. Skin warm from head to it. Pulse 112. Gave thirty drops of laudanum, with i of the oil of camphor mingled with sugar, and dissolved warm water. Rubbed the cramped leg and foot with of camphor. 

lAt 10 in the evening, has fallen asleep. No further acuation from his bowels. Sleeps and breathes naturally, untenance improved. Added some ammonia to his rley water for drink during the night. Left him in a ipeiul condition near 11 o'clock at night. 

Sunday morning, 15th July. Patient has had a comfortable night, interrupted by some slight cramps in the 



170 

legs. Slept considerably, drank much barley water and perspired profusely. No evacuations during the night except perspiration. Skin warm and still in a perspiring state, face flushed, pulse quick. Stomach and abdomen red from the action of the pepper in the poultice. Continue the barley water and take no solid food. 

lunday 10 o'clock, A. M. Countenance brightened, ently better. Linen has been changed as directed y this morning, but is again soaking wet with perspira. Pulse 105 and soft. Skin of the fingers shrivelled, % soaked in water. No pain, no cramps, no dejections, somewhat thirsty. Directed face and hands to be bed in warm soap suds, and the skin rubbed dry. ley water may be taken cold. Linen to be again 

lunday, 4 o'clock P. M. The patient has been washed shaved, is astonishingly improved and fairly out of jer. Skin warm and still moist. Pulse 94 and soft, him have chamomile tea, and gruel somewhat thicker barley water as diet. 

t.w the patient again on Monday lGth, when he cond to improve, and I informed him that on account of istance from my residence, and the pressure of busi- I should not call again unless he became worse. 

Sect. 11. — Cases of Cholera successfully treated in the 

Collapsed Stage. 

G. W. Codwise. 

Case IV. — Mrs. Margaret Duffy, aged 17 years, of good constitution, mode of life regular and temperate, has been 



171 

a large quantity of cherries ; was seized last night, July IC, with profuse vomiting and purging. I first saw her about 11 o'clock this day; symptoms present, — cold, shrivelled and lived extremities ; eyes deeply sunk within their sockets, and surrounded by a livid areola ; a faint vibration felt along the course of the radial artery ; tongue cold ; voice sharp and whispering; constant vomiting and purging of a substance resembling thin gruel ; mind sane and calm, incessant thirst, and a dreadful burning sensation in the stomach, with great pain, when slightly pressing on the epigastrium. Treatment pursued in the case : large sinapisms to the stomach and legs, hot bricks to the feet, frictions over the whole body, with Spts. Terebinth, and Mustard. I administered on first seeing her Laudanum gtt. lxx. Spts. Camphor, gtt. viii. Ess. Menth. Pip. gtt. xii. M. in water. The following prescription was exhibited q. b. h. Submur. Hyd. g. v. Gum Camphor, et Carb. Ammonia gr. ii. Gum. Opii. gr. ss. ft. Pill. 4P. M. has had butone evacuation per rectum ; vomiting continuing, occasionally ; the patient is apparently more feeble, other symptoms remain much as when I first saw her ; restlessness continues ; sinapisms and frictions to be renewed. About 5 o'clock I thought my patient dead, it was after an attempt to raise her head that she might swallow some chicken tea, which had been ordered as her constant drink ; she lay for some time breathless, pulseless and motionless ; she presently sighed, and moved her body, reaction of the heart ensued, and the pulse became distinct at the radius ; reaction commenced from this time ; I left her after 6 o'clock ; pills ordered to be continued, q. t. b. per noctem. Very little consecutive fever ensued ; I left her to her nurses about five days after. I have seen her since, well and hearty. When reaction was in a measure restored, enemas of salt molasses and water were occasionally 



172 

used, and calomel dispensed with ; she was not mercurialized. 

Case V. — Mrs. Van Home, 234 Hudson-street, aged about 32 years, of good habits and constitution, was attacked on Sunday morning at 1 o'clock, August 19, with profuse vomiting and purging of a fluid resembling dirty veal soup. She was a convalescent under my charge from a previously disordered state of the bowels, and contrary to my express injunctions, she ate corned beef and cabbage for her dinner the day previous, because, she said, she had an appetite. I was not informed of her illness until near 7 o'clock on Sunday morning, six hours after her attack. Symptoms present, — feeble and rapid pulse ; slight warmth in the extremities ; sunken eyes, with a livid areola ; severe and frequent cramps of the extremities ; vomiting and purging still profuse ; tongue still a little warm ; voice unnatural ; free from pain except when the cramps seized the extremities ; no discharge of urine. Treatment, ordered Statim Laudanum gtt. xl. saturated Tinct. Camph. gtt. iii. Ess. Menth. Pip. gtt. xii. M. ft. Submur. Hyd. Bi Pulv. Dov. gr. x. Camphor gr. ; M. S. S. At half past 8 o'clock called again, the calomel and Dover's powder had been retained until this time, and in my presence it was ejected. Cal. Bi Gum. Opii. grs. lss were now administered, and almost instantly ejected. Submur. Hyd. M Statim. I think this was retained : she is sinking very fast. Half past 9 o'clock, she is now perfectly cold and pulseless ; voice a faint whisper, sometimes does not speak but signifies by signs. Ordered Saturated Solution of Camphor, gtt. ii. every 15 minutes; for some time past she has been well rubbed with Spts. Terebinth. Cayenne pepper and Camphor in commixture, and sinapisms have been applied to the stomach and extremities and ordered to be continued and 



173 

I bricks to the feet. 12 o'clock, I ordered the Sol. nphor to be given at intervals of 20 minutes ; a glass trong brandy and water was made, a part of which she nk ; continue it occasionally. 5 o'clock, remains in same state ; continue treatment as before. Half past 9 ock, a faint tremor begins to be felt along the course he radius ; no distinct pulsation ; extremities still perly cold, and shrivelled, and dark ; renew sinapisms to les, and do not dispense with hot bricks to the feet ; s. Camph. gtt. iii. every half hour through the night, l occasional draughts of brandy and water ; left my ent for the night expecting she would die ere morning. 

August 20th. She is still in life, the pulse is quite distinct, says she is free from pain ; extremities are still dark and cold ; tongue warm, as also the face ; eyes are more animated and raised in their sockets ; voice weak, but tone natural. ft Mass. Hydrarg. 3ss. Gum. Opii. gr. iss. M. ft. Pill No. 8. i. q. t. h. There is occasional vomiting and slight discharges from the bowels, of the same veal soup looking fluid. Toast water as drink with a little ice in it, and occasionally weak brandy and water ; arrowroot diet. 12 o'clock, improved. BP. M. complains of acid stomach. Sup. Carb. Soda in solution to be given after each vomiting. 12 at night ; chicken water as drink, to quiet stomach. 

lug. 21st. Has slept a little toward morning, but is very ess, constant movement of the body. The discharges i bowels, &c, have not changed their appearance ; red pills to be continued ; chicken tea to be frequently k, and occasionally administer enemas of the same, menstrual flux has appeared, last night commenced ing urine ; she still has occasional vomiting ; hands feet are a little warm, but still look dark ; tongue is 

23 



174 

Evening, pulse improves ; she had frequent short sleeps through the day. Enemas brought away some black and very offensive stools, with black flocculi floating in them ; slime only appears at present ; continue pills through the night. 

lugust 22. She has had one free vomiting this morning, a large quantity of bright yellow bile has been ejected ist from the stomach, and some passed by evacuation nward ; sickness of stomach has ceased since. Pills ordered to be discontinued; light nourishment of ken tea and toast water ; occasional enemas of chicken ;r. Heat of body quite natural ; pulse very feeble yet, regular ; loward evening complained of feeling uneasiin the bowels, a teaspoonful or so of castor oil was mistered. 

August 23. She has passed a good night, slept well, no febrile symptoms have appeared as yet, the powers of the system gradually resume their sway, not any thing appears to be too forward, all seem to appear in succession, diet alone ordered. 

August 24. Diet alone ; I have been unable to attend this evening, from personal sickness ; Dr. had the goodness to call on my patient, and as she thought she wanted some medicine, he amused her by giving a few drops of Aromatic Spts. Camph., with a drop or two of Sol. Morphine. 

lugust 25. Dr. gave no medicine. There has been ry great atmospheric change, and toward evening Van Home began to complain of pain in the whole >men; her husband came to my room, as I was unable to id ; she had more frequent discharges from the bowels, Ordered a flannel to be applied (rung out from hot dy and spirits of camphor) to the abdomen, and an iv of starch and laudanum. 



175 

liug. 26. Dr. has not been to see her this morning, I I was forced to see her, as she cannot be left without attendant physician. I found her laboring under some jr, with considerable irritation of the intestines, and tenness to the touch. Ordered V. S. § v - or vi - were drawn ibiting a thick buffy coat, ft Cal. gr. xii. Pulv. Aloes r . Pulv. Rhei. gr. xii. followed with enemas, in a few irs if it do not operate, warm mush poultices to .ibdo- 

August 27th. Fever has subsided, and is nearly free from pain ; pulse soft and natural ; let her take a little mutton broth as diet, and toast and tea morning and evening. 

August 28th. Left to her nurses. 



Peter C. Taiten, M. D. 

Case VI. , aged 10 years, was seized with symptoms of Cholera at 9A. M., July sth. He ate his breakfast at 8 o'clock, and had been in the street ; he was first observed to use the chamber vessel frequently and then lie down on the bed, on examining the contents of the pot it was found to be the " rice-water" fluid. His skin was cool, pulse small, eye sunken, tongue cool, as also his hands and feet. He was wrapped in blankets, and heated sand put around him. A mixture of Ether, Arom. Spir. Ammonia and Laudanum was given, and hot brandy and water to allay the thirst, which was very urgent. These were immediately rejected and repeated, and an anodyne injection administered. Every thing was soon returned, having a resemblance to rice-icater. He became very restless, and could not bear the covering over his arms and chest, and he complained of great distress in the stomach. A sinapism applied could not be borne more than ten minutes. He continued to grow worse until 3 P. M., when collapse with sDasms were complete. Frictions with spirits terebinth 



176 

were used and a blister applied to the epigastrium, and soda water in its effervescing state, about a gill at a time, were directed to be given whenever he should call for drink. This immediately quieted his stomach, and the vomiting from this time ceased : pills \ gr. opium and 3 gr. calomel were directed to be given every hour. 6P. M., some more warmth of skin and increase of pulse ; tongue warm ; disposed to sleep. BP. M., has been in a stupor since I saw him last, does not speak except when spoken to ; pulse and skin better ; blue appearance of the tongue gone off; continue the calomel without opium, with the effervescing medicine. 11 P. M., continues to improve; has inquired about his father, and wishes to go and see him. 6th, half past 6 A. M., has had two bilious stools during the night ; appears in every respect to be better ; discontinued the calomel : wants something to eat; asks for milk porridge and toast ; gave him some very thin porridge ; took a dose of castor oil. Noon, oil has not operated ; complains of pain in the pit of his stomach ; repeat the oil. 3P. M ., oil has not operated ; gave an injection of infusion of catnip, and one teaspoonful of oil every hour till it produced a copious discharge. 7P. M., oil has operated well; feels much relieved; discontinued all medicines except the effervescing draught when thirsty. 7th, 6A. If., has rested well during the night ; convalescent ; discontinued all medicine ; be careful to avoid repletion. 10th, cured. 

Case VII. — Mrs. , aged 65, temperate, was seized with Cholera on the August, at 6 A. M. ; at 10 A. M. I visited her ; collapsed ; gave ice freely ; cramps ; 1 gr. opium ; friction with hot mustard infusion ; calomel gr. xij. every hour. 3P. M., reaction established ; took 5L of calomel ; bilious stools ; very feeble ; convalescent ; continues feeble ' nutriment ¦ cured 



177 

By Marinus Willett, M. D. 

insc VIII. — Eliza Smith, aged 20, resides in Walntlt:t, intemperate, was attacked with diarrhoea about the instant, which continued until the 13th, when she was :ked at 6 A. M. with cramps, vomiting and purging, was brought to the hospital at quarter before 1 1 A. M. ut thirty minutes before she came to the hospital she been bled and took a little brandy by direction of a ieian. Uas purged twice, but had no vomiting nor cramps since she was bled. At the time of her admission her extremities were cold, pulsation at the wrist barely perceptible, her respiration laborious, and she complained of pain in the chest, but could not give the exact location of the pain. As she was evidently sinking, I gave her a tablcspoonful of hot brandy toddy every ten minutes. 11 o'clock and 5 mm., no vomiting ; administered calomel grs. x. Pulv. Opii. gr. j. 11 15, thirst excessive from the time of her admission ; allowed her to have a piece of ice in her mouth. 1 1 20, seized with cramps in the legs and feet ; frictions with flesh brush ; afterward sinapisms to the feet, legs, wrists and epigastrium. 11 45, vomiting. To allay this gave Tinct. Camphor gtt. iij., which was immediately rejected. The same quantity was again administered and the vomiting ceased. At half past twelve had the sinapism removed from over her stomach, as it caused much uneasiness. At the same time the vomiting returned in consequence of her taking too freely of toast water, and was allayed by the administration of three drops of Tinct. Camphor. In thirty minutes vomiting was again excited and allayed as before. 1 30 P. M., Calomel 3j. Pulv. Opium grs. iij. Camphor gr. j. in chart 3; one every hour. 1 45, cramps in the feet and legs, for which used friction with flesh brushes and applied bags of hot sand to the feet and legs. At 2P. M., repeated powder. 3P. M., patient sinking, tVi Vif tl i» • lr»m 1 n ' rY>t liavp iniured her ¦ directed the 



178 

Ise not to give the other powder ; allowed her a small ntity of brandy in arrowroot every ten minutes. 4 10 M., purged small quantity of* fluid like rice-water. 0 P. M., vomited fluid resembling infusion of black gave Tinct. Camphor gtt. iij. ; vomiting ceased. Wished evote my attention entirely to another patient, but was uently interrupted by the nurse of Eliza Smith, who said the patient's thirst was so excessive that she could with 2ulty be kept in bed. Gave her a glass of cold water, lediately after taking the water she became quiet and t until 11, when she awoke and called for more water ; s her another glass, after which she slept well until 

14th, 9A. ML, Calomel grs. x. Opium grss. 12 M., 01. Ric. 3j. In the course of the afternoon the oil operated several times, and the patient was much better. 

15th, BA. M., pain in the left side. Applied the cups did not relieve ; then applied a vesicating plaster :h afforded perfect relief as soon as it blistered. In course of the forenoon vomited several times ; allowed warm mint tea and coffee ; vomiting ceased at 1 P. M.; ; calomel gr. x. 4P. If., 01. Ric. &•; the oil operated produced natural discharges. From this time the 2nt gradually regained her health, requiring occasiona laxative, and was discharged quite well on the 21st. 

Case IX. — Ann Kegan, aged 22 years, by occupation a cook, and of temperate habits, was admitted into the Rivington-street hospital upon the 15th of August, in a state of collapse. She arrived in the city from the village of Millstone, New Jersey ; Cholera was raging at that place ; four deaths had occurred in one house, before she left. She was attacked with vomiting and cramps about 5 o'clock A. M. 15th, admitted into the hospital at 12 o'clock noon, in the following state : surface cold, beprostration 



179 

great, great thirst, pulse small and frequent : ft Frictions with Camph. Linim. Cal. 3i. Pulv. Opii. gr. 3«. M. wine and water, and brandy and water as drink : 3 P. M., patient sinking, stomach irritable, rice-water dejections, surface cool; ft Cal. BL Opii. gr. 3ss. M. repeat friction Camph. Blister to the epigas., brandy and water in small quantities : half past 5 o'clock P. M., patient cold and pulseless, sinking ; ft Pulv. Capsici. f>\y vinegar Oij. strip and rub the whole body diligently, afterward cover warm ; hot toddy as drink : 10 o'clock P. M., slight reaction ; toast water. 16th, 9 o'clock A. M., reaction fully established, slight pain in the head ; ft Emp. Vesic. to nape of the neck. 6 P.M., bowels not moved since last night; ft Cal. and Aloes pills, No. 3. 8 o'clock P. M.. bowels unmoved, ft Inf. Senn. 3j. every hour till it operates. 17th, 3 o'clock A. M., patient has vomited bile for half an hour ; extremities cold, with clammy sweat ; pulse very small and feeble ; ft Tinct. Opii. and Sul. Ether, a. a. 3ss. M. repeat friction to the extremities ; as the skin was abraded in places it could not be used to produce any effect ; ordered them wrapped in flannel wrung out of the hot vinegar and pepper, to be repeated often ; hot sand bags to feet. Quarter past 3 o'clock A. M., some retching ; repeat Eth'r. and Laud'm. 18th, 9 o'clock A. M., last prescription allayed vomiting : at present, pulse weak and small ; general coldness ; ft Aq. Ammon. 3ss. Muc. Gum. Acac. give gss. every half hour. Half past 5 o'clock P. M., surface warm, pulse full, bowels unmoved; ft Pill. Cal. and Aloes, No. 1. to be repeated every 3d hour ; Ammonia discontinued. 20th, 3 P. M. Hyd. Cum. Creta. grs. iv. every 6 hours. 10 P. M., omit H. C. C. ft Cal. grs iii. every 3 hours. 20th, 10 A. M., bowels not moved since last evening; ft Enema. 12 o'clock P. M., repeat enema. 22d, patient improving, as she was relieved of Cholera symptoms, the after treatment was 



180 

111.1 * - 1 i» .• • was touched by the mercury. 25th, patient continues to improve. 26th, from over exertion yesterday not so well. 28th, patient again improves. 31st, not so well, pain with heat of head, C. C. ad temp. Ist Sept., pain continues in head. Discharged cured. 

Case X. — Mary Gardner, aged 30, a servant, of intemperate habits, was admitted at half past 4 o'clock P. M. fully collapsed, cramps continued, also vomiting and purging, hands corrugated, tongue cold, pulse scarcely perceptible. Treatment; 14th,]* Fric. Camph'd Liniment ; Submur. Hyd. 3i Pulv. Opii. jss. M. toast water as drink to be given in small quantities. 7 o'clock P. M., repeat calomel 3\. 15th, 9 o'clock A. M., slight reaction ; toast water. 16th, 9A. ML, reaction fully established, bowels constipated ; $ Pill. Cal. and Aloes, No. 3. 4P. M., bowels unmoved ; repeat Cal. and Aloes. 6 o'clock P. M., no stool; # Fol. Senna. 3iii. Aquae Ojss. ft. Inf. a wine glass full every hour till it operates. 17th, senna tea operated well, has pain in the epigastrium ; ft Emp. vesic. over Epigastrium. 18th, patient improving ; light nourishment with a little port wine. 19th, GP. M., 2 stools to-day thin and dark, tongue clean ; ft Submur. Hyd.grs. viii. 20th 9 A. M., li Mist. Eccoprot. ga, to be repeated every 2 hours, until the bowels move : from this time the patient continued to improve, and was discharged cured, 20th August inst. 

Sect. 111. — Cases of Cholera Terminating Fatally. By Peter C. Tappen, M. D. 

Case XI. , aged 7, was seized on the 3d July, at 4 A. M., with vomiting and purging of a watery fluid, like ginger-water, accompanied with cramps in the lower extremities and bowels. He had slight diarrhoea two days 

> 



181 



been the day previous about the door of a house where an autopsic examination was made of a person who had died of the disease. Two hours after the attack I visited him, his symptoms were cold hands and feet ; cold tongue ; pulse nearly imperceptible ; ejections and dejections like rice-water ; skin blue and shrunk about the fingers and toes, eyes sunk and surrounded with a dark areola, lips blue ; voice peculiar and indescribable ; complains of great distress in the chest and stomach. Ordered a mixture of S. Ether Jj. Aromat. Spt. Ammon. sm. Tinct. Opii. 3ss. Aq. fervent, pss. ; bottles filled with hot water to his feet ; his limbs to be rubbed with mustard and vinegar, and a sinapism to be applied to the epigastrium. The sinapism was so uncomfortable that it was soon removed ; a half hour afterward, no improvement ; repeat the mixture ; give a hot injection of brandy and water — brandy one gill, water half pint; returned in 15 minutes cold; gave a second with \j. laudanum, which was retained ; gave brandy and water to drink ; apply sinapisms to the feet ; gave an injection of 3j. of tobacco in half pint of hot water ; injection retained, but produces no sensible effects. The stimulant treatment was pursued till 12 at noon, when he suddenly and unexpectedly (at the time) died. 

Jlutopsy, at 4P. M. The contents of the chest and stomach were exposed, and presented the following phe- Inena : — lungs collapsed ; heart congested and filled with ck fluid blood ; liver filled with the same kind of blood ; I bladder filled with bile ; ducts pervious. On laying in the stomach and intestines they were found to contain uid resembling rice-water; throughout their whole extent y were lined with a thick mucous substance, which, on ng removed, presented a surface apparently healthy ; no rks of inflammation were observed ; the peritoneal coat s injected very minutely with venous blood ; kidneys 

7\ 



182 

Ktral ; bladder contracted under the pubis ; the body is mer at the time of death, and the muscles are in a state ontraction. 

lote. — I am of the opinion that the rice-water is a secretion i the arteries of the mucous membrane of the alimentary il, their action changed by some morbific matter contained in atmosphere. Parents would not allow an examination of the 

Case XII. — Margaret Parker, a market-woman, aged 50 years ; admitted July 7th, 12 P. M., had been laboring under gastric derangement several days ; at 10 this evening attacked with vomiting and purging ; when admitted was suffering under violent spasms of the legs, for which she was directed friction with Aq. Ammon. and pills Camph. without, however, experiencing much relief; dry rubbing with chalk was then applied and she felt partially relieved. Extremities cold, pulse at wrist barely perceptible, hands corrugated and sodden, with all the usual symptoms of the collapsed stage of Cholera Asphyxia. Had been in the rain during the evening. Bags of heated sand to the extremities and other parts of the body ; to have a draught of Tinct. Opii. gtts. L. and Ether gtts. xxx. ; had a dejection precisely resembling barley-water, with the grains floating at the bottom. Half past 1, repeat ether and laudanum, with effervescing mixture ; complains of pain at the stomach ; apply sinapism to epigastrium. Half past 2 spasms entirely ceased ; pulse more feeble ; patient sinking. To have Julep of Camphor and Carb. Ammon. a teaspoonful at short intervals ; 4 sinking ; half past 5 

Autopsy two hours after death. 

Lungs collapsed, but not near as much as is usual. Nothing further unusual about the chest. 



183 

Stomach. — Mucous membrane very soft and easily tor»j, exhibiting marks of chronic disease ; no marks of recent inflammation either here or throughout the intestines except slightly at the termination of the ileum ; several of Brunner's glands very much enlarged, resembling the appearance of a mulberry ; gall bladder shrivelled at its farther extremity, and usual quantity of bile. 

Brain and spine not examined. 

Case XIII. — Frederick Hennick, a native of Germany, aged 32 years, admitted July 7, from Mott-street, baker ; admitted a quarter to 10 A. M. ; habits intemperate ; attacked some hours before admission. Condition when received as follows :—: — 

Face blanched, and slightly livid ; eyes sunken ; extremities cold and livid, particularly between the tendons of the leg and forearm ; pulse at the wrist barely perceptible ; fingers corrugated and sodden. 

In a few hours he died. 

Examination of the body of Frederick Hennick, 12 hours after death. 

Abdominal muscles were unusualty rigid. The peritoneal covering of the intestines was somewhat congested, and more particularly the part covering the omentum. The mucous surfaces, however, of the stomach and intestines throughout white and no appearances of inflammation; lungs very much collapsed and much darker than natural ; liver, rather congested ; right auricle of the heart very much distended with black blood, as also the cavae ; yen- Iles nearly empty ; gall bladder shrivelled at its farther emity, and containing about the usual quantity of bile ; bladder (urinary) firmly contracted ; brain and spinal tow not examined. 



184 

CASE XIV. 

To his Honor the Mayor. 

I mr, — The two cases in Reed-street, near Green:h-street, which terminated very suddenly, were not n by myself, till within a few minutes after the ith of the patients. A very minute examination was de of these cases by Drs. Carroll, Ludlow, Kenedy and self, and it has occurred to me that you would be :rested with a perusal of the morbid appearances, v which re noted by myself on the spot, and approved by the er medical gentlemen. 

Mr. G., aged 40, pianoforte maker, of robust habit and corpulent, addicted to intemperance, and drank excessively on Sunday the Ist instant, had complained for two days previous to the attack of a stricture across the stomach ; in other respects suffered no morbid sensation, and ate in his usual manner. lam also informed that he slept till 12 o'clock on Sunday night, when the invasion of the disease suddenly took place, and he expired at 1 1 o'clock of the present day, having suffered the disease eleven hours : Dr. Cameron attended him very assiduously from 5 o'clock this morning, when the patient was seen for the first time by a physician. 

I'rom this gentleman I learn that he was affected with he characteristic symptoms of the spasmodic Cholera ; it is especially my object now to explain the morbid earances on examination of the body. 

Essection tico hours after death. Countenance very features prominent, eyes staring, and expressing wildnes-i. 

On opening the cavities of the abdomen and thorax, the stomach and large intestines were seen distended with flatus, and the smaller ones partially so. Fat abounded 



185 

Id externally, from the vascularity of the mucous memle. Large intestines natural. No turgescence of the enteric veins, nor of the veins of the omentum or hragm. The stomach contained a pint of a fluid mbling a weak infusion of coffee. A bright redness iared in the upper portion of the stomach, terminating iptly by a very determined line near the cardiac orifice ; uch paler and more livid redness existed in the lower ion of the organ. 

At the pyloric orifice the livid redness became more remarkable, and extended through the whole tract of the small intestines. The mucous coat of the large intestines was perfectly natural. A large quantity of the fluid resembling rice-water in color, and of the consistence of cream, was found in the intestines from the duodenum to their termination. 

Khere was a little more than the ordinary quantity of us. 

The liver externally was natural, perhaps a little paler than usual ; on making incisions, the black blood flowed rather more freely than in the healthy condition of that organ. The gall bladder contained about an ounce of black bile ; the duct of the gall bladder was in a perfectly natural state, and the bile flowed freely through it. Spleen and pancreas natural. Urinary bladder empty, but not particularly contracted. The heart, in all its cavities, entirely empty, as were also the venae cavae. The lungs were blue, and turgid with black blood to a very remarkable degree. The brain was engorged with blood, and its ventricles contained four or five ounces of water. The treatment of the preceding case, was antiphlogistic, but was applied at a late hour. 

Reaction had taken place in a moderate degree, but it . .. ,, c . , . > ... ciir»/"w»riil*»il lit* i"»/"vl 111 1 T\Cf* Clfiri nPfltn VY <\o OvJKJxi oULLvCUCU J vvlluWov ttllvl ¦1L (ill i 



186 



lOase XV. — John Cahill, a native of Ireland, admitted y 28, 11 A. M., has been laboring for some days past ler diarrhoea, attended by occasional vomiting of a enish colored fluid ; his dejections were discolored, lerdark; other than these, the symptoms that were sent were not strikingly peculiar ; consecutive fever n came on attended by cerebral congestion, — treatit according to general principles ; died August 2d, 8 ock P. M. 

John Cahill. — Jlutopsy immediately after death. 

E light adhesion of the right lobe of the lungs ; more than narily collapsed, but otherwise presenting a healthy jarance. 

The temperature of the room 78°, under the lobes of the lungs 100°. Right auricle and left ventricle of the heart contained a quantity of black fluid blood, while the other parts were empty. 

Liver, healthy appearance. 

Stomach. — Mucous membrane rather soft, and interspersed with red patches ; contained a grumous fluid resembling coffee. Cardiac orifice much more inflamed than any other part of the stomach. The intestines contained a fluid matter of the same description as that which was observed in the stomach. 

Bladder constricted ; nothing unusual in the gall bladder. 

Brain. — Venous congestion of membranes. In the substance of it, nothing remarkable ; ventricles filled with an aqueous fluid. Slight thickening of the arachnoid 

Kidneys, enlarged. 

Khe veins throughout the body, were unusually engorged black blood. 



187 

CASE XVI. — By Geo. E. Harral. 

To the President and Members of the Board of Health. 

New -York, August 9, 1832. 

fENTLEMEN, — I take the liberty of sending you a brief Dry of the case of Norry Gorman, 84 Barclay-street, who reported yesterday as laboring under malignant Cholera, i on account of its interesting character, and the plan reatment which in her case would have been equally :essful, as it had been in two preceding cases reported 39 Reed-street, and 53 Robinson-street, had not an irtunate circumstance prevented. 

This woman, of robust constitution, and having passed the usual period of gestation by several days, was attacked on the evening of the 4 7th instant with Cholera, after the usual premonitory symptoms. I found her in a damp cellar, vomiting and purging a fluid resembling in appearance dirty rice-water, no pulse at wrist, cold extremities, a cold pearly dead tongue, and a clammy moisture of the surface generally. Warmth was immediately applied by means of heated bricks, sinapisms to the extremities, and one covering the whole anterior surface of the body. The incessant vomiting which had harassed and exhausted her, was soon arrested by directing her to swallow small lumps of ice at short intervals ; a pill containing one scruple of calomel was given, which was retained. I then left her, and after the lapse of two hours visited her again, and found there had been no vomiting, the same purging continued ; respiration was growing more hurried ; a profuse perspiration had broken out; pulse at the wrist scarcely perceptible ; in fact she had entered the stage of collapse. Under these discouraging circumstances, I resolved to give the ether gas another fair trial ; having procured a suitable apparatus, its use was commenced, which she took 



188 

given at same time, and I left her for the night with directions to continue the exhibition of the gas, and the injections of hot brandy and water at such times as she might appear to be sinking, with warm barley-water for a drink ; external heat to be kept up as before directed. 

|)n the morning of the Bth, found reaction about to be blished ; ordered continuance of same treatment. On next visit, reaction was progressing gradually, and as c had been no operation from the calomel given last ling, the same was repeated. In the evening she was ently convalescent ; the pulse had risen, warmth had rned to the surface, the cold sweating had ceased, and ft her for the night under the same treatment, with the sing expectation of finding her in a fair way of recovery succeeding morning. Her medicine had not yet oper, but she gave evidence that it would during the night. 

ILbout midnight, however, my fears that labor would set as soon as reaction was better established, proved entably true ; and with light but regular labor pains, was shortly and safely delivered of a full grown dead d. My efforts were now directed to support her ngth by every possible means, which was fast leaving These were continued during the night with great 

I his morning, (the 9th,) prostration continued, from ;h she could not rail} 7 , and death soon closed the scene. . not parturition supervened so early, this woman, in all (ability, would have been carried safely through the emic, and afterward her delivery. As it was, the ers of life were too far expended to bear up under i. My object is more particularly to direct your attento the treatment of this case, aside from the interest ;h it otherwise merits ; at the same time I beg leave to laim any originality, my only wish being to aid mt 



189 

professional brethren in instituting honest inquiry in the treatment of an anomalous disease which is making such havoc in our country. 

I ascribe the successful termination of the two cases ye mentioned to the ether gas and the hot stimulating ctions, aided by heat and stimulants externally applied, n also fully aware that no particular rule can, or ought ie laid down for the treatment of disease, and the physii who would be governed by any fixed rule, or favorite )ry, at the bed side, must find himself often deceived at expense of human life. In this disease, as in others, he illed upon to exercise his own judgment, and to prebe for symptoms. 

I am, Gentlemen, respectfully, Your obedient servant, 

Geo. E. Harral, M. D., 

Physician, 3d Ward Medical Station. 

Sect. IV. — Cases of Consecutive Fever. 

Marinus Wiixett, M. D. 

lase XVII. — George Huntless, aged 13, was admitted into Rivington-street hospital, on the Ist of August. This :nt had been attended out of the house by Dr. Bayley, vas admitted at 3 o'clock P. M., extremities cold, with nps, — Fric. Camph. Mer. Oint. to extremities and abdoi, Cal. grs. x. internally. 10 o'clock P. M., repeat friction Cal. aj. 2d August, half past 9A. M., reaction and rmination to the head, bowels sluggish, Cal. and Aloe , C. C. to temp. 3d Aug. 9A. M., surface cold, tongue ; warm toddy, calomel 7i grs. August 4th, pain in the I, and stupor, bowels slow ; Cal. and Jalap x. and xv. sth, stupor continues ; Emp. vesic. to the head, inside 

25 



190 

thighs ; pain in the epigas., for which he was leeched, this produced only partial relief; Emp. vesic. to the epigas., Cal. and Aloe pills, No. 3. August 6th, 9 o'clock, patient stupid, and fever of low typhoid form ; dark sordes on the teeth ; Emp. vesic. to back of neck, wine whey, Stim. Ungt. to the head. 7th August, symptoms more favorable, continue whey, ft Carb. Potass 3i. Pulv. Rhei. 5». Aquae. Pluv. siv. a table spoonful 3 times a day. Bth August, patient improving, continue former medicine. 9th, patient improving, but very feeble, (low) fever abated ; general treatment was now adopted, and the patient continued to convalesce. About the 12th August, the integuments of one of the inner ankles sloughed, and an obstinate ulcer was the result ; this, with the general debility, kept him in the hospital till the 29th of August, when he was discharged cured. 

r. V. — Cases of Cholera with Congestion of the Head. By Samuel Akerly, M. D. 

I Case. XVIII. — Mr. D R , a gentleman in easy ;umstances, had a severe attack of Cholera on the sth August, and recovered with the use of calomel and ver's powder, injections of starch with laudanum, and ipisms, followed by cathartics of calomel and rhubarb. b last visit was made on the 10th of August, when furr attendance was considered as unnecessary. Having n a hale and hearty man, he felt the restraint of a low ; to which he had been confined, and began to crave re solid food. Accordingly on the 12th he ate corned f for dinner, and brought on 

X Relapse. — I was called to see him after midnight, (12th iat * Tif 11 1 1 . || flip A IcpVio rfvpc frnm Hi a linwplc xxTfrvt* mnrp 



191 

flent and copious than before, and of the rice-water kind, ere was nausea and sickness at the stomach, but no ring. He had a cold tongue, cold skin, slow and intertent pulse, loss of voice, and noist in the head. 

Ihe first evacuation after my arrival was copious, and out pain, loose and watery, and in quantity more than dlon. Remained with him all night, during which I mistered injections of starch and laudanum until his els were rendered easy and retentive. His stomach rubbed with camphor, and a mustard draft applied, but ing was given internally except a little mucilaginous 

The next morning, 13th August, gave a dose of calomel and jalap, and it became necessary to repeat the injections. In the course of the day, however, a change lor the worse took place. The stomach and bowels became inactive, the voice was reduced to a whisper, the pulse became full, slow and intermitted oftener than before. Drowsiness and stupor gave indications of congestion forming in the brain. 

IJlood-letting now became necessary, and this was first duced by the application of fourteen leeches, seven to h temple. These gave some relief, but increased benefit i derived from a copious bleeding from the arm, when patient became more easily roused, and spoke with a nger voice. Saw him frequently during the day, and erved with solicitude the varying symptoms of the ase. Though much benefited by the general and topibleeding, yet toward evening the stupor increased, and was directed to be applied to the head. 

August 14th. Has had the ice applied to his head all night with advantage ; feels comfortable and agreeable to him ; let it be continued ; voice much stronger ; states that the noise in his head was like the rattling of a wagon 



192 

Ito ear. The exertion of his own voice increased it, therefore he was not inclined to speak, and when he ted a drink he would point to it. 

August 15th. The ice was continued all day yesterday, and removed in the evening as the patient was much improved. The alarming symptoms have subsided, but this morning is very weak and the skin and eyes have a yellow tinge ; no recent discharge from his bowels ; gave a dose of calomel, jalap and rhubarb. 

lugust 17th. The cathartic given on the 15th produced one discharge ; yellowness of the skin and eyes increasgave calomel and ipecacuanha in small doses three :s a day. 

August 20th. The calomel and ipecacuanha have operated kindly, having been continued the last three days, together with bitter and tonic drinks. Is much improved in appearance and strength, though still feeble. On the 23d he took a portion of calomel and rhubarb as a cathartic, and by the 28th he was so far recovered as to walk 

P. C. Tai'pen, M. D. 

Case XIX. — Edward Prummer, a seaman from Joneswharf, aged 28 years. Admitted July 9th, half past 2P. M. His extremities were cold and pulse rather feeble, though his muscular strength was sufficient to enable him to walk without assistance. His countenance bore the characteristic marks of Cholera : sharpened features; dark livid ring about the eyes ; dirty hue of the wholeface ; he was restless, with constant agitation and tossing of the arms and legs. Soon after he came in, had an evacuation from the bowels resembling dirty gruel or rice-water. With a view of quieting his nervous system, a draught of ether and laudanum, of each 3ss. was administered, and 



193 

heat applied to the extremities. 3P. M., symptoms continue unabated ; constant agitation and restlessness, with vomiting of light-colored fluids. At the request of Dr. Tappen, the attending physician, an effervescing draught of Soda and Tart. Acid was administered and a sinapism was applied to the epigastrium. Half past 3, vomiting not relieved; repeat effervescing mixture with Tr. Opii. gtts. L; this was not retained, and the draught was continued without the anodyne. 4, same symptoms continue ; omit the saline mixture and give Pil. Opii. gr. 1 ; drinks to be taken only in very small quantities. Half past 4, vomiting less urgent; still some retching. Half past 5, has had some sleep, with disposition to slight coma. 8, has become restless again; severe spasms and cold extremities; apply heat to the extremities. Half past 8, delirium supervened ; pulse has become strong and full ; violent pulsation of the temporal arteries and carotids ; constant jactitation ; was bled to gxij. with some relief of the symptoms. Half past 7 ; symptoms of cerebral congestion aggravated ; pulse hard and not entirely compressible ; great throbbing of the temples ; dilated pupil, with strabismus and incipient paralysis of the left side. The temporal artery was opened, about JvH|. of blood taken, which reduced the pulse, and so far relieved the symptoms that the patient could be roused and answer some questions put to him intelligently. It should be mentioned that at the same time ice was applied to the head, a blister to the back of the neck, with sinapisms to the soles of the feet. During the first part of the night the patient was extremely restless, with frequent and severe spasms of the extremities. Stimulating frictions were directed to relieve the spasms. Half past 2 in the morning ; spasms subsided ; patient lies upon his back nearly motionless ; picking at the air ; balls of the eyes fixed and turned upward ; pupils very much contracted. 



194 

Imjunctiva injected ; breathing somewhat stertorous ; face warm and moist ; strength of pulse considerable, a the morning, same symptoms continuing, cups were jlied to the temples and several oz. of blood abstracted ; 5 followed by a turpentine enema which was not retained; relief of the symptoms. 9 o'clock, symptoms continue; athing more stertorous ; pulse retains some strength, rein was opened in the arm, a small quantity of black mous blood flowed out without relief of the symptoms. '. M., patient expired. 

•Autopsy five hours after death. At pylorus 1 04 Fart., auricles greatly distended ; lungs greatly collapsed, hardly crepitating ; smaller vessels containing very little or no blood; right ventricle not. so much engorged as usual; liver hard and congested ; blood flowing from it peculiarly viscid and painted ; stomach filled with a peculiar ricelooking fluid ; no marks of inflammation ; near the caput coli a large quantity of yellow fluid with black flakes ; great enlargements of mucous follicles of the colon ; no dryness of peritoneal covering as waa seen in a case Sunday morning ; no shrivelled appearance of farther end of gall bladder ; great stiffness of muscles seen in none others but those dying of Cholera. 

lirain. — Several patches of inflammation, particularly in left cerebrum ; no effusion ; vessels distended ; some jestion. 

Sect. VI. — Miscellaneous Cases. 

Samdel Akerly, M. D. 

Case. XX. — August 17th, 1832, James, the son of Mr. C C , about 4 years old, was taken at night with violent nnlc inc Jind \)\\ rtri nc whic *h fiiir*f*f*p(]pfJ thp r>rf*» 



195 

monitory symptoms of mild diarrhoea, caused by improper articles of diet eaten, unknown to the parents until after the fact. The rice-water discharges from the bowels were frequent and copious, the vomiting violent and exhausting, attended with great jactitation or tossing. 

JThe irritation in the bowels was allayed by injections of rch and laudanum, though not until frequently repeated, they were at first soon returned. 

ITo quiet the stomach, external frictions were employed ; d internally, camphor, ammonia and peppermint, in a uid form, but the latter were rejected. The distress and ising were so violent that the patient's extremities were coming cold, and young as he was, it became almost possible to keep him covered, and warm applications 

I Before midnight, and after a severe spell of vomiting, the Ise sank, the eyes were rolled in agony, and the little ferer appeared to be dying. The father who was present >ught that life was almost extinct, and resigned his child the Almighty. He endeavored to satisfy himself by :ling of the pulse, but to him it was not perceptible, iich I attributed to agitation, because I could distinctly :1 it, though beating very feebly. 

In this emergency I gave five drops of chloric ether in a little cold water. It was retained, and the patient revived. In a few minutes after gave ten drops, and it was soon rejected, but without much effort in vomiting. The patient, on account of exhaustion, being more quiet, gave an opportunity to renew the external heat, and five drops of the chloric ether was given every ten minutes without being rejected. The pulse gradually rose, the heat of the skin returned and a warm perspiration ensued, and before morning the child became composed without further vomiting or purging, and fell into a sweet sleep. 



196 

I remained with this patient all night, watched the varycircumstances of the case and acted accordingly. On succeeding day, (August 18th,) saw him frequently, gave a mercurial cathartic which operated favorably, on the 19th he was convalescent, and required no furmedical attention after the 20th. 

Case attended with Bilious Vomiting. 

By Marinus Willett, M. D. 

Case XXI. — Mary Ann Wallace, aged 19, of intemperate habits, was brought to the hospital in Rivingtonstreet on the 14th of July, affected with vomiting, purging and cramps. This patient was taken with diarrhoea on the eve of the 13th, while watching with her husband in this hospital : the purging continued through the night, and in the morning vomiting and cramps of the legs came on : at half past 10 o'clock A. M. she was put upon the following treatment : as she vomited bilious matter, with considerable pain in the head, full and strong pulse, a gentle emetic of Ipecac, was given, considerable bile was discharged, the pulse fell and pain of the head was much relieved. Cramps in the legs being severe, friction with camph'd. oil was directed. After the stomach became quiet, ordered calomel in 5 gr. doses every 2 hours until the secretions became changed : this favorable result was accomplished on the 16th instant, and the patient discharged cured on the 18th instant. 



197 

Case of Cholera cured in the stage of Collapse, by venous 

injection of warm water only. 

Stephen C. Roe, M. D. 

I Case XXII. — Catharine Boyle, aged 40, native of Ired, from the Sailors' Snug Harbor; attacked with diarrhoea Thursday, 2d August ; commenced vomiting on Friday ; nitted into the hospital on Saturday at half past 6 A. M. 

Eymptoms. — Vomiting and purging; extremities cold ; cold and clammy, and somewhat shrivelled ; pulse small scarcely perceptible ; tongue white ; countenance and sunken ; incessant thirst and restlessness. 

Treatment. — Frictions with Cayenne pepper and hot vinegar, Cayenne Pediluvia, Camphorated Mercurial Oiniment with Cayenne pepper, Cataplasms, bags of hot sand, hot chalk, &c. ; Enemata cou{cj not be administered, in consequence of a rupture in perinaeo. 9 o'clock A. M., vomiting and purging could not be controlled, symptoms still severe ; the above treatment was actively continued. 1 1 o'clock A. M., continued sinking ; the operation of transfusion now performed by my assistants, Dr. W. A. Clarke, and Mr. A. Gunn, and Oj. of simple warm water, at the temperature of 112° F. injected into the median basilic vein. Partial reaction was produced. 1 o'clock P. M., frictions again repeated to the whole surface, reaction not being fully established. 4 o'clock P. M., sinking ; vomiting checked, but the rice-water evacuations still continue from the bowels ; transfusion was again resorted to, and Oj. of warm water again injected ; pulse small and frequent, skin more natural, frictions repeated. 5 o'clock P. M., skin red and hot, complained violently of the frictions, headache and vertigo : venesection ad siv. mucilaginous drinks. 8 o'clock P. M., tongue but little furred, pulse frequent and somewhat fuller ; tenderness in epigastrio ; extremities 

20 



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• 

Im; skin natural ; slight purging still continued: fries with camphorated oil to the epigastrium, Submur. I. gr. xv. 12 o'clock, pulse small and frequent; skin ; tongue slightly furred and red at the edges ; pain and erness in the epigastrium still continued, with great t : Submur. Hyd. grs. x. and Pulv. Dover, grs. x., llient drinks continued, Emp. Camph. to the epigasn. 

Sunday morning, 8 A. M., enjoyed some rest during the latter part of the night : tongue furred, and red at the edges ; pulse quick and sharp ; skin hot and dry ; pain in the epigastrium and bowels, with other symptoms denoting the supervention of gastro-enteritis ; treatment accordingly. Discharged cured, August 20th. 

. ',' ; 

To Stephen C. Roe, M. D. 

Physician to the Greenwich Cholera Hospital' <{t. 

Belle vue, Sept. 24th, 1832. 

» 

llir, — I have the, satisfaction to, inform you that the edy which you suggested has succeeded beyond extation. I first injected an infusion of tobacco into the is according to your direction, but I have since given infusion by the mouth, and find it to answer equally , without the danger of inflammation of the vein consent to injection : two cases, however, were injected, and following is a detail of them. 

11. 8., aged 34, pregnant 8 months, was attacked with re purging without much pain, Sept. 12th, and was ted with blue pill and camphor in small doses for three » without relief: Vi. of calomel was then given, and the phor continued ; on the evening of the 16th, labor came 



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on, and she was delivered next morning of a dead child, after which, 3i. of laudanum was given. At 8 o'clock, of the 16th, vomiting commenced, and she was cold and pulseless at 10; at 12 she was nearly dead ; it was therefore considered a fair case for the trial of the remedy, in order to witness its effects. — Injection was performed, the infusion was made with ML of tobacco to the pint of water, and 3iv. of this put in about Oiiss. of warm water, at the temperature of 112° Farenheit. — About fiv. of this was first injected :. an effort to vomit followed, with deep and convulsive inspirations ; the effort to vomit soon ceased, but the inspirations continued deep and full ; in about 15 minutes the process was repeated, and the same phenomena followed ; the pulse was now felt at the wrist, and from being unable to articulate, she spoke well enough to be understood, and said she felt sleepy, but did not sleep : about 5 o'clock, death closed the scene. 

The next was an idiot, aged 14, taken in the night of the 10th, was found next norning cold and blue, with unceasing vomiting and purging : injection was performed in the same manner as above with only half the quantity of infusion ; violent efforts to vomit with deep inspirations followed ; from this time the vomiting ceased and also the purging, the body became gradually warmer, and next the extremities. 18th, about 12 o'clock, he seemed to fail, had purged once, and vomited ; I then gave him 3ii. of the infusion by the stomach, he vomited once afterward : from that time he continued to improve gradually, and is now out of danger: since then (the 10th) I have given the infusion by the mouth, and instead of increasing the difficulty as I had formerly supposed, it quieted the stomach with astonishing celerity. I have given it in three cold cases, and four of vomiting and purging, with more speedy and certain relief than I have found from any other remedy ; 



200 

anu also in iv cases 01 trie rice-water (Jiarrnc6&; these are all doing well. In order to have success it seems necessary to establish the specific effect of tobacco, and the disease immediately vanishes; the patient has then only to recover from the tobacco and he is comparatively well. 

I have thus prematurely submitted these observations to you, because I am already satisfied that there is no remedy which we have yet tried that can compare with it : all the Bits have failed in too many cases ; but with this I believe may combat the enemy on even ground, and with equal c. 

Very respectfully, Yours, &c. 

N. MORRELL, 







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