THE ASIATIC CHOLERA ! ! ! ITS SYMPTOMS, CURE, AND REMEDIES: 

JIY Dm. JAMESON, or Bengal; LEICHENSTADT.ofRusbia; RUSSELL, of I:m;i.a.mj: BOISMONT, of Paris; REESE, of New York; WARREN, of Boston ; Asn BELL, of Philadelphia. 

ILLUSTRATED BY A MAP, SHOWING [ts awful Progress in New York City, in 1832 

also, A BRIEF HISTORY OF THE PAST RAVAGES, APPROACH OF THE CHOLERA AT THE PRESENT TIME. 

NEW YORK: E. HUTCHINSON, 162 NASSAU STREET. PITTSBURGH: W. S. CALDWELL 









ASIATIC CHOLERA!!! ITS SYMPTOMS, REMEDIES, AND PREVENTIVES: 

IOM'AINIXO 

PARTICULAR INSTRUCTIONS 

IN REFERENCE TO TIIK 

IMFKKUKXT STAGES (H 1 TIIH DISEASE 

i 

¦ v 

Dm. JAMESON, or Benoal; LEICHENBTADT, of Russia; RUSSELL, or England; BOISMONT, ok Paris; REESE, ok New York; WARREN, OF Boston; and BELL, of Philadelphia. 

ACCOHFANIEO BY A HISTORY 01 

THE PROGRESS OF THIS DREADFUL DISEASE 



\KW YORK: PUBLISHED AT 162 NASSAU STREET. 

18 4 8. 



ft J> 

Entered, according to the Act of Congress, in the v;i 1843, 

Uv c. nrrrcinxsox. 

In i lie Office of tli." Clerk of tin- Southern District of New York 



CONTENTS 

Description oi the Plate . . • 4 Introductory Remarks • • Historical Sketch of the Progress of the Cholera, previous to 1817 . 0 Progress of the Disease, from 1817 to 183~. . • ''^ Progress of the Cholera at Quebec and Montrea. • .18 The Disease at New- York . . . 19 Symptoms of the Cholera . • • • .82 Appearances after Death .... !M Description of a Case, by Dr. Kirk, of Greenock . . 'Si Remedy for the Cholera • • '^' Causes of Cholera . • • • .48 Prevention of the Cholera .... ; '<* Proof that the Cholera is not Contagious . • • 52 Relapse .... - • r> -' 



EXPLANATION OF THE PLATE 

The annexed plan of the city has been sketched for the purpose of enabling strangers to perceive the evidences of non-contagion, as well ns of local origin, furnished by the presence of the epidemic cholera in New-York, in the summer of IKUi. 

The Ikuvi/ black circular lines designate the different parts of the city \\ henthe disease suddenly appeared, and in some of them simultaneously! The first cases are reported t<> have occurred in Cherry-street, and Rosevelt-street, at the point in the Fourth Ward, designated ou the map by the litter A. I>i> t the disease appeared almost simultaneously, and with much greater virulence, in the Third Ward, in Rende, Washington, and Duane streets, at the point marked 15., which is at least a mile in a straight line from the point first named ; and also in the Sixth Ward, at the point marked ( '.. which includes the location called the " Five I'oints." Within a lew days after, it appeared in the Ninth Ward, at Greenwich Village, at the point marked !>., which is nearly two miles frcm the seats of its first prevalence, and where the epidemic raged with unwanted violence, after it had nearly subsided in almost every other part of the city. Very soon afterwards it broke out in the Twelfth Ward, at the prison and hospital at Belttvue, marked 1-., nearly three miles from the place of its commencement : at Yorkville and Harlem, distant four and eight miles from the city: at Lawens-stritt, in the Eighth Ward, marked V. on the map : at < 'orlat r's lion/:, in the Se\ euth Ward, \\ hich is designate i <i., in tin' Eleventh Ward, in the neighborhood of First-street, east, of the Bowery, where a great number of cases suddenly appeared, at the point marked 11. ; and at the bouse in Ji road -street, in the First Ward, where there were ten fatal cases, — marked I. 

The several points marked by black circlet, were .so many nuclei, and perhaps include all such, where the causes of the epidemic were generated, and whence the disease spread itself abroad, diminishing in its force, and the frequency of its attacks. And with these several sources of the morbid cause, in the midst of a dense population, it is not surprising that the atmosphere of the whole city should become impregnated with the morbid influ- 

ence, and these endemics result in a general epidemic. 

It cannot be denied, that many eases occurring simultaneously at th» .several locations, were in persons who could fine bad no possible intercom with each other; and many of them had nut recently been out of their o\ immediate vicinity. Those who are acquainted with the city, need nut he formed either of the crowded and filthy state of several of these points, of the iutemperate, dissolute, and abandoned habits of the inhabitants some of them : or of the proverbial filth of the streets, as well as the housi in most of these locations. Where these causes were not obviously prese the district is known to be made ground : or some local cause of the di~e;> existed either in a large filthy stable, as at Christopher-street, Greenwich Vi lage, or in neighboring marshes, as at Bellevue. Harlem. Yorkville, Willian burg, Flatbush, and elsewhere. 

The Cholera Hospitals are designated on the map by a black spot, trilh a white point in the centre. It has been thought unnecessary to lay dowu any other streets on the map, except those necessary for the object in view Hence, the rest of the city is only described by marking the divisions of the several wards, and the prominent thoroughfares. 



INTRODUCTORY REMARKS 

The preparation of the following pages has been undertaken with a view to enable our fellow-citizens to meet fearlessly the destroyer that is moving slowly but irresistibly towards our shores. The clouds of a terrible storm are gathering blackness ; faint gleams of lightning are apparent in the eastern horizon; the thunder's distant roar is occasionally heard; and the tempest, ere we are aware, will he upon us ! Still our authorities are asleep ! We have been astonished that no precautions have been used ! 

The Cholera is taking about the same course which it did before it reached our shores in I^ : >:J, when it swept away so many of the inhabitants of our principal cities ami towns. 

The authorities of London and Paris, while the disease was very far distant, took decided measures in prepare for its desolations. Their streets were cleansed, and eminent physicians were dispatched to the places where it was raging, in order to obtain as much practical knowledge us possible concerning n. But in this country nothing is done, — not even the streets of our cities and town a are cleansed. \\ c d<> not wish unnecessarily to alarm our fellow-citizens : but we are desirous to cnll their attention to this subject, and induce them to make such preparation that they will not be alarmed when the destroyer shall appear. In tirneoi peace we must prepare for war. One great design in writing this work, has been to furnish a manual, so cheap that even the poorest persons can purchase it ; and yet so complete that those who peruse it can ascertain t xaetly what course to take, in order to present an attack ; 



INTRODUCTORY REMARKS. 

t 

and, if attacked, what measures to adopt in all stages of the disease* 

The persons named in the title, are very eminent physicians, most of whom have had many cases of cholera, in its different stages, under their own treatment ; and the utmost reliance can be placed in their instructions. 

K'hat this little book; with the blessing of Heaven, may be rumental in relieving much distress, and in saving many 

precious lives, is the sincere prayer of 

The Author. 



HISTORICAL SKETCH of the PROGRESS OF THE CHOLERA. 

I When the Epidemic Cholera Morbus appeared at. Jessore, 1817, it was supposed to be a new disease ; but upon inquiry vas ascertained that a complaint similar in all its symptoms 1 not only been described in several publications on the disses of India, but had been noticed in the earliest records of dicine. Hippocrates speaks of it, and it is described by ita3S, of Cappadocia. 

Eontius, a Dutch physician, residing at Batavia, and who te in 1629, thus accurately describes it. 

"Besides the diseases above treated of, as epidemic in this country, the cholera morbus is extremely frequent. In the cholera, hot, bilious matter, irritating the stomach and intestines, is incessantly and copiously discharged by the mouth and anus. It is a disorder of the most acute kind, and therefore requires immediate application. The principal cause of it, next to a hot and moist disposition of the air, is an intemperate indulgence of eating fruits, which, as they are generally green, and obnoxious to putrefaction, irritate and oppress the stomach by their superfluous humidity, and produce an a'ruginous bile. The cholera might, with some degree of reason, be reckoned a salutary excretion ; since such humors are discharged in it, as, if retained, would prove prejudicial. However, as by such successive purgations, the animal spirits are exhausted, and the heart, the fountain of heat and life, is overwhelmed with putrid ellluvia, those who are seized with this 



... ill* i\ • i i -i r disorder generally die, and that so <]inckly, as in the space or four and twenty hours, at most. "Such, among others, was the fate of Cornelius Van Royen, steward of the Hospital of the sick, who, being in perfect health at six in the evening, was suddenly seized with the cholera, and expired in terrible agony and convultionί before twelve o'clock at night; the violence and rapidity of the disorder surmounting the force of every remedy. But if the patient should survive the period above-mentioned, there is great hope of performing a cure. 

"This disease is attended with a weak pulse, difficult respiration, and coldness of the extreme parts ; to which are joined, great internal heat, insatiable thirst, perpetual watching, and restless and incessant tossing of the body. If, together with these symptoms, a cold and foetid sweat should break forth, it is certain that death is at hand." 1 

Sydenham, and other writers,* notice its prevalence in London, in 1669—76, and in 1741. It is said to have prevailed in several parts of Europe, from 1600 to I7SO. At Paris extensively in the summers of 1730, 17-"iO, and again in 1780, and in Switzerland in 1 696t 

|\nterior to the present age, the epidemic or pestilential form cholera, had, however, rarely appeared in Europe. It had urrcd more frequently in India, and its ravages there had :n greater. 

(icbegue de Prcsle says it prevailed in Upper Hindostan in 2, where it destroyed thirty thousand blacks, and eight hun-1 Europeans. )r. Paisley, in a letter dated at .Madras, L2th of February, 1774, says that the cholera is. often epidemic there. M. Sonnerat, in his travels in India, from 177-1 to I7s| s .-ivs that cholera prevailed epidemically on the Coromandel coast, and ai one period assumed a very malignani character, dcioying above sixty thousand people, from Cherigam to Pon•herry. The epidemic cholera morbus prevailed at the island of turitius in 1819 and 1820; and, from inquiries then made 

Mluiham. Dr.Brtdy.&c 

10 





Eommittee of British Medical Oflicers, it was ascertained similar disease prevailed there io 177r5. and which conabout two months, causing great mortality, particularly the blacks. 

KThe disease raged with great violence in India in 1781. Mr meson, secretary to the Calcutta Medical Board, says : 

I' A division of Bengal troops, consisting of about live thouid men, were assailed by cholera, with almost inconceivable y. Men previously in perfect health dropped down by dots ; and those even less severely affected were generally id or past recovery within less than an hour. The spasms the extremities and trunk were dreadful ; and distressing niting and purging were present in all. Besides those who d, above live hundred were admitted into hospital on thai y. On the two following days, the disease continued unned, and more than one hall' of the army were now ill."' 

turtis, in bis work on the diseases of India, speaks of the sual prevalence of cholera in 1752. 

It is also stated in the Bengal Report, that the cholera appeared at Hurdwar on the Ganges, in April, 1783. Its prevalence at this place is very deserving of attention. 

tt was computed that from one to two millionsof people had ambled here on the banks of the Ganges, where they sed several days and nights, crowded together, and excel to a burning sun by day, and to heavy dews and cold sts from the mountains at night. 

I The cholera, suddenly appeared among this crowd of devos, and was undoubtedly generated among them, and raged th such violence as to destroy above twenty thousand people the short space of eight days. But it is a remarkable tact it this disease did not spread from this point, not even to the laeea within a few miles, and ceased immediately on the persion of the multitude who had assi nibled at Hurdwar. 

lin 1787, the cholera prevailed at Vellore, Areot, and Trinnallee, and has been described by Dr. Duffin, Dr. Davis. I Mr. Thompson. At these places it raged with great wore, and so rapid was its progress, that many were carried in twelve hours. 



11 





12 

PROGRESS OF THE CHOLERA. 

Calcutta Report, and very destructive in a detachment of Bengal troops, marching through the Northern Circars, in the months of March, April, May, and June, of 1790. In one division, consisting of one thousand artillerists, the cholera appeared, and destroyed seven hundred of them in six days. 

Dr. James Johnson, in his work on the diseases of tropical climates, alludes to the prevalence of this disease in the vicinity of Trincomallee, about the year ISO 4. 

Several other writers allude to its prevalence in India previous to ISI7, and although its ravages have not been so great as subsequently to that period, yet no doubt can exist in the mind of any one who examines the subject, of the fact that cholera has very frequently prevailed epidemically in India, previous to its appearance at Jessore. But as it did not attract much attention in Europe previous to its occurrence at this last place, we shall endeavor to be more minute and particular in describing its appearance in 1817, and its progress since that time. 

Progress of this Disease from 1817 to 1832. 

It was at Jessore in August, 1817, and its occurrence there was especially noticed, on account of the great numbers affected by it, and its extraordinary mortality. It is reported within a few weeks to have cut off more than six thousand of the inhabitants. 



As many speculations have been and will be connected with the origin of this pestilence, as well as with its subsequent Irse through different countries, it maybe well to quote here art of the account drawn up in 1820, " by order of the govrnent of Bengal, under the superintendence of the medical ird, by James Jameson, assistant surgeon and secretary to the board." 

11 Not to speak of its frequent occurrence, so early as May, in some parts of Nuddeea and other districts, it is quite clear from the statements of the medical staff", that, more than a month previously to Jessore's becoming affected, the disease had begun to prevail epidemically in the distant provinces of 



week in August, it had firmly established itself in many other parts of Bengal. On the 23d of August, we find it raging at Chittagong, far around the eastern corner of the tract lying east of the Bay of Bengal : at the same moment in llajshahy, a central district lying east of the Ganges ; and not a week afterwards, in the high and distant tracts of Bhaugulpore and Monghyr. Soon after the middle of September, the disease, now strictly epidemical, extended itself in every direction. lithin the area of several thousand miles, thus in so short a riod brought under its influence, few towns or villages of any isiderable size wholly escaped its attacks. The only spots the eastern side of the Ganges, beyond the precincts of Ben, attacked by the epidemic in the autumn of ISI7, were ?ozufferpore, and Chupra, the principal stations of the Tir)t and Sarun districts; and the cantonment of Ghazeepore ; (1 in eachofthe.se places its attacks were confined to the vns themselves, or villages in their immediate vicinity : the >at bulk of the adjoining country, at this period, entirely •aping the disease. 

And now the epidemic began to show one of the most striking peculiarities which characterized its march. It no longer pushed its influence, without distinction or apparent choice, in all directions. It began to affect particular lines, and to fix itself in particular divisions of country ; wholly restricting itself for the time to the course of those lines and 

I Although the epidemic would seem to have beset Zila rzapore, and to have slightly appeared at Oonchara, and in ; camp of His Majesty's 17th Regiment of Foot, and of the Battalion Bth Regiment of Native Infantry, at Mongawa, ir the northern extremity of Itewa, about the middle of Nonber ; it did no great mischief, until in the end of the first ek of that month, it reached the central division of the Grand my, then encamped, under the personal command of the irquis of Hastings, near the banks of the Sinde in Bundle- 

It was here that the disease put forth all its strength, and assumed its most deadly and appalling form. It is uncertain 

13 





Koi me nioiuij. .ictj ing ii >vi, ik »">tr, in us ted insidious manner, for several days among the lower classes of the camp followers ; it, as it were in an instant, gained fresh vigor, and at once burst forth with irresistible violence in every direction. Unsubjected to the laws of contact and proximity of situation, which had been observed to mark, and retard the course of other pestilences, it surpassed the plague in the width of its range ; and outstripped the most fatal diseases, hitherto known, in the destructive rapidity of its progress. Previously to the 14th, it had overspread every part of the camp ; sparing neither sex nor age in the undistinguishing virulence of its attacks. The old and the young, the European and the native, fighting men and camp followers, were alike subject to its visits ; and all equally sunk in a few hours under its most powerful grasp. From the L4th to the 20th or 22d, the mortality had become so general, as to depress the stoutest spirits. The sick were already so numerous, and still pouring in so quickly from every quarter, that the medical men, although night, and day at their posts, were no longer able to administer to their necessities. The whole camp then put on the appearance of a hospital. The noise and bustle almost inseparable from tin; intercourse of large bodies of people, had nearly subsided. Nothing was to be seen, but individuals anxiously hurrying from one division of the camp to another, to inquire after the fate of their dead or dying companions ; and melancholy groups of natives bearing the biers of their departed relatives to the river. At length, even this consolation was denied them ; for the mortality finally became so great, that there was neither time nor hands to carry off the bodies ; which were then thrown into the neighboring ravines, or hastily committed to the earth, on the spots in which they had expired, and even round the walls of the officers' tents. All business had given way to solicitude for the suffering. Not a smile could be discerned, nor a sound heard, except the groans of the dying, and the wailing over the dead. Throughout the night especially, a gloomy silence, interrupted only by the well known dreadful sounds of poor wretches laboring under the distinguishing symptoms of the disease, universally prevailed. The army moved to a healthier place ¦ but hundredd 

14 





dropped down during every day's advance, and covered the roads with dead and dying ; the ground of encampment, and line of march, presented the appearance of a field of battle, and of the track of an army retreating under every circumstance of discomfiture and distress. From the military returns, it appears, that in this fatal week, of 11,-500 fighting men of all tcriptiona, 704 fell victims to the disorder; and of the camp ovvers, it was conjectured, that about 8,000, or one-tenth of whole, was cut oft*." 

I It has been supposed that at least 000,000 died of cholera in rty-two cities, during its prevalence in 1817 in India. 

In 1818, the cholera prevailed on the river Jumna, from its connexion with the Ganges, to the distance of two hundred leagues. I'atna, Agra, Mullra and Delhi, wen; visited by the disease. Patna contained 2-30,000 inhabitants, of whom 1,539 died by cholera. At Sharunpore, 260 perished out of 30,000 people. Agra suffered severely. At Delhi, the victims wen. 1 numerous. At Benares, 15,000 persons died in two months ; and at Allahabad, forty to fifty died in a day. At Calcutta, 13,920 persons were attacked in the last three months of 1818, and the registers of deaths caused by cholera, among the Indians and Mussulmen population, show that above 5,000 perished. 

IM'om Bombay, the epidemic extended itself towards the th, ravaged Surat, Poonah, Serror and Collapore. It was iced among the inhabitants on the high mountains which >arate Hindustan from Napaul, and also in the valleys of tmandou, Patun and Bhatgoun, the elevation of which is re than 4,000 feet above the level of the sea. 

t During the year ISIB, its ravages were as great, or greater n they have ever been since, in the course of one year. re than 140 cities or villages were visited by it, and it exded from the equator to the twenty-eighth degree of north tude, and over an extent of thirty degrees of longitude. 

Ei 1 819, the progress of the cholera was not so great as in two preceding years, li prevailed for a considerable porofthe year in Calcutta, but the number of deaths did not :ed 1,459. In the Presidency of Bengal, a great number 

15 





of cities in which the cholera prevailed the year before, were visited by it this year also. 

The citadel of Jaragurth, built on an isolated rock, at a height of one thousand feet above the plain, was visited by the epidemic, whilst the inhabitants of a city situated at the foot of the mountain entirely escaped. 

It has been calculated that 150,000 people died in the Presidency of Bombay, of the disease in 1819. Entire villages were depopulated, and the terror was so great that the crews of many vessels, loaded with cotton, deserted and fled in the night. At Bombay, it was ascertained that from the month of April, 15,945 individuals were attacked by the disease. 

The island of Sumatra was also devastated the same year by this epidemic. 

In the isle of France it is said to have destroyed from 10,000 to 20,000 persons in ISI9. The space over which it spread during that year, was about 40 degrees of latitude, and 50 of longitude. 

The number of cities in which it prevailed during the year, was about 64, or only one-half as many as it ravaged in 1818. 

In 1820, it raged in the Presidency of Bengal, the President of Madras, Bombay, Penang, Ceylon, the island of Bourbon the Philippine Islands, Sumatra, Siam, Tonquin, and Cochin China. A less number of cities was attacked than in 1819 (42 instead of G4,) yet it appears that the morbific influenc extended farther, and comprehended 60 deg. of longitude and 40 deg. of latitude. 

In IS2I, the disease visited the same places, nearly as i the previous year; and, in addition, Kishme, (an island situatec at the entrance of the Persian Gulf,) Ormus, Muscate, Ben der Abouchir, and Bassora — where, out of 60,000 inhabitants from 15,000 to 18,000 died in eleven days ! From Bassora it was carried to Bagdad, Borneo, and Java. Batavia los 17,000 inhabitants, and the entire island of Java, 102,000. 

Such was the progress of the cholera in the course of the year IS2I. We have seen that it spread from places situated under the 40th degree oflongitiule and 35th deg. of north lati- 

16 





Bth (leg. of south latitude ; a space of 43 (leg. of latitude and 70 deg. of longitude. In 1322, it visited many of the places which it had visited previously. Jt also extended to Canton, Pekin, and ninny other cities of China ; and to Syria. The number of deaths, and the number of cities infected, were much less than in the preceding years. In ] ; j, British India nearly escaped its ravages — but I'crmah and China suffered much, also the north of Persia, and the borders of the Mediterranean and Caspian Seas. In the course of the year it extended to the frontiers of Europe, to Astrachan, and Orenbourg. In 18S4, few countries were attacked by cholera; but the higher classes suffered wherever it did prevail. From L 825 to 1830, comparatively few places were attacked by the disease; stdl it was working its way towards Europe. In LB3O it reached Moscow. At the height of the epidemic, 244 persons were attacked in one day. The consternation was great throughout the Russian empire. The Emperor liberally offered a reward of 25,000 rubles (about $5,000) for the best dissertation on the nature, causes, prevention, cure, &c. of cholera. In 1831, it reached Archangel, Warsaw, and almost every village of unfortunate Poland. Ju May, it broke out in Riga, where it raged until late in July. It also prevailed at the same time at Polangen, Dantzic, and other ports on the Baltic. On the 26th of June, the cholera, appeared in the imperial city of St. Petersburgh. The Czar became terrified, and with his court retired from the city, and surrounded himself with a cordon militaire, allowing no approach from without. It broke out at Mecca, about the first of May. LB3l, at the lime when innumerable pilgrims from every part of the empire were collected there to visit the holy places. It is said, that of 50,000 pilgrims to the shrine of Mecca in 1831, about •20. 000 perished of the cholera. The disease appeared at Berlin in the course of 1831, and prevailed to a. great extent in Hungary. It soon reached Austria; and at Vienna destroyed more of the nobility and 

17 





people belonging to the upper classes of society, than it ever had at any other place. It was likewise more fatal here, than it had ever before been noticed, to the physicians and other attendants on the sick. 

Oct. 2G, it appeared at Sunderland, in England. Tn a few weeks after, it broke out at Newcastle, Gateshead, and numerous places in that vicinity; and on the J7th of December, it first appeared in Scotland, (at Haddington.) 

ilMic progress of the cholera in IS-S2, was greater in extent n during any previous year ; for, it not only spread to most the great towns in Europe, but reached this western contilt, and our own country. 

The cholera appeared at Edinburgh, on the 27th of January, IS;>2, but its ravages in that city were not great< It also appeared about the same time at various places in the neighborhood of Edinburgh and Glasgow, and early in the year it reached London — the largest city every visited by pestilence ; but, very unexpectedly, its ravages in that modern Babylon wen; very inconsiderable. It appeared for the first time at Paris, on the 24th of March; and in that splendid city it prevailed with great severity. Some days, the deaths amounted to nearly one thousand. The printed reports give SOL deaths on the 9th of April. It has been calculated that 20,000 died of cholera at Paris between the 24th of March and the end of the following April. 

Progress of the Cholera at Quebec and Montreal. 

Irhe first appearance of the epidemic cholera on this contiit, was at Quebec and Montreal. At Quebec, the disease ameneed on tin; Bth of June; and in a few days after, sevecases occurred at Montreal. 

On the 7th day after its appearance at Quebec, 143 died of the disease; and on that and the succeeding five days, the deaths from cholera amounted to 711 — being an average for the six days of US deaths per diem. From the commencement of the disease to the sixth of August — a period of fiftyeight days — the number of deaths from cholera at Quebec imounted to 1790 

18 





At Montreal, the disease raged with great violence, as will be seen from the following statement of the cases and deaths, from the commencement of the disease to the 13th of July, 

Daily Cases. Daily Burials. Total Cases. Total Dtp.tlis 16, 381 86 1709 . 261 17, 474 102 2183 363 18, 261 128 2444 491 19, 338 149 2781 640 20, 165 94 2946 734 21, 15 76 3097 810 22, 109 52 3206 862 23, 83 31 3289 893 24, 51 21 3340 914 2a, 44 :?:* 3384 947 26, 27 23 3411 976 27, 21 25 3432 996 28, 22 20 3454 1016 29, 37 21 3491 1037 30, 32 22 3523 1059 Julyl, 23 17 3546 1066 2, 13 20 3559 1076 3, 11 14 3570 1110 4, 23 17 3593 1127 5, 22 13 3615 1140 6, 19 9 3634 1144 7, 13 9 3647 1153 8, 14 11 3661 1164 9, 10 9 3671 1175 10, 7 6 3678 1184 11, 14 10 3692 1190 12, 15 10 3707 1200 13, 9 10 3716 1210 Afterwards its severity abated. 

The Disease at New-York. 

The cholera commenced at New-York about the 24th or 26th of June. The second day of July, the Board of Health announced that eleven cases had occurred, all of which had terminated fatally, and that three new cases had that day been reported. The progress of the disease afterwards was as 

19 





03 — < m &> — - 22 4) ;J « n "C I Ji i i si i ft ! I II I 5 15 3 18 10 2 12 G 11 13 24 8 7 IT> 7 42 13 .'JO* 88 ti (! L 3« 25 8 29 13 40 10 II 21 9 18 30 !>7f X'"> 4 10 14f 2S 10 44 22 43 109 (i 13 25 41 11 45 31 53 129 1(1 15 2."> 50 12 32 39 48' H!» 10 I<> 25 51 13 27 39 35 101 10 22 17 49 14 4:5 43 28 II") 15 29 22 66 15 60 53 20 133 28 31 15 74 16 92 51) 21 163 45 32 17 94 17 60 63 23 146 19 29 12 «) 18 65 59 14 138 22 15(5 14 72 19 114 77 11 202 42 28 12 82 20 132 66 28 226 48 42 10 100 21 191 100 20 311 61 33 10 104 22 154 7(5 !) 2 241 50 35 5 1 91 2,'{ Ki;s 42 26 231 46 17 20 X) 24 lrtrf 51 22 35$ 2<X> 57 22 7 LOJ 96 25 99 45 10 'i 157 21 32 5 3 (JI 26 75 4H 14 4 111 2:5 21 7 1 55 27 7'i 46 '3 122 2;} 18 5 4(i 28 9;{ 49 1 2 145 Wl 20 4 1 68 161 58 1 2 122 19 15 ,*} 3 39 62 35 3 3 103 14 19 3 :] 39 59 52 1 9 121 2:5 20 :} 2 48 Aug47 33 4 2 92 L 3 21 3 I 41 47 24 0 10 81 U 17 0 3 ;)1 3 48 :r> 1 5 90 14 8 1 I 24 4 48 35 3 2 HS 17 11 2 0 30 5 57 38 0 1 9(5 21 8 0 0 29 G tiO 38 0 3 101 21 15 0 1 37 7 57 31 0 1 89 19 12 0 I 32 8 50 32 0 0 82 12 9 0 0 2t 9 47 2G 0 0 73 18 10 0 0 28 10 <!() 34 0 3 97 18 7 0 1 2(1 133 41 0 2 7(i 18 15 0 0 33 32 33 0 2 67 !> 12 0 2 23 »;:} 41 0 1 101 11") 6 0 I 22 18 24 0 42 8 7 0 15 33 29 13 75 14 9 4 26 39 37 3 79 14 11 1 26 28 25 10 43 M 8 2 21 38 3d 1 7<; <; 13 0 19 .2859 1817 556 92 5323 937 780 305 38 2057 

'These include nil in Bellevae Hogpital, from June ?7tli to July 7th. f These include all in Bellevue on the Bth and 9th. I Including two dayi 

20 





It is worthy of notice, that during the prevalence of the cholera at New-York, t he number of deaths from other diseases was greater than usual, notwithstanding the number of inhabitants had greatly diminished. The same was observed at Berlin. 

The disease appeared at Albany, July 3d, and, up to August 18th, 1131 eases occurred, of which 319 terminated fatally. Then it declined. 

A few cases of cholera occurred at Philadelphia, about the middle of July, but the disease soon subsided, until the 27th, when it again appeared, and continued for a considerable time. 

The sth of July, it appeared at Detroit, where it prevailed for some time. The 17th of July, at Buffalo, and soon after, i ho tlisease prevailed in several towns on the banks of the Grand canal, in the state of New-York. 

It appeared in several towns in New Jersey, about the middle of July, and the 24th of the same month it broke out at Norfolk and Portsmouth, in Virginia, where it raged with great violence, especially among the colored population. 

Several towns in Connecticut were slightly visited by the disease, in the course of July. 

It appeared in Rhode Island about the first of August ; and the 15th of the same month, two cases occurred at Boston; and about the same time it commenced at Baltimore; and, within a few days, several cases occurred at Elizabeth city, .North Carolina. 

The first of July, more than fifty touma were visited by tl epidemic or malignant cholera, and the disease appeared Sti to be extending in every direction. It visited Newark, Prince ton, Trenton, New Brunswick, Elizabethtown, &c, &c, l\e\ Jersey; Cleaveland, and other towns, in Ohio ; New Have) Hartford, New London, &c., Connecticut ; Troy, Lansing burgh, Rochester, Utica, Syracuse, Poughkeepsie, Lockpor Brooklyn, Schenectady, &c., &c, state of New-York ; Wil mington and Newcastle, in Delaware ; and, finally, Spread over the lencth and breadth of the Union 

21 





22 

SYMPTOMS OF THE CHOLERA. 

Simptoms of the Cholera. 

In the description of the disease, there is very little difference among those who have been conversant with il. The following is a general statement of the symptoms, and their course. 

I There take place vomiting and purging, in which the ordiry contents of the alimentary canal are very effectually and ry rapidly evacuated. Then ensue copious and frequent disarges from both stomach and bowels, not of the ordinary sections found in those organs, but of a thin turbid fluid, com>nly colorless, having some small opaque masses floating in These evacuations are preceded and accompanied by rearkable constitutional affections. At first there are general slings of indisposition ; or there are still more remarkable evenccs of disease in the countenance and general appearance, liich are easily recognised by the experienced physician, lien the patient is scarcely aware of his own change. The Ltient only acknowledges some ill feelings, of an indefinite laractcr, and such as seem common to many ordinary diseases ; or he complains of a partial deafness, with some giddiiss, or even actual vertigo. There is, however, manifested, not expressed by him, a sense of anxiety, such as arises iin a physical rather than a moral cause ; and some acute servers have thought that this is always to be discovered long the precursory symptoms, when opportunity is afforded of witnessing them. But how far this is true, universally, or even generally, it is not easy to decide, because few patients are under the eye of a skilful observer at this period; and, further, because a large proportion of seizures occur in the night. Despondency of mind, and often a sullen despair are very commonly noticed after the confirmed state of the disease has commenced. Immediately after the first evacuation, and sometimes before any, a sudden prostration of strength ensues. The patient can no longer stand, and exhibits many of the symptoms of the first stage of a violent fever. He has an extreme coldness, with a remarkable shrinking of the whole body, most especially noticed in the countenance: also with a loss of all natural color, sand a lividity in tho^xtremities. The pulse gradually sinks, until it can no long^- be felt at the 



SYMPTOMS OF THE CHOLERA 

23 

wrist. The sense of faintness and of exhaustion at the stom 

ach is extreme. Cramps and spasmodic affections ensue in the limbs, and subsequently in the trunk, attended by violent distress and pain. The pain often causes the most courageous to make noisy outcries, and to roll themselves about as if frantic. But, separate from the agony of pain, the patient sutlers an anguish, referable to the heart, which is probably equal to any physical misery men are called to endure. This anguish is perhaps the same in kind which arises from affections of the heart, induced by various causes, — from moral emotion, from sympathy in sudden and violent injuries, from inflammation in or about, the heart, or from embarrassment, when it is the seat of an organic disease. ]n this instance it is connected with that sudden failure in the functions of this organ, which constitutes an important and characteristic part of the cholera. The tongue is moist, but greatly altered in its appearance, shrinking and growing pale, like the skin. Within, there is a sense of great heat, and this is accompanied by an unconquerable thirst and craving of cold water. The secretion of urine fails, while there exudes from the skin a clammy and cold sweat. The heat deserts the surface, and yet the patient can rarely be induced to allow his body to be kept covered. At length the respiration becomes labored in many instances, while even the heart can scarcely be felt to pulsate. In the confirmed state of the disease, the countenance acquires a peculiar character, so that it has been called the cholera countenance. It has been also called the triangular face. "It is difficult to describe, but it bears a striking resemblance to the 

appearance of age; and seems to arise from the paleness, wasting and shrinking of the features, and the depressed am disturbed state of the mind, conveying into the countenance strong expression of care, anxiety and alarm." A peculia and strong odor is often perceived from the body of the patieiu Sometimes the air expired from the lungs is sensibly cold and Dr. Davy states that the lungs give out less of carbonic acid in the air expired, than in health. The tongue becomes cold and often shrivelled. At a late period, in severe cases, the skin assumes the feeling of a wet hide. Meanwhile, the intellect is unimpaired and the senses very nenrlv so • although 



the failure otherwise is so ns to transform the patient in a short time to the appearance of a " living corpse." A few hours suffice to m;ike him a real corpse. 

The disease in India often destroyed life in two or three hours. Indeed, the patients there sometimes fell down, and expired almost nt once, when it had not before been noticed that they had been invaded by the disease, though probably it might have been noticed had attention been called to them. Death was very rarely protracted beyond thirty-six hours : or, at least, if it occurred at a later period, it was after a different Course of symptoms. When the disease does not prove fatal, relief takes place spontaneously within thirty-six to seventytwo hours, in most instances ; and by aid of remedies it is often obtained much sooner, as well as more certainly. But Bdmelimes the convalescence is slow, the constitution having suffered greatly by the violence of the disease. This was noticed in India. In Europe it has been observed, much oftener than in India, that continued fever, with a low typhoid character, has ensued upon the first disease, Tind continued for an indefinite period ; not unfrequently proving fatal. In India, fever of a bilious character did occasionally ensue. In these cases the whole disease may perhaps be regarded as a fever, commencing with remarkable coldness and prostration, and accompanied by the local derangement of the stomach and bowels. To form an adequate idea of the disease, a more detailed account of it is necessary. For this purpose it may be divided into different stages, although these may-not always be recognised distinctly. We cannot perhaps make these known in any way better than by quoting the following graphic description, from Mr. George Hamilton Bell, who witnessed and studied the epidemic in India for several years. The latter Xt of the quotation contains some particulars, besides the sription of the different stages of the disease, which are firmed by other writers. 

" In describing this disease, I reckon four stages 

"I. The invasion of cholera is so insidious, that the individual attacked may be quite unconscious of the presence of the first stage of it. Generally speaking, indeed, it is only to be detected by those well acquainted with the disease, and by 

24 





whole course of the disease, the appearance oi the countenance is one of the most highly characteristic symptoms^ An intimate friend, perhaps, observes, that the person attacked has an expression of anxiety, that his complexion is unnaturally earthy, and that his eves seem sunk in his head. In reply to inquiries, the patient will perhaps deny that he is unwell : he mnv «iv however, he is a little deaf; and, if minutely questinned, he may admit that he has indescribable sensations of being out of order, and that he is unaccountably depressed and Listless : he may have no nausea, hut he has tormina of the bowels, and perhaps an uncomfortable sensation of heat at the nit of the stomach ; the pulse will he found quick and weak ; (T hare never found it have the febrile throb ;) the hands and (eet feel cold ; the nails are blue, and he has had one or more unnatural alvine discharges. The first of these is generally characteristic ; there is a sudden call, and the whole intestines seem to lie at once emptied, followed by a feeling of weakness. 

"Thus, 'while the servant (a. Hindoo) of Captain 11. was brin< T in ir in breakfast, his master was struck with his appear^ ance, and asked him what ailed him. He replied, he had nothing to complain of hut deafness, which he ascribed to sleeping in the cold night wind. His master, alarmed at his looks, sent him to the hospital tent, (the epidemic was prevailing in the camp to which the gentleman belonged.) On minute examination, the man was found to have had some suspicious stools, his pulse had sunk, his skin was cold. He had cholera, and became rapidly worse; and although he was put immediately under treatment, and was a man of good habits and Btron" constitution, he had a hard stru<:L r le for his life.' 

" It is unfortunate that the first statre of' cholera is only to be discovered by the most, experienced eve ; and that even when the patient himself has a suspicion of Ins condition, the risk of exposing himselfto ridicule, from its being ' a falsa alarm.* may keep him silent, while the acknowledgment of Ins fears might have been the means of saving his life. Jt is to this insidious approach of a malady at all times so mortal, that, in part at least, must be ascribed its being so alarmingly destructive <"•') its first breaking out at a station patients being extremely 

25 





«1 1)1 [O iJill ) v > JL I* *"-% willl 1l 1 1 1 ' 1 1 1 1 i. 1 lliC^tXlJo I* Iwlt Lilt \ ct/wK assistance. 

"~\ r J'hc second stage of cholera is more decidedly characterized. The pathognomiu appearance of the countenance, to those who have ever seen the disease, is no longer doubtful: the eyes are sunk in the head; the lips are blue; there is v ghastly look about the mouth ; and the whole features arc shrunk. The patient does not now deny being unwell; he acknowledges having passed some peculiar stools, and probably has had vomiting; these have been followed by great prostration of strength : there is tinnitus aurium ; often slight deafness and vertigo; the pulse is more decidedly affected — it is weak and thready; the skin is cold; there is much thirst, and a burning pain at the pit of the stomach ; but the ligue is not dry — it is moist and white. When the ratio mptomaUim of the disease is under consideration, it. will be sessary to take particular notice of the fluid which is passed in the stomach and bowels; at present it is sufficient to ,y that, it is not alimentary, or excrementitious ; it is either lomogeneous and almost limpid, or a turbid fluid ; or is like iter in which grain has been boiled, with pieces, more or s numerous, of opaque white or yellowish coagulated matter iting in it. The manner in which the discharges take place characteristic : the desire is sudden, unaccompanied by ping or nausea, and the stomach or bowels are emptied at :e, and with some violence : the gastric and intestinal evaition are similar in their appearance and nature. 

"3. In the third stage, the appearance of the countenance is still the most prominently characteristic symptom. The Kss, surrounded by a dark circle, are completely sunk in the kets ; the whole countenance is collapsed ; the skin is livid; and the expression so altered, that the patient's most intimate friend can hardly recognise him. The surface is now generally covered with a cold sweat ; the nails are blue; and the skin of the hands and feet is corrugated, as if they had been loiiL r steeped in water; the sensibility of the whole surface is deficient, but it is by no means uncommon for patients to complain of a burning heat in their cold skin. Vesicatories do not act, even boiling water does not raise a blister! The voice 

26 





is hollow and unnatural. If the case be attended with spasms, the Buffering of the patient is much aggravated, and is sometimes excruciating. The spasms commence in the hands and feet like cramp ; they stretch up the limbs to the trunk, which however they do not always reach. In some cases again the muscles of the abdomen are principally affected, and they are drawn towards the spine (luring the whole course of the disease. These spasms may have commenced early in the disease ( being on some occasions the very first symptom. The discharges from the stomach and bowels are at this stage very irregular: in some cases they are still very frequent J in others, after one or two evacuations, they wholly cease. The pulse at the wrist, if it have not ceased, is scarcely perceptible, and the heart is beating feebly; and when the spasms are severe, they frequently, even though the pulse be still quite distinct, stop it during the paroxysm. The same effect is produced by excessive vomiting. The breathing is slow and often oppressed : this also sometimes occurs early in the disease ; the exhaled breath is cold ; and although the heat of the body is some degrees below the standard, the patient throws off the bed-clothes, and beseeches the bystanders to allow him cool air and cold water. Hickup is not an uncommon symptom. 

(•4. In the last stage, the intestinal evacuations have most ly ceased ; the eyes, completely sunk in their orbits, are sed and flaccid, turned upwards, and half-covered with the lids; the snasms are now commonly at an end ; the extremities, indeed the whole body, is that of a corpse; and the impression communicated by the skin has been well likened to that of " a damp hide ;" every artery has ceased to pulsate, and the action of the heart, if perceptible, is a mere ilutter; the whole body is bathed in a cold and clammy sweat: it is painful to witness the oppression of respiration and jactitation of the sufferer. The dying man can still be roused — but, when undisturbed, he generally appears in a state approaching to stupor; and though often in a humor which might almost be termed sulky, is in most cases coherent to the last. These symptoms are the immediate forerunners of death. 

" h' blood be drawn during the progress of the disease, it is 

27 





found, in the outset, dark-colored ; as the case advances, the blood becomes thick, there is ;i deficiency of serinn, it coagulates quickly, and does not assume the butly coat. In the last stage of the disease, the current in the veins has stopped, and the blood is so grumous that it can scarcely be forced out, in the smallest quantity, through a large orifice. 

I' The whole course of these stages, generally speaking, does exceed sixteen hours; and, unluckily, the practitioner is lorn called in until the first, and part of the second stage c passed. The period consumed by each of the above ficial divisions, varies in every case. J have seen instances which death ensued in less than four hours after the comncement of the disease ; and others in which its latter stages, h the pulse quite imperceptible, had already lasted a whole 

I- The condition of the mind is remarkably collected during whole progress of this terrible illness ; for though patients, the malady advances, are unwilling to be disturbed with ¦stions, this appears rather to result from the want of phyd energy than from any intellectual failure. Indeed, as the d event approaches, the only wish a patient seems to have, obe allowed cold water, and to be left to die in peace. It been well said, that a patient in the last stage of cholera, v be called ' a living corpse.' 

I A curious phenomenon has been several times observed : sr a patient has been some time to all appearance dead, when the attendants were dressing the corpse, spasmodic tches have taken place in the limbs, having in some instaneven extended to the muscles of the; body; and general smodic contractions have supervened. This peculiarity, ; believed, has also been observed in Russia. 

" Cases often occur in which one or more of the above de- 

I'd symptoms do not appear. There maybe no spasms; vom ii ing and purging may early cease, or there may have n only one large alvine discharge, followed by a mortal apse, the patient seeming to be at once struck with death; although, on the very lirst appearance of the disease, he walked to the surgeon, his pulse is found to be gone, his 

28 





henrt has ceased to beat, blood can be trot only by drops from the veins, he lays down his head, and dies without a eom-11 These anomalies arc not confined to individual instances, but are found to occur, as Mr. Scott well expresses it, in ' local epidemic visitations.' Thus, he says, 'when the disease appears epidemically in a town or district, or in the lines of a corps or the camp of a marching regiment, it may on one occasion be distinguished throughout, by the absence of vomiting, and the prevalence of purging; and on another, by the excess of vomiting, and, though more rarely, by the absence of purging. Spasm may be generally present in one instance of invasion ; in another, it may not. be distinguishable.' " J was on one occasion called upon to send assistance to a district in which the disease was thus described to exist: 'It commences by attacking the sufferer with an agonizing heat: in the stomach, vomiting and purging, and lock-jaw; death ensues in two hours, and often more rapidly: it bids defiance to every remedy.' — (Extract from letter of the Hon. Mr. Harris, Principal Collector, Sooilda.) "But, in a\.i. cases, there arc the collapsed countenance, blue lips and nails, shrunken fingers, the total failure of the usual secretions, deficient animal heat, suspension of the pulse, and remora in the venous circulation."* The symptoms of the cholera, in England arc thus described in the Medico- Chirurgical Review for April, 1832: — " The cholera in England has maintained a striking resemblance to the oft-repented descriptions of its symptoms in other countries. Thus, the severe vomiting and purging of peculiar characteristic secretions; the nausea, internal burning at the epigastrium ; intolerable weight, anguish, and oppression ; the paroxysms of severe pain commencing at the stomach, and rapidly extending over the whole alimentary canal; the ardent thirst ; the cramps; the deadly prostration, anxiety, and dejection ; the conscious feeling of the hand of death ; the failmg of the circulation and animal heat ; the peculiar cold sweat; shrinking of the skin and subjacent tissues; sharp- 



29 





ening of the features; contraction of the fingers, and prominence of the tendons; the hollow, sunken eye; the leaden aspect of the surface, particularly visible in the hands, feet, nails, lips, and the circles around the mouth and eyes ; the black, thick blood, often not to be obtained; the difficult and slow respiration; cold breath and tongue; the whispering voice: and if death comes not in this shape, the fever rapidly coming on, often takes the last stage of typhus. The sudden invasion, speedy death, or as rapid recovery, have all been witnessed in England, as well as in the north of Russia, and on the banks of the Ganges. 

But this alarming catalogue, drawn up from the whole, pre sents no current picture of any individual case. These diflfe cut symptoms in different persons vary infinitely, in the degre I their severity, from the common diarrhoea, with little pai 1 no cramps, and no greater a flection of the circulation am iperature of the surface than occurs from the operation ( ordinary purgative, up to the sudden attack of a prostr; i so alarming, that the sick man becomes scarcely sensib tain when the secretions are retained, and the heart's actio ks at once. 

r'o illustrate these different forms, we have made the followselection of cases. 

BPhe following bears a greater resemblance to common lera, than to severer cases. 

Mr. A. Hopton, Deputy Governor of the jail at Durham aged 58, of rather free habits ; general health not very gooc On the 14th of January, he felt oppression at the stomac sense of heat and uneasiness, with occasional nausea. A two o'clock on the morning of the following day, he was seize< with violent purging, attended with violent cramps in tl limbs ; the evacuations were almost incessant throughout th day — thin and watery, of a pale white color, almost withoi smell. At eight, in the evening, there was great alteration i his appearance ; countenance blanched and anxious ; features sharp ; skin rather cold, and covered with a clammy sweat ; pulse slow and weak ; breathing oppressed ; complains of most distressing thirst ; some softening of cuticle of fingers ; the cramps are not constant, but recur at intervals ; most vu>- 

30 





lent in the hands and feet ; occasionally extending to the thigh ; inclined to sleep in the intervals. ¦ 

(Treatment. — Coffee, mustard, brandy, opium, cayenne p^p*, camphor, carb. ammonia, and oil of peppermint* The nptotns continued somewhat mitigated on this day and the owing. 

Il'he premonitory symptoms have been, in some cases, of g duration; in others, absent. They are, uneasiness: a ise of heat and disorder in the stomach and bowels ; irejntly diarrhoea, which at first presents no peculiar character that a man could tell whether an attack of the cholera was sending or not : this has prevailed, in some cases, for a ek or more before the attack ; in others, it has only preceded other symptoms for a few hours, or a shorter period. 

The elder Sproat, aged 69 — the first case of acknowledged cholera in Sunderland — had been laboring under diarrhoea a week or ten days before his seizure. On Wednesday, Oct. 19th, he had been taken worse : on Thursday and Friday, he had vomiting and purging of feculent matter, but no symptoms of collapse. On Saturday, he was greatly better; took a mutton chop to his dinner, and went out to his keel in the afternoon. In about 20 minutes he returned, and was taken very ill, with severe shivering, giddiness, cramp at the stomach, violent vomiting and purging. On Sunday morning, he was sinking: pulse imperceptible; extremities cold; skin dry; eyes sunk; lips blue; features shrunk; whispering voice; violent vomiting and purging; cramp of the ealvos of the legs; and complete prostration. In the afternoon his skin became warmer, but the other symptoms continued. On the 24th he was quite collapsed, with aggravation of all the symptoms, except the vomiting, which had entirely ceased ; stools passed involuntarily. On the following morning he was less 

Epsed ; countenance more natural; blueness of the lips disappeared ; the vomiting dad ceased ; but the purging continued less violent, and nearly imperceptible; extreniicold ; spasms of the legs continued. Towards evening, purging and vomiting had entirely ceased; he became >y ; the other symptoms continuing. On the morning of 26th, he was much weaker; pulse scarcely perceptible; 

31 





found, in the outset, dark-colored ; as the case advances, the blood becomes thick, there is a deficiency of serum, it coagulates quickly, and does not assume the bully coat. In the last Stage of the disease, the current in the veins has stopped, and the blood is sogrumous that it can scarcely be forced out, in the smallest quantity, through a large orifice. 

I' The whole course of these stages, generally speaking, does exceed sixteen hours; and, unluckily, the practitioner is lorn called in until the first, and part of the second stage c passed. The period consumed by each of the above ficial divisions, varies in every case. I have seen instances which death ensued in less than four hours after the comncement of the disease ; and others in which its latter stages, h the pulse quite imperceptible, had already lasted a whole 

I" The condition of the mind is remarkably collected during whole progress of this terrible illness; for though patients, the malady advances, are unwilling to be disturbed with 'stions, this appeare rather to result from the want of phy- Eil energy than from any intellectual failure. Indeed, as the il event approaches, the only wish a patient seems to have, obe allowed cold water, and to be left to die in peace. It I been well said, that a patient in the last stage of cholera, v be called ' a living corpse.' 

" A curious phenomenon lias been several times observed : After a patient has been some time to all appearance dead, and when the attendants were dressing the corpse, spasmodic twitches have taken place in the limbs, having in some instances even extended to the muscles of the body ; and general spasmodic contractions have supervened. This peculiarity, it is believed, has also been observed in Russia. 

"Cases often occur in which one or more of the above detailed symptoms do not appear. There maybe no spasms; the vomiting and purging may early cease, or there may have been only one large alvinc discharge, followed by a mortal Collapse, the patient seeming to be at once struck with death ; and although, on the very first appearance of the disease, he has walked to the surgeon, his pulse is found to be gone, his 

28 





the vein's, ho lays down his head, and dies without a complaint. 

" These anomalies are not confined to individual instances, but are found to occur, as Mr. Scott well expresses it, in 'local epidemic visitations.' Tims, he says. ' when the disease appears epidemically in a town or district, or in the lines of a corps or the camp of a marching regiment, it may on one occasion be distinguished throughout, by the absence of vomiting, and the prevalence of purging ; and on another, by the excess of vomiting, and, though more rarely, by the absence of purging. Spasm may be generally present in one instance of invasion ; in another, it may not be distinguishable.' 

" I was on one occasion called upon to send assistance to a district in which the disease was thus described to exist: 'It commences by attacking the sufferer with an agonizing heat in the stomach, vomiting and pursing, and lock-jaw; death ensues in two hours, and often more rapidly; it bids defiance to every remedy.' — (Extract, from letter of the Hen, Mr. Harris, Principal Collector, Soonda.) 

B, in all cases, there arc the collapsed countenance, 3 and nails, shrunken fingers, the total failure of the cretions, deficient animal heat, suspension of the pulse, iora in the venous circulation."* 

The symptoms of the cholera, in England are thus described in the Medico-Chirurgical Review for April, I S-32 :—: — 

" The cholera in England has maintained a striking resemblance to the oft-repeated descriptions of its symptoms in other countries. Thus, the severe vomiting and purging of peculiar characteristic secretions; the nausea, internal burning at the epigastrium ; intolerable weight, anguish, and oppression ; the paroxysms of severe pain commencing at the stomach, and rapidly extending over the whole alimentary canal; the ardent thirst; the cramps; the deadly prostration, anxiety, and dejection ; the conscious feeling of the hand oi death ; the failfng of the circulation and animal heat; the peculiar 



29 





30 

SYMPTOMS OF THE CHOLERA. 

ening of the features ; contraction of the fingers, and prominence of the tendons; the hollow, sunken eye; the leaden aspect of the surface, particularly visible in the hands, feet, nails, lips, and the circles around the mouth and eyes ; the black, thick blood, often not to be obtained; the difficult and slow respiration; cold breath and tongue; the whispering Voice: and if death comes not in this shape, the fever rapidly coining on, often takes the last stage of typhus. The sudden invasion, speedy death, or as rapid recovery, have all been witnessed in England, as well as in the north of Russia, and on the banks of the Ganges. 

E3ut this alarming catalogue, drawn up from the whole, pie ts no current picture of any individual case. These differ 

I symptoms in different persons vary infinitely, in the degree their severity, from the common diarrhoea, with little pain no cramps, and no greater affection of the circulation and perature of the surface than occurs from the operation oi an ordinary purgative, up to the sudden attack of a prostration so alarming, that the sick man becomes scarcely sensible of pain when the secretions are retained, anil the heart's action sinks at once. 

To illustrate these different forms, we have made the following selection of cases. 

B[*he following bears a greater resemblance to common lera, than to severer cases. 

Mr. A. Hopton, Deputy Governor of the jail at Durham, aged 68, of rather free habits ; general health not very good. On the 14th of January, he felt oppression at the stomach, sense of heat and uneasiness, with occasional nausea. At two o'clock on the morning of the following day, he was seized with violent purging, attended with violent cramps in the limbs ; the evacuations were almost incessant throughout the day — thin and watery, of a pale white color, almost without smell. At eight in the evening, there was great alteration in his appearance ; countenance blanched and anxious ; features sharp ; skin rather cold, and covered with a clammy sweat ; pulse slow and weak ; breathing oppressed ; complains of most distressing thirst; some softening of cuticle of fingers ; 



inclined to sleep in the intervals. 

Treatment. — Coffee, mustard, brandy, opium, cayenne pep- S; camphor, curb, ammonia, and oil of peppermint* The nptoma continued somewhat mitigated on this day and the owing. , 

The premonitory symptoms have been, in some cases, of long duration; in others, absent. They are, uneasiness; a sense of heat and disorder in the stomach and bowels ; fre- 

quently diarrhoea, which at first presents no peculiar character so that a man could tell whether an attack of the cholera was impending or not : this has prevailed, in some cases, for a week or more before the attack; in others, it has only preceded the other symptoms for a few hours, or a shorter period. 

The elder Sproat, aged 69 — the first case of acknowledge! cholera in Sunderland — had been laboring under diarrhoea week or ten days before his seizure. On Wednesday, Oc 19th, he had been taken worse : on Thursday and Friday he had vomiting and purging of feculent matter, but no syntl] toms of collapse. On Saturday, ho was greatly better; too a mutton chop to his dinner, and went out to his keel in th afternoon. In about 20 minutes he returned, and was take very ill, with severe shivering, giddiness, cramp at the stou ach, violent vomiting and purging. On Sunday morning, h was sinking; pulse imperceptible; extremities cold; ski dry; eyes sunk; lips blue; features shrunk; whisperin voice; violent vomiting and purging ; cramp of the calves o the legs; and complete prostration. In the afternoon his ski became warmer, but the other symptoms continued. On the 24th he was quite collapsed, with aggravation of all the symptoms, except the vomiting, which had entirely ceased ; stools passed involuntarily. On the following morning he was less collapsed; countenance more natural; blueness of the lips had disappeared; the vomiting had ceased ; but the purging still continued less violent, and nearly imperceptible; extremities cold ; spasms of the legs continued. Towards evening, the purging and vomiting had entirely ceased; he became sleepy; the other symptoms continuing. On the morning of the 26th, he was much weaker; pulse scarcely perceptible ; 

31 





the lower extremities ; the nails were livid. He was comatose, and died at 12 at noon. 

Premonitory Symptoms slight, and of short duration 

Susanna Clark, aged 18. December 6th, about live in the evening] she complained of uneasiness and distension of the stomach and bowels — her countenance became pallid, and expressive of much anxiety and distress. She was attacked with vomiting and purging of bilious fluids, and with cramps. She continued in this state until eight in the evening) when bleeding was unsuccessfully attempted. She took brandy, and a mixture containing laudanum, capsicum and ammonia. The vomiting ceased, she became much better in the night, and, on the morning of the 6th, her pulse was full and her body warm, complaining of little except a. pain in the head : but, about midnight, the cramps, vomiting, and purging returned ; she became cold, and apparently almost lifeless, though slill .sensible. Her pulse was gone; her eyes deeply sunk : she remained in the same state through the day, until mx at night, when she became comatose, and died at eight. 

Says Dr. Bingham : "In the cases which have occurred at New ork and Albany, the same symptoms have been noticed. The second week in July, I saw many cases of the disease in New ork, m all of which, the above symptoms were present. Firtft, diarrhoea, though often of only short duration, then nausea and vomiting, though in some instances the vomiting was slight, to winch succeeded a sinkingof the circulation, coldness and blueness of the surface, burning thirst, spasms, and death. In most of the cases that I have seen, the discharges from the stomach and bowels were light colored, resembling arrow root and water, or starch and water, and were without odor. In many cases, however, vomiting and purging were; not among the most, prominent symptoms, and the stage of collapse or great prostration, did not appear to arise from profuse discharges, a.s in many of the eases the most remarkable for Slid- 

32 





SYMPTOMS OF THE CHOLERA. 

33 

Appearances after Death. 

The Bengal Medical Report, drawn up and published soon after the appearance of the disease in India, thus refers to the results of post mortem* researches: 

" Of those who died, it was believed, perhaps rather fancifully, that the bodies sooner underwent, putrefaction, than those of persons dying under the ordinary eircumstanees of mortality. The bodies of those who had sunk in the earlier stages of the malady, exhibited hardly any unhealthy appearance. Even in them, however, it was observed, that the intestines were paler and more distended with air than usual ; and that the abdomen, upon being laid open, emitted a peculiar offensive odor, wholly different from the usual smell of dead subjects. In t-he bodies of those who had lived some time after the commencement of the attack, the stomach was generally of natural appearance externally* The. color ol the intestines varied from deep rose to a dark hue; according as the' increased vascular action had been arterial or venous. The stomach, on being cut open, was found filled, sometimes with a transparent, a green, or dark flaky fluid. On removing this, its internal coats in some cases were perfectly healthy; m others, and more generally, they were crossed by streaks oi a deep red ; interspersed with spots of inflammation, made up of tissues of enlarged vessels. This appearance was frequently continued to the duodenum. In a'very tew cases the whole internal surface 

of the stomach was covered with a coagulable lymph, or curdled water ; on removing which, a bloody gelatine was found laid on the interior coat, in ridges or elevated streaks* The lan r e intestines were sometimes filled with muddy fluid, sometimes avid, with dark out', like tar, just as the individual had died in the earlier or later periods ol the; attack. In most cases, the liver was enlarged, and gorged with blood. In a tew it was large, soft, light-colored, with greyish spots, and not very tumid. In others again it was collapsed and flaccid. The gall bladder was, without exception, full of dark green or black bile. The spleen and thoracic viscera were in general 





healthy. The great venous vessels were usually gorged ; and in one case the left ventricle of the heart was extremely turgid. The brain was generally of natural appearance. In one or two instances, lymph was effused between its membranes, near the coronal suture, so as to cause extensive adhesions. In other cases, the sinuses, ami the veins leading to them, were stuffed with very dark blood." 

Description of a Case by Dr. Kirk, at Vennel Hospital, Greenock. 

Feb. 1532. Malcoin M'Millan, aged 13, employed constantly in his father's pilot boat, was brought to the hospital in a state of collapse. His extremities cold and blue ; no pulsation to be felt at the wrist, temples, or carotids : face and lips very cold ; countenance dull ; eyes suffused ; eyelids sluggish ; tongue soft, clean, cold ; voice very feeble, and said by his friends to be completely altered ; is rational and drowsy ; complains of pain at and below the navel, which is not increased on pressure. Half-past three. Has had an evacuation of about three ounces, of a light brown colored fluid, resembling boiled oat-meal gruel, and of a slightly feculent smell. Four o'clock. Apply a mustard poultice to feet ; has more heat in his body and extremities; pulse perceptible at the wrist, 108; has some thirst; to have four grains of calomel, and a small quantity of brandy and water. Quarter past five. Symptoms much the same : repeat the calomel. Six o'clock. Pulse imperceptible ; had a little brandy and water- Quarter to seven. Pulse perceptible ; repeat the calomel. Half past seven. Pulse very feeble, 116 ; delirious Half past eight. Repeat the calomel. Nine, P. M. Pulse imperceptible; skin colder; face pale; eyes, more sunken; repeated the brandy and water ; injected an enema of three pounds of water, as hot as the hand could bear, to which add an ounce and half of spirits of wine. Ten, P. M. Face bedewed with cold clammy perspiration ; pulse still imperceptible ; extremities warmer ; has retained the enema ; repeated calomel and diluted alcohol. Eleven. Withdrew the enema and injected another, with two pounds of water and two ounces of brandy, and one drnchrn of laudanum. Twelve. Continue 

34 





medicine^ pulse 134. Half-past twelve. Pulse imperceptible extremities ratl.cr cold; eyes suffused. Dr. Kirk now pro nounces the ease incurable, from the state in which he fine the brain. One, A. M. Respirations 34 in a minute, op Bssed ; pulse imperceptible at carotid ; chest laboring; hei increased ; much low moaning, of the most piteous description. Had two drachms of alcohol in a little cold water a fe\ Kutes since. Quarter past one. Countenance is indescriha dark, sunk and cadaverous ; no evacuations or vomiting enty minutes past one. Breathed his last. 

Examination o/M. McMillan's hmhj twelve hour* after death, — Eechymosis of the lower limbs and outside of arms ; abdom nal viscera immensely injected, as in high inflammation ; lung collapsed ; blood Quid ; coagulable lymph filling the who right ventricle as a polypus, and a small polypus in the left the various ganglia highly injected and reddened ; bladd< empty, corrugated, and injected ; internal membrane of th bladder highly injected, like acute inflammation ; heat of th apartment SS ; thermometer in the bowels 89 ; internal men brane of bowels injected highly ; glary matter like dirty mi cous lining the whole cavity of the stomach and ileum ; splee turgid ; considerable quantities of pus in pelvis of kidney, am whole substance containing more blood than natural; gall bla< c!er distended ; the longitudinal sinus of the brain containin in its whole length a polypus, like a white worm, very firm i texture ; membrane of brain highly injected. 

In Asia, Europe, Canada and the United States, the results of post mortem examinations have not been uniform and satisfactory. 

35 





REMEDY FOR THE CHOLERA 

The cholera has not been found to be less under the control of an appropriate treatment than any other disease equally rapid in its course. When remedies oi a proper kind have been administered in the early stage of the complaint, and ju- 

diciously managed, a favorable termination has in the majority of eases been the result. The difficulty is to induce patients to apply sufficiently early for medical aid, — with the loss of a very lew hours the chances oi recovery are greatly diminished* 

"If the disease," says Anuesley, whose experience in the treatment of the epidemic cholera during its prevalence in India, was considerable, " be taken at its commencement, or within an hour alter the seizure, it is as manageable as any other acute disease, but the rapidity with which it runs through its course, requires the most active exertions before it can be cheeked, and the loss of an hour may cause the loss of a life." 

In Europe and this country, premonition of the coming on of the most violent form of the disease is given in a. very Large majority of cases by diarrhoea or some intestinal disturbance, marked by flatulency — sudden calls to stool, and watery or mucous dejection. 

The remedy, the good effects of which, in the treatment of cholera, appears to have been most generally acknowledged, and the early employment of which is most insisted upon, is bleeding. 

Bleeding from the arm in the first stage, when the pulse is full, and the temperature not reduced, is often sufficient to cut short the disease. The patient always feels immediate relief, particularly where the head has been much affected. The bleeding should be performed in a. horizontal position, and the patient remain quiet for some time afterwards. We are directed by Dr. Dyrsen to increase the flow of the blood from the arm by frictions to the surface of the body, with flannel cloths wrung out of hot water, or by bleeding during immersion in a warm bath. 

According to Mr. Bell, "in no case in which it has been possible to persevere in blood-letting until the blood flows 



freely from the veins, and its color is recovered, and the oppressed chest is relievedj will the patient die from that ;itt;ick of the disease." He directs, thai when the blood hasonce begun to How, it will be allowed to escape till these changes are observed. The absence of the pulse is no prohibition to the use of the lancet, unless it be accompanied by other symptoms of great debility, and the system has been exhausted by previous evacuations, and the surface is covered with ;i cold clammy sweat. Even under such circumstances, many attest the advantages of blood-letting, especially when preceded by sinapisms, the application of dry heat and frictions to the surface, and diffusible stimulants internally. In some eases of cholera, Dr. Lefevre remarks, the pulse ceases to beat very early, but upon opening a vein the blood Hows slowly at first, gradually the current becomes fuller and stronger, the pulse beats very sensibly, and the heart, thus relieved is enabled to continue the circulation. The only eases in which bleeding would appear of doubtful propriety, during' the first stage, are those occurring in old, debilitated subjects, and in constitutions completely broken down by intempera nee. Pni Frictions are recommended as remedies of great efficacy in all cases of cholera — they are best adapted to, and have been {bund most beneficial in the early period of the attack. They may be effected by mere dry rubbing with the hand, or a warm flannel, or the flesh brush, and, it' persisted in, will often restore the circulation to th • extremities, which were previously cold and senseless ; but it requires great per¦ severance, and long continuance, for ii is necessary to keep up the circulation after it is restored : hence it can only be recommended in those.' circumstances where there are plenty of attendants to wait upon the sick. \ arious liniments have been proposed to aid- the effects of friction, bui they may be superseded by steady rubbing with the baud, which should be sprinkled occasion all v with a little powdered starch, or a. little camphorated oil, to prevent wearing on the skm. Ihe friction should be moderate, beginning at the upper and lower ex- 

37 







proceeding gradually to the thighs, abdomen, and chest. An advantageous method of friction, is by the use of hare skins or warm flannels, well impregnated with the penetrating fumes of gum benzoin, kepi in readiness in a state of fusion. By its stimulating and gently bracing quality, this gum is admirably adapted to the present purpose, and its pleasant odor will be grateful to those who are attending a crowded hospital. " Thus, then," properly remarks Corbyn, "by stimulating the cutaneous nerves, avoiding rude and unscientific applications, we shall find thai the principal internal organs will soon sympathise with the surface* The arteries will be excited to propel the blood into the corresponding veins, and animal heat will again be circulated to the extremities and the skin." 

I Stimulating Liniments and Poultices. — The sinking of the ciration being great, or simple friction, as above recomnded, failing to produce the desired effect, or there being a ieiencv of attendants and good nurses to give it a fair trial, have recourse to liniment. The liniment composed ofeain>rated spirit and ammonia, will answer every purpose. ien the spasms are severe, Mr. Annesley prefers the spirits urpentine. If a stronger irritant be required, the following I answer ¦ 

Tincture of caritharides, two drachms. Camphor, three drachms. 

Soap liniment with opium, four ounces. Mix. 



Powdered mustard seed, two drachms Oil of turpentine, an ounce and a half. Olive oil, half an ounce. Mix. 

Rubbing with ardent sprits is evidently improper, as their rapid evaporation will have a tendency to increase the coldness of the surface. 

Among the most powerful, successful, and indispensable external applications, for the purpose of restoring action and sensation, we may reckon mustard poultices. "Jt may be said of them, that they are indispensable, and there is hardly any stage of the disease in which they may not be employed with 

38 





K be indicated, and they should be repeated continually."* pain in the bowels, and even the sickness, are often intaneously relieved by the application of a large mustard tice over tin' abdomen, and much pain is saved the patient, if it l>e applied early."t Ju violent eases of the disease-, tlmplicationt Implication to the ancles, wrists, calves of the legs, inside i arms and thighs, and along the spine, is recommended Strongest terms in various treatises on the cholera, and ¦1 persuaded, from the beneficial effects which we have seen result from the practice, that it is one which should never be neglected — it would be as welt probably to deter them, however, until the full effects of dry frictions have been tested. When the skm has been made sore by the use of poultices, anodyne fomentations, or even pulverized opium, sprinkled over the tender surface, will often be useful in relieving pain and nausea.! Dry Heat. — This remedy is strongly recommended by many of the practitioners who have witnessed the cholera in the north of Europe. Mr. Kennedy also recommends it in the iirst stage of the disease, after bleeding, the warm bath, and the other remedies which are immediately demanded. He remarks, '•'as soon as the cramps are subdued, or have received a decided check, the patient} with all possible' expedition, should be removed from the bath, aud placed between dry heated blankets. Dry warmth should be further afforded by surrounding his body and limbs with bags of heated sand. Here dry heat, be it remembered, is the remedy, and not the sand which contains it. On this principle, bottles of hot water rolled in flannel, have been employed, aud, also, hot ashes, bran, oat meal, &c. &C. A more efficient mode of applying <lrv heat, than any of these, may suggest itself; but occasionally, to prevent loss of time, we must take the first that offers." Blisters would appear to be less proper than poultices in the iirst stage of the cholera, from the slowness of their action. In the second stage, however, they may be demanded, should local congestions or chronic inflammation occur. A large blis- 

• Corbyn, p. 203. t Lefuvrc, Obs. on the Nut. aud Treat, of Cholera, p. 58, et soq. i Ibid. 

39 





ter over the abdomen will be found serviceable after cupping this parti if reaction be yet slow. Vapor and warm bath* should be used with caution. Opium. — No remedy has been proposed in the treatment of cholera, which has so great a muss of testimony in its favor as opium. Nearly all physicians, whatever may be their opinions as to the nature of the disease, employ it in some shape, at one period or other of the disease. By some it is recommended in the largest possible doses; by others, however, when given in smaller doses, it is considered much more efficacious, and less liable to produce injurious consequences. Mr. Orton considers it " probable that ;i single dose of opium alone, given at the very commencement of the disease, would be found, in a great majority of instances, to put an effectual check to its progress." He warns us, however, against an excessive use of the remedy. When given in large doses, its secondary, perhaps its immediate effects, he thinks are an increase of that oppression of the vital powers which so strongly marks the intense degrees of the disease. He prefers giving it in substance to the tincture, as less liable to be rejected. Four grains be recommends for the fust dose 11 — to be repeated} if a favorable change is not produced, in diminished doses, at intervals of from three to six hours. Calomel. — '1 'he exhibition of calomel in cholera is a practice which has been pursued by a majority of the English surgeons in India; and it is spoken highly of by such of them as have witnessed the disease in the north of Europe. In many instances the use of calomel has been carried to an enormous extent — doses of a scruple to half a drachm being considered the smallest which are adapted to the disease; others, however, have condemned the use of the remedy to this extent, and recommend it to be given in smaller doses, frequently repeated, and, in general, combined with opium. The evidence which is advanced in favor of the beneficial effects of calomel under both modes of administration, might ;it first view appear pe rfectly conclusive ; but in making up our mind jn this subject, we tiro to recollect, that in almost all the cases which are adduced, where the [tract ice is supposed to have 

40 







the same time been employed — especially bleeding — frictions 

and stimulating applications to tin- surface, and very commonly 

the warm bath also. Upon the early and judicious employment 

of the Last-mentioned remedies, nearly .-ill the writers 

agree that the cure of the disease mainly depends 

Injection. — When the irritability of the stomach, or incessant 

vomiting, prevents the exhibition of remedies by the mouth, 

injections appear in sonic cases to have been useful. From 

the great irritability of the intestines, their speedy rejection 

prevents, in the majority of instances, ;iny great advantage 

t their use, in the commencement of the attack. In the r stages of the disease, however, they are of signal service, 

especially in such cases as have been attended with much 

spasm, and the bowels continue sore for a long time after, and 

every motion is productive of pain. Here an injection com- 

posed of half a pint of flaxseed tea and ten (twenty to thirty V) 

drops of laudanum produces immediate relief. Administered 

in this manner, the opium is less liable to produce injurious 

consequences than when given by the mouth. Injections of hot 

water, above blood-beat, have been highly spoken of in cases 

Kreal collapse and general coldness of the surfaces. After 

remaining in a while, the water may be withdrawn by the 

syringe, and a fresh supply introduced. Tobacco injections 

have also, as we shall soon see, been recommended and used 

I. Fife speaks favorably of injections of mustard ; they have, •edilv brought on a discharge of urine, after it had been en- 

tirely suppressed. 

Internal Stimulants. — The exhibition of ether, brandy, am 

monia, and other stimulants, we find to be very generally re- 

commended, especially in the advanced stage ol the diseasi 

fiey are directed to be continued until reaction is fairly estashedj after which they are to be gradually relinquished^ In the early stage of the disease, their good effects are said to In- less evident than during that >eriod in which the clammy 

sweat, icy coldness of the surface, scarcely perceptible pulse, 

and sunken countenance, indicate a state of collapse, which, 

if not speedily removed, the loss oi the patient is inevitable. 

Now, experience has everywhere, we believe, shown not only 

41 





the utter inability, but also the directly injurious tendency of internal stimuli in the stage of collapse. They only tend to sink still further and irrecoverably the patient. When of use, it is in the early or forming stage in certain nervous habits, and before the coming on of congestion or of subsequent inflammation. It is then that camphorated ether, ammonia, &c. have been found serviceable. Many would appear to have employed the most powerful stimulants even from the very commencement of the attack, and with no sparing hand. This practice cannot, however, be too severely reprobated. Stimulants require at all times much judgment and great caution in their employment, or they will most assuredly produce far more harm than good. Mr. Bell very properly warns his readers against the practice so generally adopted in India, of prescribing inordinate doses not only of internal stimulants, but likewise of calomel and opium. He maintains that some individuals, in whom the disease appeared to be checked by them at first, nevertheless eventually died from their poisonous operation. 

Drinks* — A strange diversity of opinion exists among the writers upon cholera, as to the proper drinks to be allowed the patient. By some, diluents of every kind we're entirely prohibited, inconsequence of a supposition that they increased the vomiting. The great desire of the patient is far cold water; he appears to labor under the most distressing thirst, tlio calls of which, it must be evident, cannot be disregarded, without materially increasing his sufferings, and, eventually, the disease under which he suffers. Mr. Scott, in common with nearly all the best practitioners, concedes the propriety of allowing some bland diluent, but maintains that it should be given of tepid warmth ; he conceives that cold drmks are always dangerous, and generally fatal-* This was the opinion very generally of the surgeons in India. Mr. Annesley, however, gave cold water with a slight impregnation of nitric acid. This was the general drink at the hospital under his care, and was found to relieve the most distressing symptom of the disease — the burning sensation at the stomach. From 



42 





very fully settled) that cold drinks are 1101 more prejudicial tli.-ui warm, and when desired by the patient, should be freely taken with advantage,* and even the lower orders of the Russian people drank their quasi as usual, and with seeming licneiit. The diluted nitric acid, he suites, may be added with great benefil to the common drink. Fifty drops of the diluted acid, added to ;i pint <>i water, sweetened to the taste, is a grateful beverage.f Mr. Orton allowed usually only moderate quantities of a weak infusion of ginger, with the addition of a little sugar and milk.j Dr. Dyrsen, <>i" Riga, says, that when the thirst, is great, warm or even hot drinks are ilie best, and are often retained and even desired by the patient. He directs infusions of ilie various mild aromatic herbs, or, when these are unpleasant to the patient, oi common black tea. But, when the patient desires earnestly cold drinks, they may he given in small portions ami n lime, without tear of any bad consequences. Fresh milk, moderately cool, he states, has been found very beneficial, and when the diarrhoea is considerable, a deeoeiion of rice or pearl barley, thin tapioca, and the like, to which, when there is entire absence ot pain or tenderness of the abdomen, a little red (Port) wine may be added. A cup of strong coffee he has found very readily to suspend the vomiting in this disease : he advises I lie patient, in case ot' the drinks being rejected by the stomach, to be allowed to swallow small portions ol ice, somewhat rounded into the shape of ;i pill, by being rolled between the fingers,^ a practice also recommended 

Treatment of thr stage of Reaction or of the Cholera Fever. — After the more violent symptoms ol the disease have been remove — that is, after the vomiting and purging have been suspended, the regular action of the heart established, and the circulation and heat ot the surface permanently restored — the attention of the physician must be directed to guard against 

* By Mr. Bell also, and some few of th<^ practitioner* of India, r<>l<l lemonade 

43 





to produce a healthy action of the bowels. Congestion is most liable to take place after the first stage or that of collapse is over, in the liver and lung?, and sometimes in the head also. For this, moderate blood-letting, local or general, according to circumstances, is the most, certain remedy. When febrile symptoms with determination to the brain present themselves, topical bleeding will be found very successfully to relieve it. The judicious employment of blisters, and of cold applications to the head, will also be of advantage. When the healthy condition of the bowels has nut been produced by the remedies administered in the first stage, moderate doses of calomel, followed by castor oil or other mild purgatives, will be demanded. As soon as the discmarges have become feculent, the 

lient may be considered out of danger, and the purgatives lontmued — but not. until then. Tenderness or fixed pain he region of the Stomach or any part of the abdomen, calls the application of leeches.* 

The great debility which necessarily continues for a. short time after the symptoms of the first, period of the disease have been removed, would appear to many to demand stimulants, powerful tonics, and a nourishing diet; but these are dangerous remedies. Simple debility is seldom dangerous in this or in any other malady : it is best removed by a light, unirritating, and very simple diet, in connexion with properly regulated exercise. Change of air has been found to exert a remarkably beneficial cflect during convalescence from cholera, provided it can be obtained without much fatigue or expo- 

IkVe need hardly say, that much depends upon the careful ¦ntion of the patient during some time after recovery, to ud nil the exciting causes of the disease, and thus prevent scond and perhaps fatal attack. Strict cleanliness, lemper:e in the widest signification of the term, appropriate cloth, equanimity of mind, regular exercise and repose, are the 3 means to ensure a perfect restoration ot health, as well as continued enjoyment. 



44 





Safe Prescriptions por rHE Cholera. — Dr. Nelson, Member of the Medical Board and Commissioner of Health of Montreal, thus describes tl neiH which he found most successful : First Symptom. — The principal medium through which remedial means can be applied, is the stomach. We are therefore compelled to look u> this organ first; and as no remedy can be of service there unless it lit 1 retained, we must, before all other things, arrest the vomiting, if there be any, and suffer the stomach to become perfectly calm before any other medicine or substance be introduced, lest by so doing we arouse the evil |usl subdued. As relatt s to the stomach, there are two distinct stages in the disease — and on a just appreciate of these will the success of the practitioner depend. The fir is the vomitingi the second is the stage ot collapse, or sinkin when all vomiting shall have ceased. Now, as the only know means to stop vomiting in this disease, and many others, i.s paralyze the stomach, we must carefully hear in mind, whi prescribing for the first, not to overdo the thing, lest, when w require the energies of the stomach, in the second stage, w find them irrevocably lost in a collapse, which is joined to tl common sinking of all parts of the body into death, (the sei sorium excepted.) Here resides the first and greatest seen in prescribing tor a cholera patient; and which, to the unol serving multitude, has occasioned so much apparent discrei ancy in the treatment of different practitioners. In the fir stage, tin; most sedative treatment i.s essential; while in t! second, the very opposite — that of excitation. 

How to paralyze the stomach, and consequently to arrest tl vomiting. Three very particular circumstances are to } borne in mmd — Ist, the remedy ; 2d, how to he administers 3d, comportment of the patient. After all that, has been sai< it will be loiui'l that every practitioner from the Ganges to tl Vistula, has been forced, whatever his preconceived notioi may have been, to look to opium as his anchor of hope; but is to be regretted that a remedy so good, so perfect from ma administration, should have been turned into a two->edge< sword, at once curing and killing the patient. Opium has bee givea m every tonn, and m various combinations; this last i 

45 

REMEDY POll THE CHOLERA, 



account for. There is such an inordinate sensitiveness at iliis stage, in this organ, that it will nor suffer scarcely the smallest bulk of any substance : how injudicious, then, to augment the size of the remedy, by the addition of medicated waters, in themselves useless; and how much more unscientific to add 3 stimulant to your .sedative, when the hitter effect is the object of the prescription. Let the remedy then be a sedative, and not a stimulant ; give opium, and let the dose he concentrated to the smallest size : give one grain of solid opium, it must be swallowed dry : and it' that be rejected, give ;i second, and so on to ;i third ; it will randy happen, if the 3d circumstance he observed, that a fourth dose shall be required. One grain of opium i.s so small a. body, that the stomach can easily bear it, while the same remedy, given in form of a draught, from size alone shall be injurious. 

3d. The patient is naturally restless, and any motion of the body is more or less communicated to the stomach, and it has been observed, times out. of number, that the mere turning round of the patient, has so acted on the stomach as to set it again in operation. Motion of the body may so act on the abdominal surface of the stomach, as to afFect the internal with a sensation of foreign substance, and thus account lor the effect. To sum up, for the vomiting stage, give one grain of opium, and give it dry ; give nothing else till vomiting shall have ceased for several hours, and keep the patient in the most quiescent state possible. During all this time, the patient sullers intolerable thirst; this he must bear with. Drink will be returned almost before it reach the stomach, and cannot relieve the symptom for which it was given, whilst it gives the patient oue more dreadful convulsion, each of which hurries him to his end with a ten-fold degree of velocity. Bear in mind, that one grain of opium is as effectual in arresting the irritability of the stomach, as ten grains, while the latter dose would not only do the same, but also paralyse the stomach beyond the term of resuscitation. The abuse of opium too frequently occurred at Montreal. 

Second Stage. — All is now quiet, and now is the time to give stimuli. Small doses of warm brandy, warm punch, 

46 





aether or ammonia ; but be careful to choose such as are palatable to the patient. 

The second symptom to bo analyzed is the asphyxiated state of the extreme parts of the body, and also the apoplectic state, as the French call it. of the more central viscera. This asphyxia is known, as the term implies, by the cessation of circulation, and blueness and coldness of the surface. Portu nately it is not difficult to appreciate the indication, though one may not be so sure of its success. The cause is perhaps internal, but unknown : but the wet state of the surface, by evaporation, contributes more rapidly to cool down to the term of death. While you are calming the stomach, take also in charge this last symptom, and treat it thus : Dry the surface of the body by napkins, and then still further dry it, by rubbing the patient over with powdered chalk ; and by previously heating the chalk, you will render it doubly useful. For this purpose chalk was recommended by a gentleman of Quebec. If chalk cannot be had, the best article as a substitute is Hour; but be careful in heating it not to sufler it to grow brown, lest by the change of color its intransmissibility of caloric bo diminished. By fomentations and moist heat, we are undoing with one hand what we are attempting with the other. Moist heat is in the very teeth of natural philosophy, and lie who uses it, publishes his deficiency in the collateral branches of his profession. 

Id. The third symptom is spasm. In attending to the two . as recommended, we do all that is requisite for the third. urn, as an antispasmodic, and frictions. 

All other remaining symptoms are unworthy of notice in this hasty sketch. They are jnere concomitants, or sequels of the 

47 





CAUSES OF CHOLERA 

preciable causes of disease give rise to cholera, is unknown t us. That it. is in the atmosphere we have every reason to he lieve, hut in what state or how combined, we cannot with an certainty ascertain. It is, however, encouraging for us to know ;is we now positively do, from all which has transpired in th history of the disease, that the concealed general or aeria cause is comparatively harmless, unless effect is given to it b our subjection to evident modifying agencies. 

Preceding and accompanying the appearance of the cholera iv ;i country or city, there have been deviations from the usua state of the weather and season — unwonted vicissitudes or ex tremes, with changes iv the electrical state of the atmosphen These would not probably be of themselves adequate to th production of cholera but for the additional predisposing caus of unfavorable localities. The chief home and seatofcholej is in low, damp situations — on the banks oi rivers or near poo and ponds of water — or which are encumbered with vegetable remains, and filth of any kind. Those? parts of cities thus situated and circumstanced, have always suffered most, and Bometimes been the exclusive seats of the disease. In all the chief cities of Uiudostan, as in Calcutta, .Madras, Bombay, Seringapatam, &c. &c. ; oi Russia, as in Moscow, St. Petersburgh, Astracan ; of Germany, as in Vienna, Breslau, Berlin, Hamburgh; of France, as in Paris and other places; of Great Britain and Ireland, as in London, Sunderland, Newcastle, Gateshead, Musselburgh, Dublin, Cork, &c ; this fact has been 

placed beyond doubt. 

{In Montreal, Quebec, New York, and other places, similar tiinonv has been afforded. Additional intensity is given to ¦ unfavorable locality by narrow .streets, numerous small I ill-ventilated houses, crowded with inhabitants. Low, ler-ground lodgings increase greatly the: risk of their inmates /ing the disease, and the danger of its terminating in death. 

Experience has also fully shown, that in regard to the manner of living, the intemperate, the devotedly sensual in any 



49 

CAUSES OP CHOLERA 

way, those unclean in their persons, ;m<l who arc deprived of Ks supply of wholesome aliment, are peculiarly liable ease, and to perish under its attack. The drunkard where been singled out as a victim oi the disease, on its first appearing in a place. The comparative exemption en- Sed by females, lias been entirely lost to them by a dissolute le of life. Women of this class have been among the foremost sufferers from cholera. 

Food of a bad quality, irritating the stomach and bowels, has often proved an exciting cause of the cholera. Meats, which, though nutritive, task excessively the digestive powers of the stomach, are to be avoided, such as fat pork, smoked heel, lobsters, clams, and crabs. 

Water, under all circumstances, the best drink for mankind, may be given of such temperatures, and so prepared by boiling, as to be adapted to every stomach, and to prove both safer and more healthful than any other liquid whatever. 

Any sudden or considerable debility of the nervous system is to be gfreatly dreaded, as of itself laying the body open to an attack of cholera. On this account, anxiety, fear, and the depressing passions in general, should not be allowed an abiding place in our minds. Many have been destroyed by fear alone — but on the same ground as that on which a tranquil mind is recommended to be preserved, an equable state of the senses and functions generally should be maintained, by regular hours of sleep — regularity of meals — and the accustomed daily ex- Lone' exposure to the sun, and great fatigue, have been found to he powerfully contributing causes ot cholera. If circumstances require imperiously such an exposure, additional circumspection is to be exercised in the manner ot living in other respects, and an especial avoidance of the night air and dews, or of getting wet with rain. 



PREVENTION OF CHOLERA 

gest themselves to the reader, after he has been made acquainted will: the causes oi the disease. The preventive and precautionary measures will consist in a careful avoidance of those situati< us in which the air is foul, stagnant, and loaded with moisture, and of every thing which has a tendency to reduce the energies of the system, either by over-excitement or direct debility, rind to impede the functions of the skin, or to induce disturbance of the digestive canal. 

The iirst and most important rule for the avoidance of cho- 

lera, is to preserve habits of strict temperance — no excess oi any kind to be indulged in, nor experiments made of what the body will endure, either in the way of abstinence or repletion. 

The next rule is to observe the strictest cleanliness of person clothes, and habitation. 

The third rule is to preserve the body, by means of warm clothing, from the sudden impression of cold following heat, oi cold with moisture — more care is demanded than under ordinary circumstances, and garments of cotton, or still better of woollen, next the skin, should be worn, even though they ma\ be thought a little too oppressive. The feet should, above all, be preserved warm and dry. 

An avoidance of late hours, crowded assemblies, long continued mental exertion and depression, will be so many circumstances worthy of attention by those who would diminish the chances of an attack of cholera. 

Another important rule is not to sleep in damp beds, or in low, damp, ill-ventilated apartments, and to shun exposure to the night air of swampy or marshy districts. 

Time is invaluable in cholera, and much of the success in curing the disease, will depend on tin 1 early administration of suitable remedies, lint urgent as may be the demand for assistance, it ought not to be rendered at mere hazard — with the risk often of increasing in place of diminishing the danger 

of the patient. 





sued by our public authorities, in order to prevent the introduction of the cholera, into this country. Believing as we do, that all the facts connected with the rise and progress of the disease prove it to be an epidemic, depending upon some pc- 

culiar morbid change in the constitution of the atmosphere, corresponding with, or caused by, terrene emanation.-, we conceive that any attempt to exclude the disease from amongst us by quarantine regulations, which are always injurious to the commercial interests of a nation ; or by a system of absolute non-intercourse with those countries where the disease prevails, would he as ridiculous as it would be unsuccessful. We have tn what has been the result of these meaDB, when carried ) execution with all the strictness which it was in the power he absolute monarchs of the north of Europe to enforce, in instance have they succeeded in staying the progress of the tilence, hut: have undoubtedly, in many instances, aug- 

mented the misery and sufferings of the people, and the number of victims to the disease. They have, in fact, been in the end entirely abandoned as worse than useless. But though the power of the government cannot, be exerted to guard our shore? from the approach of the epidemic, it may be exerted in such a manner as to disarm the disease of much of its malignity, and prevent ils extensive spread amongst us. This inav be done by establishing at home, and without delay, an enlightened system of medical police; by taking effective measures to ensure the cleanliness and proper ventilation of our cities and their suburbs ; by enforcing upon every class the importance of temperance, and especially of abstinence from every species of intoxicating drinks ; by promoting, by every possible means, the comforts of the poor; by preventing their exposure to excessive; fatigue, to cold and dampness, and to the noxious atmosphere of filthy, ill-ventilated, and crowded dwellings, and by endeavoring to supply them with food which 18 at once cheap, sufficient in quantity, and wholesome in iiality; and. withal, by endeavoring continually, instead of exciting unnecessary alarm, to tranquilize and strengthen the public mind, and to inspire confidence in all classes oi our citizens. Solar as these important [joints are carried into execution, 

51 





52 

FIE CHOIjERA NOT CO^VTAGI'U . h 

we may rest assured that much of the danger of the introduction of the cholera into our country will be removed.* 

PROOF THAT THE CHOLERA IS NOT CONTAGIOUS. 

A very large majority of physicians and surgeons of India arc decidedly of the opinion that the cholera is not contagious. Their observations led them to the following inferences: — 

KLst. That medical men, hospital assistants, &c. were not re liable to take the disease than the rest of the community; many instances less so. 

Ed. That it. was not communicated by the clothing and S of the sick to healthy subjects, or even to those laboring er the disease. 

Id. Regiments, marching from one station to another, get it of a sudden, on reaching a certain spot; and the disease suddenly disappears in a day or two, after changing their and. 

Bth. It appears suddenly in a place, continues a week or , and as suddenly disappears. 

Kth. Particular parts of a station, or camp, are attacked preference to others, when the communication is unre?ted. 

lith. Banks of rivers and water-courses are more obnoxious n high and dry situations. 

¦th. On a change of the weather, the disease is sometimes ¦sted. 

litb. The disease passes by intermediate towns and villa, and seizes on more distant ones — a fact inexplicable on principle of contagion. 

* The following extract from the official regulations issued by the Austrian (»o-vorninent, will afford a UieAll hint to our authorities at home : — " Tlie authorities of different towns arc enjoined to keep a rigorous watch over all taverns, inns, and houses of entertainment, as welt as over all provision shops, to prevent, as far as possible, intemperance among the people, and the sale of unwholesome food ; and they are particularly required to ascertain the good quality of the bread delivered by the bak-.TK. " 



9th. Seclusion from, and non-intercourse with the infected, seldom or never afford security against the disease. 

10th. The crow of a ship from England took the disease immediately on her coming to anchor in Bombay harbor, before there was any communication with the shore. She bad passed up along the Malabar coast, about seven or ten miles distant from the shore. This plight to set the question at rest forever, as showing the power of atmospheric influence in producing 

In the language of Dr. Kirk, of Greenock, we would say, "No man who carefully examines the habitudes of this disease without prejudice and prepossession, can come to any other conclusion but that, in all great irruptions of it, it is an epidemic depending on atmospherical and malaria influence. Dr. Lawrie's most graphic and excellent description of the disease at < lateshend and Gateshead Fell, need only be read by any unprejudiced man to convince him that the unfortunate seized on the morning of the 26th of December, were smitte by an atmospherical epidemic, and not by contagion. 'Tl inhabitants of Gateshead,' says Dr. L., ' fell asleep on tl 25th of December, in perfect security, and devoid of panic but before the sun rose on the 20th, fifty-five individuals hat been seized, thirty-two of whom were destined not to see set.' I have no doubt that a pre-disposition from the state o the atmosphere exists in every devoted locality of cholera, fo a length of time before it actually supervenes." 

" Many who died of cholera at Newcastle," says Mr. Lizars, of Edinburgh, " were dissected, and some even sixteen hours after death, without propagating contagion ; indeed, with the exception of one, all the practitioners — upwards of fifty in number — are non-contagionists. Dr. Fyfe, of Gateshead, found in sixty-seven cases, that forty-four of these were single individuals of families, varying from three to eight, many of them sleeping in the same bed with those sick with cholera. There was unlimited intercourse ; nay, it. was impossible to separate the diseased from the healthy." 

53 





Course to be pursued to prevent the Cholera 

I Most countries and cities have published directions which ye emanated from medical men. respecting the prevention the disease. Such directions have undoubtedly been of \'il service. The following were published at Paris, by the. Jentral Commission of Health." 

I Ist. The little danger there is of being attacked by ti olera, should keep up the spirits. We should, therefore, n 3turb ourselves, nor should we think of the disorder, but t opt the precautions necessary to guard against it. The lc. ir, the less hazard. Bui as tranquility of mind is a grei sservative, we must avoid everything which excites stron lotions. ani?er, fear, arc;!' exhilaration, &c. ¦Jd. It has liccii observed, that the purer the air, the less ¦ liability to cholera. 

I Poo much attention, therefore, cannot bo paid to the sail ousness of our dwellings. Care must be taken that man not occupy, much more sleep in, the same apartment; tha ¦ premises be ventilated in the morning and in the cours the day, by opening the windows and doors as often, an< jping them open as long as possible. It is proper also t cc in dwelling-houses, large earthen vases, containing chl< ed writer, (made by pouring upon one ounce vi' chloride o c, one quart of water.) The purification of the air may b > produced by a clear and bright fire kept in the fire-plac a short time. 

iJare must be taken that the doors and windows are not nod until after <fee is entirely dressed, bo as not to be exed to chills. It will be best to pass into another apartment ing this operation. 

There should be no curtains about the beds; nor should any utensils be suffered to remain dirty, but be cleansed as noon at used, and always contain a little water. The humid air of dwellings — unhealthy at all times — becomes very dangerous when the cholera prevails ; no clothes, therefore, should be dried in the sitting-rooms, and especially not in the bed-chambers. Not only must the bed-rooms be aired, but the utmost salubrity must be preserved in houses, and out-houses. It is 

54 





also important to cleanse privies wim i g n purify them once a day with chlorured water, or water only. All their conduits should be closed except when in use. Every one should take care that house-slops are emptied as soon as produced: that they do not remain between the pavements of the courts and alley.-; and that, they pass off rapidly by the conduits and -utters which carry them to the street-. It. is necessary indeed to keep up this flowing, by copious washings, if the descents are pot sufficiently rapid. The window-panes should be washed at least once a week, for the action of lighi is useful to health. Every species of garbage, both animal and vegetable, requires great attention ; their accumulation should therefore be prevented, by the earliest, possible removal of them. Useless domestic animals should be expelled. Swine, rabbits, fowls, pigeons, &c. should not be kept in confined places, or c\en in spacious alleys where there is little air. The inhabitants of houses, particularly in the populous quarters, should in this respect watch mutually; they should, besides, contribute each one his part, towards the cleanliness ol the streets, especially where they are narrow. It is the interest 3d. Chills are thought, by those physicians who have observed the cholera, to be among the causes most favorable to ihe development of the disease. Care should therefore be taken to dress warmly, and to guard the abdomen, and keep the feet, from the action of cold. For this purpose, it will be well to wear a woollen girdle, woollen or flannel under-vests next the skin, and to use woollen socks, to be changed or washed when they become moist or-dirty. should be worn when necessity obliges one to remain where it is damp or cold : in a word, people should so warm themselves, that the feet should be protected from cold and moisture. Many persons, particularly of the working classes, have the very bad practice of standing with their naked feet upon the cold ground when they go to bed, and more so when they rise, and even walk upon it. This custom cannot be too much censured, as it becomes particularly dangerous during the prevalence of the cholera. 

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56 

PREVENTION OF CHOLERA. 

The fear of chills, even in summer, should prevent people from sleeping with their Bashes raised. There should be a moderate temperature within doors; for rooms that are kept too warm, render their occupants more susceptible to the cold to which they are exposed on going out. 

For the same reason it is proper to keep early hours, and not pass part of the night in promenading, going to meetings, to the coffee-houses, ale-houses, taverns, &c. ; above all, when the nights an; very cold and damp. 

Llh. To endeavor to lead an active life — shunning as much possible excess of fatigue — is one of the best means to mee tranquillity. Occupations which involve men in disputes injurious. The same may be said of labors which occasion eprivation of usual sleep at night. 

I Mention has already been made of the usefulness of woolle lies and socks; but these vestments should always be kep in. Cleanliness is always necessary to health. They \vh ¦c the means of taking occasional tepid baths, will do we ise them, but must remain in them no longer than may b •I'ssary to clean their persons. Care should be taken t )<• with warm linen, and to avoid immediate exposure 1 ernal air on leaving the bath. This precaution is specially till when the season is cold. 

i)ry frictions are beneficial. They are easy to be ad minisid by rubbing or having rubbed, in the evening — or, better, ruing and evening — the body, arms, thighs, and legs, for a liter of an hour, with a soft brush or a piece of woollen ;h. 

Kn reference to dress, the season will best determine its racter; but in no case Should people dress too slightly. 

lith. When the cholera prevails, the mode of living is a mat of great importance. Sobriety cannot, be too strongly re amended. Very many cases are known in which the cholera owed the excesses of the table — and it is proved that th mperate are particularly exposed to this malady. 

Well-cooked provisions, roasted and not too fat, fresh fish, eggs for those who have good digestion, and light and wellbaked bread, should form the chief nutriment. 





57 

PREVENTION OF CHOLERA. 

P. We do, not think of excluding from these last, pogood quality. We even approve of dry haricots, ias, and beans, plain. Crudities, such as salads, rad, are injurious. Salted provisions and salt fish should d, and swine's flesh a^cd as little as possible. Heavy pastry are altogether prohibited. 

In the season of fruits, it is necessary to be very cautious in ir use, above all, when they are not perfectly ripe, for they y prove very dangerous. Cooked fruits are less exceptionl', but they should never be eaten in great quantities ; and . less should they form the chief part of the meal. There >ome food, healthy in general, 'but. which, by a peculiar .c of the stomach, is of difficult digestion with some. Every , in this respect, should consult his stomach. 

Beverages do not require less circumspection in their use. Very cold drink, taken when one is warm, is dangerous. There is no necessity for quenching thirst, except when perspiration ceases: that is, no necessity for cold drink when one is in a sweat. 

I The consequences of this abuse are fatal, in proportion t coldness of the drink. The water should be clear, — filteret ter is preferable to all other. There should be added y little vinegar or brandy when we wish to drink it pure (i spoonsful of brandy, or one of vinegar, to a pint of water, iecially if the season is warm, and one is obliged to do co eal labor, which, by exciting perspiration, provokes thirs 1 makes it necessary to drink often. Reddened water, that writer to which a little good wine is added, is also beneficial. In short, water slightly aromatic may be successfull}used : that is, having a stimulant infusion of peppermint, or camomile (a pinch of mint, or six heads of camomile, to a half pint of boiling water, to which add, after cooling, half a pint of cold water). 

Nothing is more pernicious than the abuse of strong liquors. It has been proved by a great number of cases, that the cholera attacks the intemperate, and even those who, without making a habitual use of strong drinks, commit occasionally, by enticement, a single excess of this kind. 

The use of ardent spirits, taken alone and before breakfast, 



a, habit so common <imoi)g the lower class ot work-people, rind so hurtful at. all limes, becomes particularly fetal when cholera prevails. Persons who have thia habit should eat something! at least a piece of bread, before swallowing the brandy. White wine should not be taken before breakfast, without the same precaution ; and then only in the smallest quantities. 

I During the prevalence of the cholera, bitter brandy : that is, mdy into which bitter and aromatic plants are infused, or, her, Absynth brandy, is preferable to common brandy, me, taken in moderate quantity, is a proper beverage during d at the end of a meal : but it. should be of a good quality. is better to drink half the quantity and have the quality suiior. New and sharp wines are more hurtful than beneficial. id wine is preferable 10 white. The) who have the means mixing it with gaseous water, such as Seltzer water, natural manufactured, will do well to supply themselves with this 

salubrious and agreeable drink. Beer and cider, especially when now, when not well fermented, or when sour, dispose to colics and diarrhoea, and thus become very dangerous. What has been said applies with stronger force io sweet or new wine. (Signed.) JIJGKE, Pa rise t, EsQUIROLj Chbvallieίi Leroux, Legrand, Baron Desgenettes. 

The Edinburgh Board of Health say : " Experience has shown, thai the most essential precaution for escaping the disease, is sobriety, — that intoxication during the prevalence of the epidemic, is almost, sure to be followed by an attack ; and that those addicted to drinking are the most subject to take cholera, and the most likely to sink under it. In like manner, strict attention to personal cleanliness ; to cleanliness and ventilation of dwelling-houses ; to warm clothing; to regularity of hours for sleep; to keeping as much as possible within doors at night ; and to taking food before going out in the morn- 

58 





RELAPSE 

Can the >;i!ne person bo afflicted more thnn once by this spasmodic cholera ? On this point oui information does not permit us to decide. Rela*pses in those not fully recovered are Baidtohave been fn quent. In some instances the disease is said to have occurre< in the same person twice and even thrice. Mr. Bell speakso this as common. Bui we are assured by Mr. Jameson, that, i such instances did occur, they were extremely rare. The f<> lowing extract from his report, contains so much curious info mation, thai we are unwilling to abridge it. " Another curious circumstance in'the economy of the di ease, was, that not only were persons who had once- undergo! its attacks tree from its further assaults; bui even individual rind bodies of men, who, having come within its pestilential ir fluence, had escaped unaffected, were nevertheless much les obnoxious to its future visits, than those who had noi bcfbi been exposed to the virus. In other won!-, a village whic was visited by the epidemic during the first year of its preys lence, would, on the disease reappearing in thai part (A' the country, be much less like to suffer than another village, which had no] before \)(^*\i affected : and ;m individual going from the former into the infected air of the hitler, would have ;i better chance of immunity than its inhabitants, who had not undergone the previous seasoning. This was the case, to a greater or less degree, in every part of the Provinces ; in which it was generally remarked, that the epidemic, on its recurrence, either did not. at ;ill revisil the places formerly affected, or only in ;i much lighter manner, than those to whom it. was yet a stranger. In Tirhoot, particularly, in which the epidemic twice appeared, :it two distant periods, the truth of this oli.-jervation was strikingly illustrated, since, according to the information <>f a very intelligent observer, not. a single instance occurred, of the disease revisiting the same place, throughout the whole extent of the district. We add the following remarks, from an experienced physician in one of the southern states. 

59 





60 

PREVENTION OF CHOLERA. 

" Cities and towns where the disease prevails should be avoided. It is not enough to fly from these, after the epidemic has made its appearance. So soon as it becomes probable that any densely-peopled district will be visited by this dread messenger, all persons who can do so, should leave the place, and iro into the country. 

I' Cholera finds its appropriate aliment in the congregated sses of these places. In sparsely settled regions, it never vails. Hence, while four thousand persons died in the city Oroomiah, Persia, last summer, not one of the missionaries S attacked, being afctheir health retreat, only six miles from city ! For greater security, some of the missionaries nt to the mountains, some fifty or sixty miles from the city. t one of thi' mountaineers was attacked, except a few who 1 visited the city. These died, but no others were seized. 

" So also, while the epidemic was very fatal in Wheeling, Pittsburff and Cincinnati, on the Ohio river, in 1 *•'{:> and JS-'54, it passed by Marietta and other smaller towns, lying between the former, on the river. And this too, while many persons passing up from Cincinnati, ordown from Pittsburg and Wheeling, died on the steamboats, and numbers were buried on the island opposite Marietta. 

" People, then, living in the country, or in small towns; remote from crowded cities, need have no apprehensions of a visit from the cholera, in the form of an epidemic. Isolated cases may occur any where, the atmosphere being universally tainted, in a greater or less degree. Hence, during the preva- 

Ice of cholera, derangements of the bowels, which, in ordiy cases, would excite no alarm, must now be carefully tched, and remedies promptly applied, or they may termi,e in genuine Asiatic Cholera. 

X' But if persons are obliged to remain where the epidemic travailing, what means of prevention can they resort to? 

" First, (iroitl all stimulating food and drinks. Dr. Bond, an eminent physician, says: 'let the temperate drinker of intoxicating beverages, take " the Pledge," and hasten to the woods. His stomach will attract the cholera like a lightning-rod ; and his system make little resistance, but run down to " collapse " in two or three hours.' 



M Second, with regard to d\ct t avoid excess m the UB6Ol every kind of food, and gtw vt> every thing which experience has proved to be indigestible. Beef, mutton, poultry, eggs, — are usually safe articles of (bod. Apples and peaches, fully ripe, are harmless. Green corn and beans, and cabbage, are to be avoided. "Thirdly, as to clothing make no sudden changes. It is important to keep Up the insensible perspiration, by preserving a healthful action of the .skin. Bathing should be continued, if one is accustomed to it; otherwise, it should not be adopted* >; Finally, — ' Above all things, keep calm ; and, in order to this, keep busy — always employed. Never be idle, nor among idlers. If idle, the mind will prey upon itself, and then, through the nervous system, on the body ; and if you seek idle company, yon will hear all the gossip about cases of cholera, and, despite your courage and firmness, the depressing influence of these reports will steal upon you, undermining that healthy tone of feeling and spirits, which is the best defence against the constantly acting cause of disease, under the circumstances supposed. But, while we say, keep busy, we must caution against all fatigue. To this point, neither exercise nor labor ought to be carried. It not only favors an attack, but, in all malignant forms of the disease, greatly lessens the chance of recovery.' " 

THE CHOLERA NOW APPROACHING ! 

A recent number of the London Sun utters the following note of alarm in respect to the advancement of the cholera : 

" The great scourge of humanity — a scourge more awful than Attila and his Huns — more terrible than the eruptions of a volcano — more devastating than the throes of an earthquak — the great scourge of the Cholera, — is at this moment advancing towards us with silent but indomitable rapidity, if we may believe the intelligence received almost daily from the frontiers of the Russian empire. Its course is described as being north-westerly, and it is said already to have penettgonies 

61 





which desolated the world in IS-'i^! Those agon iei are not yet forgotten : nor can years obliterate the recollection o( a pestilential malady so mysterioui in its character, so inexorable in its iliilusio!), and so inexplicably dismal in its progress through the nations of Christendom. It pressed forward like an avenging fiend, and decimated the nations, as ai a breath of the Nemesis. This terrible and destructive plague has again made its appearance. Alter ravaging the territory of the Calmucks, it has disseminated in contagion among the sorts of Nicholas. Ft has travelled from the walls of Astrachan to the hovels of Charkav, and appears to have already descended like a curse upon the inhabitants of Kiev, on the hanks of the Dnieper. There may unquestionably be much exaggeration in the accounts received from Caucasia, namely, that during an interval of nine months no, les.s than 1.7,050 individuals were attacked with the disease in that kingdom, and that out of these 6310 perished. There may be likewise a certain degree of exaggeration in the assertion, that during its passage through the streets of Astrachan, 137 persons wen.: smitten down with the cholera in a single day, viz: the JiOth of July. But, heightened as in all likelihood the intelligent is. by the fear of its recipients, there cannot be a moment doubl but that the pestilence is again abroad upon the wing of the wind, and that it is stealing gradually towards the cci tral portions of continental Europe. With the experience o l^-'rJ before them, it becomes the bounden duty of the Legi lature to provide such measures of precaution as may tend mitigate the miseries resulting from the cholera, in, the even of its advancing so far in a south-westerly direction as to assai the population of these islands. Better even than the vig lauee of the most stringent code of quarantine, are those sin pfe measures of sanatary legislation for which we have clamo ed so long and so earnestly. A contagion that defies the obstacles of quarantine, may be deprived oi a considerable proportion of its virulence by the systematic cleanliness introduced among a whole people by a proper scheme of sanatary legislation. Is not this self-evident ? And, being self-evident, shall its importance be depreciated, when the great scourge 

62 





THE CHOLERA NOW APPROACHING. 

63 

I the cholera is for a second time impending over the plan d cities of the eastern hemisphere ? God forbid ! G>o< bid that men should be so blind to the dictates of reaso rather, that they should .shut their eves against the trut ieh is forced upon their comprehension as if by instinc c warning voice which comes to us from the banks of th ieper, tells us of the danger; the combined arguments ( >erience, reason, and instinct, proclaim to us how that dai ¦ may be in the readiest manner avoided] or, in the mo rible extremity, how its anger may be in the most efficiei nner assuaged." 

IL letter from St. Petersburgh, of the 3d of January, LB4B, resents the cholera as expected at that city — and every paration was made to meet it. At Moscow, from the sth he 11th ultimo, there were 110 cases and 64 deaths, la 

I eastern portion of the empire, the Governments of Kasi Orembourg have suffered most. The Cossacks of tl al have also been great sufferers. After acting for sou upon the above two provinces, the malady has extendec ie north and west, and gained the centre, in which la ions of the empire Toula has suffered the most, havii 782 cases and 24(> deaths. At Kalonga, there have bet ases and -37 deaths. It makes the same eccentric mov ts as in 1331. Thus, having once entirely ceased >1 about the middle of November, it afterwards again mac ppearance there with fatal effects. Hitherto the easter ters have, next to Caucasus, suffered the most cruell; said, that the Russian army in the Caucasus has sus id numerous losses, and even the mountaineers themselves have not been spared. 

A recent paper in New-York city says: 

" Those who rest secure on this side of the Atlantic, aboi the non-approach of this pestilence to our shores, are foolish] lifferent to precedent, and act most unwisely. What ha mred before, is likely to occur again ; and it is therefor ninal to neglect such sanatary regulations as would be ca culated to moderate its ravages or prevent its spread. Cleai liness and temperance are the great levers by which th enemy can be baffled. Impure air, filth, and intemperance are its surest propagators. Alarm and nervous apprehension 



add considerably to its fatality ; and therefore when any cases may occur, they should at once be taken to a hospital >et apart for that purpose. Chloride of lime should be freely used as a disinfecting agent; and slacked lime should be employed in whitewashing the lanes and alleys of a populous city. During the last visit of the cholera in Europe, social parties were much recommended by the faculty, by which to excite the fimal spirits and promote gaiety and good humor; these were md excellent preventives against the career of the pestilence among the middle and upper classes. We find it an imperative duty to keep this important matter before the public eye, with a view to induce the civic authorities and individuals to remember that 'prevention is better than cure.' " 

Another still : 

"All accounts from the Old World show that America must inevitably be visited, and that shortly, by the terrible scourge of cholera ; and, as yet, nothing is done either by National, State, or Municipal Authorities, to prepare for it. Most of our readers will remember, that the cholera of IS32 — 3 was preceded by a remarkably mild and humid winter like the one now passing. If this be not proof of what may bo expected, it certainly is a remarkable coincidence, as in both instances accounts of cholera in Europe reached tills country at tin.' same season. We look for some slight attacks before the dawn of another new year — and for its prevalence, as a pestilence, kring the spring and summer of 1549. Bicknell's Reporter that a commission be appointed to visit the scenes of the pestilence, to inquire minutely into its history, and ascertain the best prevential and remedial measures. We heartily endorse the proposition. While, however, we perform every possible preparatory duty, let the dread enemy be met without fear. Dr. Dawson says, in relation to the cholera of 1832, that it was generally remarked that the most perfect immunity Was among those who combined habits of cleanliness, temperance, and industry, with a happy and tranquil mmd — fear being reckoned among the most active causes of the disease — a proposition borne out by the medical men who visited the sick, and who generally escaped all attack." 

The London Times states that several unmistakable cases of Asiatic Cholera have recently occurred in London. 

64