THE CHOLERA: AND HOW TO CURE IT. SAMUEL OICKSON, M. D., AUTHOR OF "THE FALLACIES OF TIIK FACULTY.' LONDON: CHARLES OILPIN, r ,, BIBHOPBGATB STREET, WITHOUT. p554«- Its,- I LONDON : TRINTBD FOH CHAHLES (iILTIK, BISHOPSOATE STRBET. -^ D ?L S? t>o INTRODUCTION. rROXO-THERMALISM. — ITS DOCTRINE OF HEALTH, DISEASE, RESTORATION, AND REMEDIES. )r. Dickson's work called "The Fallacies ok the Faculty, explaining the Chrono-thcrmal system of edicine, and proving the so called science; of meicinc, as taught in the schools, and practised on ie public, to be little better than a random netork of guesses; lias passed through five editions this country, as many in the United States of merica, and has been translated into French, ennan and Swedish. The book and the author lave been alternately abused, plagiarised and nrispresented,* and the system itself scouted as 1* The Report from the Select Committee on Medical jgistration, ordered by the House of Commons to he printed, 16th July, 1847, contains the following, among other " evidence :" — Veneris 180 die Jimii, 1847. " The Right Honourable T. B. Macaulay in the Chair. "Edward James Seymour, M.D., called in and ex- amined — " 1350. Are you one of the Censors of the College ? — I have been Senior Censor and Junior Censor. " 1360. Are you not aware that many persons are calling themselves physicians, and are practising as physicians, fkery, and without acknowledgment adopted practised. twidc amelioration of the practice of physic has ted from such unacknowledged use of Dr. Dickson's discoveries, but still the probability is I have no other authority for su doing than the diploma 1 foreign university ? — I know of no such persons but homoeopathists ; and there is a Chrono-thermal man, or ething of the kind, hut I am not personally acquainted i that case." Not personally acquainted with that case ! Why, thei Dr. Edward James Seymour, did you volunteer your " cv dence" upon it } You did it to sneer down a Medica Reformer. Yes, you deliberately went out of your way t slander a man whose torch of truth had set the old walls o your College in a blaze. You qualified your falsehood, 1 be sure, with the quibble that you were " not personall acquainted with that case." Turn to the London Media Directory — Dr. Seymour, — that book is doubtless on tl table of every College Censor — and blush, if blush you cai when you read there the true qualifications of the mdiv dual you have been pleased to call " a ehrono-thermal man with no other authority to practice than " the diplom of a foreign university." For the reader's benefit, and 1) Dickson's justification, we may as well state them here :—: — I'ickson, Samuel, 28, Bolton Street, Piccadilly, Physician \uulification , M.1)., Glasgow, \KY,\ ; Member of the Roya ego of Surgeons of Edinburgh, 1825 ; formerly a Medic cer in the British Army ; author of — 1. "A Treatise o Diseases of India ;" 2. " Fallacy of the Art of Phys taught in the Schools ;" 3. " Unity of Disease ;" Ulacies of the Faculty, with the Principles of th •ono-thennal System of Medicine ;" contributor to tl ancet" of a Paper on the Asiatic Cholera, and of variou er Papers to the "Lancet" and "Medical Times." 4 I Ilttl UIL- I ' Itj Ii Lj XJL Jltl* L. J.ll> »ll 111. (LI LI of Chrono-thcrmalism, or at best have only an indistinct notion, derived perhaps from their doctors; that it is some new and dangerous quackery, set up at random by some one who has never had a professional education, and who knows nothing of "the ills that flesh is heir to," and all the long list of specifics and remedies so abundantly set forth for them in the pharmacopoeias. It is necessary, therefore, to state, that Dr. Diekson was regularly educated in the schools of anatomy as a surgeon, and as regularly took his diploma as a physician, — that he practised both branches of the profession, as an army surgeon, serving on the medical staff in India, and administered for years the usual routine remedies for the usual diseases, with the usual success ; and it was precisely this success, with its long continuance of diseases, the fewness and slowness of its complete recoveries, and the number of its deaths, that continually forced upon him the question — Does medicine us taught in the schools deserve the name of a science ? And, after long and careful observation, he was led. to the conclusion, that the teaching of the schools is not a science, that it too often takes the partial results of disease for the disease itself, overlooks the most important phenomena of vitality and mortality, and takes some single result of a drug as a proof of its sovereign efficacy. 5 any quite unmedical inquirer might find himself utterly puzzled. First, the nosologies, or lists of diseases ; second, the pharmacopoeias, or lists of remedies ; third, the medical directories, or lists of men diplomaed as skilled practitioners of the mysteries of medicine ; and fourth, the registered returns of mortality. Let any one look over these returns from week to week, or year to year, cither for particular districts, or the who country, note how large the number of dcatl is between the ages of 15 and (50, a period en bracing the very flower of youth and vigour < the prime. Turn, then, to the causes of all thes deaths, every one of the diseases set down h; its description in the nosology, its remedy in tl pharmacopoeia, and every case had its physician few of the deaths are set down as sudden, thei was time enough for duly-administered remedic to be effectual, and force of life enough, with som little help to have shaken oft' the disease. Wit these facts before them, it is the duty of medica men to be somewhat cautious how they arrogate t themselves the true science of healing, and to in vestigate, immediately it is brought before them any new theory of disease and remedies ; and it i no less the duty of the unprofessional public, t read and learn something for themselves, that in their own knowledge they may have some safe- 6 guard against what often may fairly enough be called the routine quackery of medical attendants. Chrono-thermalism is here, but it is no quacker Of all systems for the treatment of disease, tl chrono-thcrmal requires the greatest skill and mo observant attention on the part of the physieia The name chrono-thermal is made up of two Gree words, which literally mean, time and heat, and sufKciently expressive of Dr. Dickson's discover that all the vital movements in health are periodi have alternations of certain rates of motion, cc tain periods of action and rest, certain lives o temperature and nervous energy, — that every di case is a disturbance of the order or rate of tl natural or healthful movements, and consequei temperature, and rate of wear and tear of tl body,— that every such disturbance or disease intermittent, having, like ague, its cold or lowes stage, its hot or highest stage, and its stage of res in which the vital movements and temperature ar the same as in health, or make the nearest ap proach to it. Whatever amount of disturbane there may be, there is a continual effort amongs the vital forces, to get back to the habitual o healthful alternations and rate of motion and teni perature ; and when the vital organism is suffl ciently strong to resist the disturbance, so that n vital organ is consumed or mortally wounded in the struggle, this bismedicatrix natune, or healing 7 I( )I*C*(* ()I llrtLlllOj >\ 111 ()\(i(.(illiO 1 1 10 Cll>itlS(j (111(1 ()I itself restore the periodicity of health. In some diseases, as measles, small-pox, scarlatina, typhu and other admitted fevers, the precise number o days, until the fever will yield to the natural eflfbr to restore the state of health, is known and give in the medical books ; and it certainly says vcr little for the orthodox remedial measures, tlia most of these; diseases run their stated time i spite of the remedies. The chrono-thennal reme dies are such as aid the restoring force of nature It is perfectly well known, that quinine, hydrocyanic acid, iron, silver, copper, strychnia, musk, assafetida, balerian, colchicum, suit/,, bismuth, tin pentitie, opium, and arsenic, to which should 1 added the hydropathic treatment, which, aft( all, is but a portion of Dr. Dickson's doctrine exercise a more or less rapid and powerful effec upon the rate of vital motion and temperature Whatever the condition may be, the effect o these agents is to disturb it, and the mor powerful of them do so almost instantaneously They require, however, to be administered with the most watchful attention to the stage, or fit of fever, in which the patient may be, and in the first instance, the very smallest doses that can produce any effect, until their effect upon that particular patient is clearly seen ; for all these rcme- 8 ill every case with absolute certainty beforchaiu what their action will be. The chrouo-tlicrma remedy at the wrong period, exasperates that pa ticular fit, but given at the right time, it assuag and shortens its duration. There is no such thii under chrono-thermal treatment as a fever runnii through its stated number of days. During ever n't of excited action and increased temperature, tl remedy is such as diminishes that action, lower the temperature, and brings on, sooner than wonl occur in the fits of the disease itself, the pcrio< of rest ; so also the stage of diminished action broken in upon, both extreme periods arc short enedj the alternation of disturbance is itself dis turbedj and the natural force, by the lengthenec periods of rest, aided in its struggle to restore th healthful alternations and balance of vital motion and temperature. For more full explanation o Dr. Dickson's discoveries, theory, and practice, w must refer the reader to " Tin: Fallacies of th Faculty." |3ut it is essential even here to call attention the fact, first urged upon the public by Dr. :kson, that in every form of disease, bleeding iens the natural restorative force, diminishes vital power, is, in fact, a wilful abstraction of very essence from the system. It makes the on of remedies comparatively weak, recovery 9 a \\a\s more s cm, is* c(.i am, an som< lines - possible. On this subject, Dr. Dickson says, " I " have not always had this horror of blood-letting. " In many instances, I have formerly used the " lancet, where a cure, in my present state o " knowledge, would have been effected without " but this was in my novitiate, — influenced 1) " others, and without sufficient or correct data t " think for myself. Jn the army hospitals, 1 ha< " an opportunity of studying disease, both at horn " and abroad. There I saw the tall fine soldier, o " his first admission, bled to relieve some sym] " torn, or to fainting ; primary symptoms were g< " over by such measures, but once having entem " the hospital walls, 1 found that soldier's face b< " come familiar to me. Seldom did his pule coun " tcnan.ee recover its former healthy character. 11 " became the victim of consumption, dysentery, o " dropsy; his constitution was broken by the firs " depletory measures to which he had been sub " jected. " Such instances, too numerous to escape my " observation, naturally led me to ask, — Can this "be the proper practice? It was assuredly the " practice of others— of all, could all be wrong V " Reflection taught me that men seldom act for " themselves; but take for the most part a tone "or bias from some individual master. I had the " resolution to act for myself, and my conviction, 10 " gained from mucb and extensive experience, is " that all diseases may not only be successfully " treated without loss of blood ; but that blood" Letting, however put in practice, even where it " gives a temporary relief, almost invariably injure " the general health of the patient." " Were I," says Dr. (Jully, writing ten year subsequently, " to detail the instances that hay " come before me at Malvern, wherein a serii " of nervous and other symptoms have date( " through years, from in some cases, a single Larg " bleedingj the recital would appal many wh " look upon that operation as very simple and ver '• innocent; because very commonly practised." — And againj Dr. Dickson says, "the long shiver " of the severest ague, the burning fever, the fatal " lock-jaw, the vomiting, cramps and suffocation of " Cholera, the spasm of asthma and epilepsy, " the pains of rheumatism, the palpitating and " tumultuous heart, the most settled melancholy " and madness, dysentery, consumption, and every " species of palsy have 1 traced to loss of blood." Fortunately for humanity, this denunciation of the system of letting out the life-blood, has not been in vain. Far fewer now arc bled into weakness, disease or death. On the approach of such a disease as Cholera, it is not possible too strongly to impress upon the public, that any bleeding, no matter under what pretence, 11 Cholera, and may even suddenly bring on an attack in its severest form. ]t may also be as well to remind practitioners of medicine, that every immediate purpose which in any case can be answered by blood-letting, is attainable by the harmless method of tying a wet bandage tightly round the arms or legs. One further fact as to blood-letting, it may be worth while to mention, that in a given quantity of blood, the first, taken from a healthy subject, there are a certain number of red globules; in the next bleeding, even long afterwards, there arc found fewer of these globules, and even years after if the bleeding have been heavy or frequent, the original proportion of these red globules is not restored. It may be that we have not yet discovered the essential use of these deep dyed particles in the blood, whether they be a cause of motion and life in the blood itself, whether they arc essentially connected with its electrical condition, or with the vital energy of the; brain and nerves ; but we do know that they arc slow and difficult, if not impossible, of restoration, and that just as difficult is it to restore energy, tone, and high vitality to a system from which they have been abstracted. We again, therefore, urge upon our readers, that whatever other absurdity they may submit to, they set themselves resolutely against losing by leech or lancet a single drop of 12 blood, tor the blood is tnc me, and on it depends the power to resist disease and to recover from its attacks. There seems little reason to doubt that before any very long period, the same conditions will be present bere as have given rise to Cholera in India and on the Continent of Europe ; as however, the majority are not attacked even in those places where the epidemic is most prevalent, it follows that all might escape its influence, if they could be put in the same condition of resistance. It is perfectly notorious, that comparatively few of those who are in vigorous health, or who have opportunities of occasionally breathing fresh country air, or who live in good houses, and are not over worked, nor over nor under fed, nor crowded together in sleeping apartments, nor addicted to intemperance, are attacked by Cholera. If a deficiency of electricity in the earth or atmosphere, or any disturbance of the currents of that all-pervading influence, bring on Cholera, by depriving us of our vital electricity, and so paralyzing the nerves that give life to the lungs, stomach, and other vital viscera, it is still certain, that by far the greater number are enabled to withstand the deprivation or disturbance whatever it may be. Instead, therefore, of perpetual apprehension at the approach or near neighbourhood of Cholera, there should be the mo-it active exertion made by every one to get into the best 13 indeed who cannot succeed in ensuring their own safety, if they will take the trouble and practice sufficient self-denial. JOf all protective* against Cholera, the most ectual is a clean skin, which fortunately the mber of private baths, and the public baths and shhoiLses enable every one to have at no great st and witli very little trouble. To preserve the skin in such cleanness, assures its perfect tone and health ; it is not sufficient to bathe occasionally, or even once a week, the entire person should be completely washed every day, and that for the very reason that makes most persons think it unnecessary, because we are so closely covered by our clothes. On that very account the pores of the skin which may be called the vital safety valves are clogged by the deposits of the insensible perspiration. Doubtless many persons will be utterly astonished at the idea of having to wash all over every day. For them it is quite trouble enough to wash face, hands and as much else as is seen above their dress. It is better, however, to take this daily trouble than to be trembling from day to day at the thoughts of Cholera And after all, this daily purification of the skin is no such difficult matter. The best and easiest way of accomplishing it is to have a coarse sheet partially wrung out of cold water, thrown 14 sheet briskly for five or six minutes, and then to rub dry with as coarse a sheet or towel as the skin can comfortably bear. Those who adopt this practice, or who even rub all over every morning 01 night with a well wet towel, will soon learn from their sensations of increased vigour, spirits and •xeneral comfort, that even so simple a process may be a powerful resistant to disease. Those who fancy that it would be impossible for them to bear the touch of cold water, can dip the sheet or towel in warm water, but if they use a warm sheet they should have a dry one thrown over them along with the wet one, and be rubbed over both, that they may not feel chilled by the rapid evaporation of the warm water. Next in importance to keeping the skin clean, is occasional change of air, which the railways make sufficiently easy to the great majority. So lonj; as it pleases the authorities to make what the Times most justly calls a churned stagnant pool of the Thames, and to poison what should be a source of health, by pouring the whole drainage of the million population of London into the river, we cannot recommend the metropolitan population to seek the invigoration of pure air upon the Thames. If the working classes object, that either of these measures of protection arc too expensive for them, we have but to reply, that for the most part the 15 111 I I S o|)l ILL 111 L^lll™ IJtHilvl *' tl li\ I |lllrJllV,~llWll>™Vi3 111 increasing the tendency to Cholera would be more than sufficient to accomplish both the above powerful means of prevention. It is also important to avoid crowded ill-ventilated sleeping apartments, and it should be borne in mind that night is the period of greatest liability to attacks of Cholera. There can be no doubt that, were the system of model lodging-houses so extended as its complete success so far proves it might be, the victims of Cholera would be greatly diminished, merely by the increased comfort, healthfulness, and cheerfulness of a residence in such apartments. It may be taken as a proved fact, that Cholera is not caused by any pestilent exhalation ; it does not rise from choked-up sewers or cesspools, or open stagnant drains, or the churning of a city's filth up and down its rivers ; but each and all of these debilitate, and dispirit, and weaken the power of resistance to disease. Under such circumstances, the healthful alternations of motion and temperature are in the condition most easy of disturbance, and most liable to be upset by the conditions, whatever they may be, that give rise to the epidemic of the day. It becomes, therefore, the public duty of every individual, to see that Government and the various local authorities do not sleep over sanitary measures, and that no pretence ot \esuu i ignis 16 The City authorities are no more entitled to continue any festering cause of pestilence, than men have a right to lurk behind a hedge with some deadly weapon to be discharged on passers by, or to poison the daily drink of a whole people. In conclusion, it may be well to remind on readers, that although in some instances attacks o Cholera seem to come on with the utmost severity almost instantaneously, and without any prenioni tory symptoms ; yet, in by far the majority of cases the patients are disordered in the stomach aiu bowels, and are out of spirits and oppressed with feeling of lassitude and uneasiness for some days In every such case, the best advice is, to avoi< ijiKick medicines and self-doctoring' ; send for ( medical man at once, and trust yourself entirely t( his care. In cases, however, where premonitor symptoms have either not been present, or hav< been overlooked, and the attack of Cholera is sud den and severe, where there is no difficulty 0 breathing, it can do no harm, and may very pro bably afford considerable relief to foment the sto mach, with flannels wrung as dry as possible on of hot water.* * The best mode of administering these fomentations i> to lay a folded blanket across the bed, under the patient's back, to pour water nearly boiling on the flannels, ami wring them in a towel, and having laid them over the 17 however severe, are tlic reverse of dangerous. 'They are, in fact, the struggle of nature to furnish the Brain with an increase of vitality for the resto- Stlie paralyzed nerves. Dr. Wardross that, in his ingenious work on Diseases art, spasms have a purely mechanical y constricting the great muscles of the r constrict also their veins and arteries, stop the supply of blood to and from them, diminish the quantity of venous, and increase that of arterial blood in the heart, and excite it to greater activity. Thus a larger supply of arterial or vitalized blood, and the power of generating more nervous energy, arc furnished to the brain. The cramp, therefore, is an effort of the healing power of nature. We do not yet know how the paralysis of any important nerve produces spasms, but we do know that the tendency of these spasms is to enable the Brain to revitalize the nerve. In Suffocative Cholera, unless air be artificially furnished to the lungs, the cramps increase the danger. As no air can be inhaled, there is no vitalised blood in either the heart or arteries, the increased quantity sent to the brain is but an increase of pressure, that brings rapidly on the stomach, to lap the blanket tightly over, and pull up the bed-clothes. The flannels should be changed about every six or eight minutes. 18 INTRODUCTION. heavy stupor of approaching death. In Suffocative Cholera, therefore, it is important to stop the spasms, and the external application of chloroform for the purpose deserves a trial.* The great point however, the real resource for the preservation of life, is to get, as Dr. Dickson has most forcibly urged, air into the lungs. Do that and the mortalism of Suffocative Cholera is overcome, you gain time for the action of remedies, you may try the effect of a galvanic current along the course of the gastric branch of the paralyzed nerve, and there will, at all events, be intervals of vitality for the administration of the more active chrono-thermal remedies. It is right to state that Dr. Dickson is in no way accountable for this introduction. — Ed. * The hot fomentation mentioned above should also be used in Suffocative Cholera, but not for any long time, and in every case it would be well to place a folded handkerchief or linen bandage wrung out of cold water round the throat, covering the wet bandage witli one of flannel, suf- 19 REVELATIONS ON CHOLERA. Tin; Cholera is coming to England ! — What is the meaning of this cry ? — What is this Cholera — this word which carries such fearful import to the ears of the world at large ? The term Cholera is a derivative from the Greek words x^'h bile, and f>ito, I flow. It conveys, then, not the least information as to the nature of a disease, where neither the abundance nor paucity of that secretion — its vitiation or variation — is an element entering into the danger to life which the phenomena called Cholera involve. To know Cholera, you must know every wrong movement of the body. To describe Cholera, you must describe every purely functional disease to which humanity is liable ; for, with the single exception of structural change, for the development of which the complaint is too brief in its duration, there is not a possible morbid movement which may not occur in its course ! Its study is consequently pregnant with instruction, equally to the inquiring physiologist, and to the lover of pathological research. Hitherto the morbid anatomists have been almost the sole authorities on Cholera. Confining their H observations to the post mortem changes which the Brain exhibits on dissection, certain ot them suppose the disorder to consist in a peculiar inflammation of that organ ; others, looking to the dark and vascular state of the stomach and bowels, believe inflammation of those parts to be the origin of every Kind change : not a few imagine the liver lief seat of mischief, from the congestion general betrays; while the state of the ivsencc or absence in the alimentary each in its turn been stigmatised as the immediate cause of the disease. There are not wanting some, however, who believe that the post mortem appearances, which their brethren look upon as causes, are in reality the mere effects or results of nervous derangement; forming their opinion on the rapid succession of the symptoms in life, however difficult they may find it to connect them with the discoveries made after death by the scalpel. From this discrepancy of opinion on the very nature of the disorder, is it wonderful that the practice should be equally unsettled? Bleeding, blistering, and leeching, in rapid succession, if not simultaneously, have* been had recourse to by those who ascribe to the disease an inflammatory origin. Emetics and purgatives, with calomel usque ml /museum, form the sheet-anchor of all who look upon the state of the liver or the bile as its proxi- 2 others to prescribe the bile of the ox, and having prescribed it, they have not failed to vaunt its \irtues in the disorder! — Those who see in Cholera a rapid exhaustion of the powers of life, naturally turn with contempt from such modes of treatment, and fly, too exclusively perhaps, to stimulants and cordials. What a picture of the medical science of the nineteenth century ! The correctness of the present designation of the disease, we do not mean further to discuss ; it is more desirable to ascertain the extreme symptoms which all unite in calling " Cholera/ and to be aware how far these differ in their essentials, from another form of disease which may have received the same denomination. An individual with Hushed face, full bounding pulse, and hot skin, is in a totally different state from one labouring under difficult breathing and oppression at the chest, pallid withal, and pulseless, though there should be present in both a multitude of other symptoms perfectly identical. Both of these states having been produced by the- same epidemic influence, receive the same name; but they have this difference, that the difficult breathing of the one makes the very danger from which the other, enjoying an immunity from this symptom, is free. The first is Cholera mitior, analogous to English Cholera ; the second is Cholera asphyxia, or Sitffocative Cholera. We shall first consider that form of the disease which, from the early difficulty of breathing, lias 11*1 f~*\ 1 A 1 been (iciiominiitrd i noiera Aspnyxia. 3 ( holi:ua. Cholera Asphyxia. Mr. Orton lias well described the symptoms: — "An extraordinary depression of spirits, and " general uneasiness, come on, attended by tremor " and sense of debility, giddiness and headach ; " and occasionally ringing in the ears is also felt, " particularly on rising from the recumbent posi" tion, or making any sudden movement : pains " resembling those which attend the accession of " fever, are frequently felt in the limbs. The bowels " are griped occasionally, and natural loose stools " occur. Nausea comes on. The circulation and " temperature of the body are variously disturbed ; " but most commonly the pulse is accelerated and "' weakened. The skin is moist, and colder than " usual to the hand of another. In general, how" ever, the severer affections quickly set in. Acute " griping is felt in the bowels, the stools become " extremely frequent and watery, and change to a " grayish-white colour, so as exactly to resemble " the congee or barley-water. Vomiting conns " on ; and, after the common contents of the " stomach, a clear watery fluid, interspersed with " flakes of mucus, is discharged. Copious sweat " breaks out, and the anxiety and debility rapidly " increase. The countenance assumes a very pecu" liar appearance, by which alone the disease may " generally be distinguished. This is so remark" able, as occasionally to render servants reeog" nized with difficulty by their masters, even in the 4 " early stages of the disease. It is usually during " a tit of vomiting that spasms of the muscles are " first felt. They affect occasionally the whole < " the muscles of voluntary motion, but particular! " those of the legs and feet. The respiration, froi " the first accession, is observed to be hurried an " oppressed, and is frequently complained of. A " the disease increases in violence, the colour o " the whole surface changes to a livid /me, particu " larly round the eyes and at the extremities. Th Surface is bathed in cold sweats ; the bands an< eet, and afterwards the whole body, rapidly groi E)ld." — "From the first setting in of the disease 1 extreme thirst invariably attends ; and, notithstanding the coldness of the body, there is 1 ardent longing for great quantities of cold Bater, which, however, though gratefully and agerly received, frequently affords no relief to " the morbid sensation."- — "Great oppression and " sense of anxiety are also referred to the pne" cordia. The urine, when it does appear in the " early stage, is pale and watery ; but, under the " existence of the severer symptoms, that secretion, " as well as that of bile, is completely suppressed, " The tongue is natural at first, but in the course " of the disease it becomes furred and deficient o " moisture; and dryncss of the mouth and throa " is very generally complained of. The hands an " sodden with cold sweats, shrivelled and wrinkle* " like those of a washer-woman after a day's labour, " and frequently of a dark blue colour. There is 5 " rent his remaining niber. At six o'clock in the evening a sens f coldness and slight nausea, came on, but die ot amount to actual faintness. lie took a dost f salts of his own accord, which acted on hi owels, and produced vomiting ; but he passe< :i uncomfortable night. All day on Wednesday ie patient was ill, but was not seen by any 8 " Thomas was called to him, who found him in a " very strange condition. No pulse could be felt, " the extremities were cold, the fingers blue, the " breathing short and very laborious ; yet the " patient was sensible, though somewhat deaf, and " confused in his ideas. Some diffusible stimuli " were exhibited; and on Thursday night, at ten " o'clock, the writer of this article joined Mr. " Thomas in consultation. A very particular ex" animation was now made of the arterial system. !' A weak fluttering and indistinct movement was " felt in the region of the heart, when the patient " lay over on that side. The chest sounded badly "in every part. No respiratory murmur could be " heard through the stethoscope ; but the situation " was unfavourable for auscultation, being in one "of the most noisy streets of the metropolis. No " pulsation could be i'elt in the descending aorta, " the inguinals, carotids, radials, or, in short, in " any artery of the body. The examination was " repeatedly made, and with the utmost care. The " patient was sensible, but restless, and complained " of an indescribable oppression and sense of anxiety " in his chest. lie was thirsty, the tongue dry and " furred, the countenance clouded, the extremities " cold and pale, the nails blue, the breathing very " short and somewhat laborious. Bottles of hot " water were applied to the extremities, and dif" fusible stimuli of the most powerful kind were " exhibited internally, though with some difficulty, a 3 9 tis tiii* s[(nti a cit i?*(t s t r r l l (t ()( t* , inotlioi'woi'dSj 111 1 (*( * " had vomiting.] In this condition he remained •• the whole of Thursday night, and was found on '¦ Friday morning exhibiting precisely tin* same ¦¦ phenomena. The stimulation, with frictions, ¦• fomentations, &c, were continued. At five, " i*. m., the medical attendants again met, but not •¦ the slightest mark of arterial action could be felt "in any tangible artery, lie had not slept any '• in the night or during the day. The tongue was '¦ more loaded; there was some intellectual aber' ration, and the muscular debility was extreme. ¦ He could hardly turn himself in bed, and when ¦¦ his head was raised he was threatened with syn" cone. A stimulating salt-water bath was ordered " at ten o'clock at night, and in the meantime the " stimulation was continued. This day he took " twenty grains of calomel with compound extract " of colocynth, and the bowels were well cleared. " At half-past ten at night, while preparing to '¦ place the patient in a warm bath, a slight pulsa" tory motion could be felt in the carotids; and " shortly afterwards, while in the bath, the, radial ' arteries began to pulsate though very feebly. (' ( ' From this time a gradual and almost imper'¦ ceptible improvement took place in the arterial " action and animal temperature, till both were " completely developed. The freedom of breathing ¦• corresponded in the improvement of the function ¦¦ of the circulation, and, in two days from the '• appearance of arterial pulsation, a smart febrile 10 New Series, No. viii. p. 102. I have said that Cholera Asphyxia, like every other form of the disease, may take place from loss of blood. The reader will judge whether, while describing the effects of flooding in the female, Dr. Blundell has or has not described its essential features :—": — " When blood," says Dr. Blundell, " comes away in large quantities from the uterus, " alarming symptoms soon begin to appear : the " tongue, lips, and cheek, become pale and ghastly : " the pulse frequent, (1 fcO, L50,0r 160,) small, and •• perhaps intermittent, disappearing in the wrist " for a few seconds, or even for a few minutes, '• nay, for an hour or more, and then returning ; " and there is weariness and weight in the limbs, " and fainting, and sighing, and vomiting. Now all " these symptoms you may throw together, under " the head of symptoms alarming in a high degree, " but which are not to be looked upon as indiea" tions of immediate and almost certain dissolution. " When the patient is about to die in consequence " of the blood she has lost, in addition to the " preceding symptoms, which may have been pre" cursory, the following also frequently occur: — " The whole body becomes damp and chilly, the " very breath becoming root, as you may feel some" times by putting the back of the hand a little " before the mouth — and the pulse intermits very " much, or perhaps it is permanently imperceptible " in the wrist; which it may be for minutes, say, 11 " for half an hour, an hour, or even longer than " this, before the dissolution takes place; and soon " the patient becomes restless, and wishes to tiller " her position ; and no persuasions induce her to " be quiet — relief Hies before her — she changes her " position, and again she changes, but remains " uneasy still ; and now the irritability and e.\-" haustive oppression continually augmenting, she " »cts at last into a state of involuntary jactitation, " throwing her limbs about on the bed ; and these " are speedily followed by a cessation of the cardiac " and pulmonary actions." — Lancet. Mr. John Bell, who had the eye as well as the hand of a painter, will give the finish to this description of loss of blood :—": — " The countenance " assumes, as in asphyxia, a livid hue, from want of " circulation ; the face becomes all at once deadly " pale; the circle round the eyes is livid; the lips " arc black ; and the extremities arc cold. The "¦ patient revives, and faints again. With a low " and quivering pulse he is sick, and his voice i.s " lost. The countenance is not of a transparent '¦ paleness, but of that clayey and leaden colour " which the painter represents in assassination and " battles." The surgeons of the Indian Army, who know Cholera Asphyxia at a "lance, will testifythat this description is a perfect picture of that disease. Spasm, suppression of urine, blindness, with craving thirst, are all prominent symptoms of loss of blood. In experiments upon dogs, 1 have 12 CHOLERA. Appearances on Dissection. We shall now advert to the appearances which have been observed on dissection of the bodies of persons who have died of Suffocative Cholera. These have been, pretty uniformly, a general fulness of the internal reins, particularly of the head and intestines ; water has been observed in all the ventricles of the brain. The lungs, much collapsed, — or gorged with blood, have been remarked to contain frothy sputa ; in either case, they contained little air, and suffered no further collapse upon opening- the chest. The right side of the heart has been generally engorged ; and the blood, when found in the left side or in the arterial system, has been for the most part fluid, and very dark. The gall-bladder, sometimes gorged with bile, has occasionally been found almost empty, its ducts for the most part closed by spasm. The small intestines have been tumid with flatus; and the great gut, which seldom contained any foeces, has been more or less contracted. The urinary bladder has been generally empty and contracted, though sometimes full of pale urine. Arguing from these appearances on dissection, the most absurd notions have been entertained by some practitioners of the nature of the disease. Inflammation, congestion, and all manner of traces l)l (lit llllllllli 1 ''I 111- I tt- v , 111 l V. VI- II .VII L\J t\ 13 CHOLERA. may be curious to know whether or not we find, on the post morion examination of animals bled to death, a similar congestion of the internal veins, and a general agreement in the appearances detailed. " All the larger veins of the legs were opened "in a small dog. At first, the pulse was accele" rated — soon after it became slow and languid. " The heart's motions, though feeble, were never « irregular ; and indeed, long before death, they " could neither be seen nor felt. Borbonjynd (or " rumblings of the bowels) were early heard, and " lasted a long time. The breathing at first was " hurried; soon it became slow and laborious, and "at last convulsive. The pupils were frequently " examined ; they became gradually less and less " obedient to the influence of light, and at length " ceased to contract altogether. Slight spasmodic " contractions took place, first, in the femoral and " abdominal muscles : then the head, neck, and " fore-legs were likewise powerfully affected with " spasms. " At this time a deep step seized the animal : " he breathed slowly and with difficulty, and, for " a little time before death, respiration at inter" vals was suspended altogether. \N benever the " breathing was strong and quick, the pupils re" covered their tone, and the Mood was more "strongly propelled. In an hour death closed '¦ the scene. " The dissection of the licud «us first lugun. 14 " turgid vessels, the larger of which were of a " very dark colour. A bright red spot was ob" served near the eornua, where some degree of " sanguineous effusion had taken place. The "' sinuses were full of blood. In all the ventricles " there was more or less water effused : the base ''of the brain, and the eighth and ninth pair of " nerves, were inundated with water. A net-work " of red vessels was spread round their origins, " and the optics were in the* same state. In the '¦' cervical and lumbar regions of the spinal mar" row, there was a considerable degree of redness. " The right side of the heart was full of blood ; the " left auricle contained a little. Some blood was " found in the large veins, and a few clots in the " thoracic aorta. " The stomach, and all the intestines, were " tumid with flatus ; the veins of the mesentery ¦• were turgid. The turgid state of the veins of " the head was very remarkable : indeed, through" out the whole body the veins were tumid." In another experiment, "the right side of the heart " contained a good deal of fluid blood ; the rectum " and urinary bladder were found contracted and " rugous."* The collapsed state of the lungs, so constantly observed after death from Cholera, is also very remarkable in animals that have been bled to death. Indeed, both the essential phenomena in * Dr Seeds on the Effects of Loss ut lUOOII Medical Gazette, "-'ml January lttoO. 15 life and the post mortem appearances would scorn to be identical. The reader lias seen that paralytic and spasmodic action, so frequent in the epidemic Cholera are equally frequent results of Cholera from loss of blood. I have repeatedly known palsy of one side follow bleeding from the arm. Paralytic, blindness and deafness, are common both to Cholera and haemorrhage. During the epidemic, spasms of the stomach and intestines have been very generally the forerunners of paralysis of both. This has been incontestably proved, by the most potent stimulants and irritants, however administered, being retained, — and by pills, powders, food, &c, being found after death completely unchanged throughout the whole track of the alimentary canal. The gastric or stomachic branch of the pneumo-gastric nerves then being proved to be palsied, can we doubt that the pneumonic or respiratory portion also is in the same state, when, by artificially paralyzing it, we have every essential symptom and change witnessed in those who have died of Suffocative Cholera ?* "In general, when these nerves Hnow more than seventeen years since I published Mncet, a paper on this disease, in which I showed th took place from a palsy of the pneumo-gastric or eighth pair of nerves. Dr. Wilson Philip, in a pamphlet of his, published long after, particularly alluded to the analogy betwixt cholera and the effects of the division of these Elle endeavoured to reconcile the symptoms with lilt of dissection, in a different manner from what der will find submitted in these pages. 16 " tion immediately becomes laboured, or hurried " and irregular, and the animal dies in the space "of a few hours. In a dog, in which the par vagum " (pnenmo-gastrie pair of nerves) was divided in " the neck, the animal survived three days. There " was dyspnoea (difficult breathing) with frequent " vomiting and the stomach was found to have " become inflamed."* Loss of voice, so frequent in Cholera, is a constant effect of this operation. Digestion in both cases ceases to be performed. In both, the arterial blood becomes gradually darker and darker, and the subject grows cold. The lungs after death, from this operation, arc found as in Cholera, tumid, and partly gorged with blood, partly filled with frothy sputa. In general also those organs are similarly collapsed and engorged, and as in the disease in question, seldom or never suffer any further collapse on opening the chest. The whole internal veins are similarly loaded with very dark blood, and the right side of the heart is gorged with it. As a result o this operation, Sir B. Brodie found less carboni acid evolved. Dr. Davy particularly called th attention of his medical brethren to the sam fact in Cholera. Sir B. Brodie, after artifieiall paralyzing these nerves, inflated the lungs, am restored the natural colour of the blood. I founc • Mayo 18 1 8 Phsyiology. — Mr. Mayo lms here mistaken congestion for inflammation. The same mistake has been made by writers on Cholera. 17 18 that this could also be done in Cholera; for, immediately after a patient had ceased to breathe, 1 commenced the process of artificial respiration, and found, upon dissection as I had anticipated, blood in the left ventricle and aorta of a scarlet colour. The essential symptoms, and the post mortem appearances both in Suffoeativc Cholera and in oases of division of the pneumo-gastric nerves, are identical. Kra Asphyxia, then, may be the effect of ng in nature acting on the Brain and so as to withdraw, by shock or otherwise, their influence from the various nerves of the body, but more particularly from the nerves necessary to the functions of respiration and digestion. Arsenic, vcratria, prussic acid, and other poisons, can produce all the symptoms of this disease. And according to the particular nerves most deprived of the ccrebro-spinal influence, do the symptoms of the patient during the epidemic, vary — in one being mild and tractable — as in cases where the respiratory nerves are not involved; in another passing rapidly from life to death, or exhibiting numerous forms of disorder, such as lockjaw, palsy, epilepsy, apoplexy, delirium, and even hydrophobia — puzzling the physician alike for a denomination and a remedy. Before we endeavour to explain the rapid succession of the symptoms which principally characterize the fatal form of the epidemic, I may is, according to the degree of that diminution, a Languor in the performance, or a morbid increase of that part's action or function. The complete absence of such influence is marked by a loss ot function of the part. These propositions I consider as demonstrated, 1. Because the interruption of the cerebrospinal influence, by pressure on the motor nerve of a muscle, causes tremor, spasm, weariness or Ksy, according to the degree. Similar pressure a sensific nerve, increases or diminishes sensai. Applied to a glandular nerve it increases, diminishes, or prevents secretion. 2. Palsy is often preceded by muscular tremor, spasm,* or languor ; — amaurosis, by false or double vision ; — loss of hearing, by ringing in the ears, or partial deafness ; — loss of feeling, by tingling pain or numbness ; — idiocy, by hallucination, delirium, or stupor. t. These phenomena can all be produced b passions, cerebral shock, loss of blood, dc fectivc nutrition — whether as regards food o air — and by substances, the admission of whic into the system in health prevents assimilatioi They may be produced also by the various poison Each and all of them having been witnesse tSir B. Brodie found spasmodic notion to be a frelt result of decapitation — another proof, if such were ting, that spasm is the effect of diminished cerebral 19 of them, on the fairest principles of induction, must be ascribed to diminution of cerebral or nervous influence over the different organs with which they are associated. trhat increase and cessation of function should h mark a state of decrease of this influence *ht at first sight appear paradoxical ; but a lc reflection will teach us to explain the fact. Every organ of the body has an acting, con trolling, and directing power. Diminution in th acting power of a muscle is known by weariness < weight, and inability to move; tremor and spas modic movement show diminution and loss of th controlling power : the former, being merely rapid succession of incomplete spasms, marks th possession of more of this power than the latte Pain, numbness, and insensibility, are evidence of variation and loss of the perceptive or directin power. Complete palsy is the effect of the tota absence of all these powers. In the same manner I explain the disorders of the glandular system. Excess of secretion proves the absence of the controlling power ; diminution and suppression, the diminished state or loss of the power of action ; vitiation, the loss of the power of combination or direction. I Morbid action, then, so far from being the effect increased vital energy, is in reality the symbol ts partial absence. The frequency of the rice-water appearance of 20 during this epidemic, lias, by some, been supposed to throw a mystery over the disease in questio But this appearance is sufficiently explained 1 spasm of the gall-ducts preventing the admixtu of bile. In thirty eases which I myself examinee after death, I could not force the bile through tl gall-ducts by any pressure of my hand. Th spasm of these ducts is often induced by the pa sions, is an instance in proof that in this disea it is caused by cerebral alarm or shock. I ha\ seen this same rice-water-like fluid vomited by girKmmediately after amputation of the thigh, he constitution having taken alarm at so great a injury.* In the course of the epidemic Medite ranean Fever, the ejections of some of the su fererSj more especially those who had been large depleted, precisely resembling the matters throw up in Cholera. Adverting to the case of M Boyd the surgeon of the hospital, Dr. Denmar says, — "1 was called to him in the middle of tl " night, and found him scarcely able to articulat " vomiting a turbid or whey-coloured fluid ; wit " excessive anxiety, sobbing, and a pulse extreme] " weak; cold clammy skin, and the features pa " and shrunk. "t The disease had become Cholei Asphyxia. The subject of it recovered. ¦ shall not take up the time of the reader with hypotheses of authors, nor attempt to show * The operation was performed by the late Mr. Liston. + Medico-Chirurgical Transactions. 21 !3 futility of the reasoning of those speculatists, 10 affirm, that vomiting and spasm in this epimic are efforts oi' nature to get rid of something xious from the system. These, as in hsemorrgie Cholera — Cholera from loss of blood — are •rely symptoms of a diminution of cerebral or rvous influence over the respective organs to fHie essential symptoms, then, and the post Hem appearances in both, are identical. Exin the one, and you require little to add in delation of the other. In both eases the sensorial or voluntary powers remain almost to the last. It is by these that the pectoral, intercostal, and other external respiratory muscles act ; and you do therefore sec them acting with tolerable freedom till a short time before death. How then does the fatal result in both instances take place from asphyxia — from suffocation ? — We shall here consider more fully the functions of the pneumo-gastric nerves. The pneumo-gastric, or, as they arc sometimes called, the eighth pair of nerves, supply by their recurrent branches, certain muscles of the glottis and larynx necessary to respiration and voice. They send branches to the lungs, the stomach, and heart. Through these nerves, the chief vital organs are immediately influenced by the Brain. Through these nerves, also, the vitality of the blood is maintained. Where these nerves are paralyzed, the blood gradually dies ! ¦.':- over the stomach, — whether artificially produce! as in the ease of stun, division of these nerves < loss of blood, — is followed by vomiting. To th a passive or palsied state succeeds, and no stimu hints, however 'powerful, can again rouse the orgi into action. Digestion, is also interrupted; and w remark, that undigested meat is frequently se< in the ejections of the Cholera patient. The feeb or whispering voice observed in the disease show that the muscles necessary to that function are als paralyzed ; and the sighing and anxiety prove tin the respiratory process is interrupted. That th must be by a derangement principally of the /'/ ternal muscles of respiration, is further proved 1 the external muscles being observed to act freely under the control of the will. The sufferer raises his chest to its full height; but you see the abdomen becoming at the same time lank and depressed, and you therefore know that the lungs do not receive their proper supply of air.* The ; Mr. Orton has allowed this circumstance to escape his notice. He has also forgot, that upon dissection the Lungs were collapsed, and contained little air. "We have the '•' evidence of our senses," he say 3, " to convince us, that " there is no deficiency in the quantity of the air taken li into the lungs. On the contrary, we see the respiration " hurried, which convinces us that an unusual quantity " must be taken in." The hurried respiration is an evidence of the attempt to take in air ; hut the depressed abdomen in life, and the collapse of the lungs observed after death, demonstrate that the effort is unsuccessful. 23 diaphragm ascends in proportion as the chest ascends, and the lungs arc not expanded. There is an obstruction to breathing ; and the following is the manner in which this is produced: — The dilating muscles of the mouth of the windpipe, — the glottis, — which the pneumo-gastric nerves supply, becoming, like other muscles, wearied or paralyzed, cease to act. The lips of the glottis, having nothing to open them, meet in close approximation, and, when the patient endeavours to inspire, little or no air is admitted. Expiration, on the contrary, is performed with comparative facility j because the rush of the air outward assisted by the weight of the descending ehes expands the glottis, which opens like a valve, am the egress of the air is thus little impeded. It wi be seen, that at every successive inspiration am expiration the quantity of air in the lungs must b lessened ; and that the lungs themselves must co lapse and diminish in size. They resemble more and more the lungs of the child that has never breathed, and sometimes sink like them, when placed in water after death. To preserve the child from asphyxia, — from suffocation, — there is a direct communication betwixt the right and left sides of the heart, by means of the foramen ovale — a hole which becomes closed soon after birth. The sufferer in Cholera having nothing of this kind, the blood must gradually accumulate in the right side, for the gradually collapsing lungs intercept the full flow of the blood. The pulmonary artery 24 becomes more and more gorged with thick viscid un-aerated blood, and the common secretion of the mucous membrane of the lungs, by the constant effort at inspiration, is worked up into the frothy sputa which dissection shows after death. Those who attribute the absence of pulse at the wrist to a cessation of the heart's action, are in the great majority of cases in error. Could sufficient blow reach the left side of the heart, there would 1 no want of arterial pulsation ; but as the left si( receives only a small quantity, it cannot by its mo rapid contractions supply the extreme arteries. Tl external veins, as a consequence, receiving little ( no blood, must be necessarily nearly empty ; am this is the reason why, when a lancet is plunge* into them at an advanced stage of the disorde a few black drops only escape; for the atnu spheric pressure forces on to the right side of tl heart the whole contents of the external vein However loaded the right side of the heart ma be, this blood cannot retrograde into these vein for the valves with which they are provided pre vent this. The superfluity, therefore, will be foiuu in the internal veins, which, having no valves relieve to a certain extent the overloaded righ heart. That the extremities are cold and livic is partly owing to the diminished nervous fore of the body, and partly to the blood which the contain never having come into contact with th atmospheric air. In pueri cerulci, the greater part of whose blood passes through the open foramen 25 ovule, the extremities are cold and blue, but they are not shrivelled as in Cholera, for they are sufficiently supplied with blood, though that blood, from its partly un-reratcd state, is unable to maintain the nervous influence necessary for the sufficient generation of heat. I The whole symptoms of Suffocative Cholera ar ressive of diminished nervous influence : ant internal congestion so often looked upon as th inmate cause, is, in reality, the effect of th apse of the lunys, caused by the paralysis of tl umonic portion of the pneumo-gastric nerve hat produced enormous congestion of th gs, liver, spleen, &c, by strangling anima vly ; and the experiments of Professor Colcma lonstrate, that the whole air of the lungs nearly exhausted in animals so destroyed. Collaps of the lungs, visceral congestion, and a dark am uncoagulable state of the blood, arc common t both the Cholera patient, and the dog that ha been killed by hanging. |[t Arould be only wasting the time of the reader attempt a formal refutation of the variou 'ories that ascribe the origin of the disorde inflammation, congestion, &c. The authors o ;se have evidently mistaken the congestive re ts of suffocation for primary local inflammatio 1 congestion. Their reasoning being foundec false facts, their treatment necessarily partake the errors in their theories. The extreme thirst, so common in Cholera, like 26 CHOLERA. in particular cases of the disorder, is a mere morbid sensation. Whenever the Brain loses its' perfect control over the digestive organs we find more or less thirst. It is present in the Passions of Grief and Terror, where also the sighing and anxiety show the inability to breathe freely. It is the death-thirst of the wounded in a field of battle, and of all who have lost much blood. As it is, for the most part, an early symptom of the disease, the patient, if on a march, from its urgency, naturally seeks to assuage it at the first ditch or tank h comes to. His friends, in such instances, not un frequently ascribe his disorder to some poisonou principle in the water. Though we cannot agre with their views in this respect, it must not b denied, that when the epidemic prevails, drinkin cold water alone will sometimes set up every symp torn of the disease. The restlessness remarked in the epidemic malad; I common to every disease where the respirator acess is impeded. Take the symptoms of rson whose lungs have collapsed from an art ial cause — the effusion of blood into the thora 1 example ; and this restlessness, in commo with some other symptoms of Cholera, cannot fai to strike the reader. " You will find him," sa} Mr. John Bell, "with bloody foam at his mouth Kis face pale in the cheeks, and livid round th ps and eyes ; heaving the breast with intoler blc anguish, tossing from side to side in bed." The cold sweats are expressive of the complete c 2 27 want of tone in the cuticular apparatus, and with the small quick pulse, mark that state of extreme prostration common to the moribund in all diseases. Objections may he urged, that the differei symptoms of Cholera remarked on the division o the pneumo-gaatric nerves, are not present in ever ease of the disease. The simple answer to this i the Brain in Cholera does not always lose its con trol over the same nerves. Moreover, its diniinu tion of influence is often confined to a portion o division of the pneumo-gastric nerve. This ner\ is not a simple chord ; it is a combination of man filmls having each a separate influence. In one case of the epidemic you may have, for example, vomiting with loss of voice, but without any symptom of difficult respiration. Here the stomachic vocal fibrils are paralyzed, while the pulmonic portion still possesses the cerebral influence. The patient in this case shall perhaps have a full quick pulse, Avith hot skin ; his arterial blood will be red ; and if a vein be opened, the blood may flow per snltwn. Let the Brain in addition lose its influence over the pulmonic portion of this nerve, what a difference in the state of the sufferer. In the former case, the patient may have little to complain of. The loss of voice is inconvenient, the vomiting is troublesome ; but he can breathe freely, and he has perhaps little or no thirst. In the latter, the respiration is hurried ; the pulse is quick, small, and almost imperceptible ; the thirst insupportable; and the whole appearance that of 28 a dying man. Such, then, is the wide difference betwixt Cholera Mitior and Cholera Asphyxia .' Vomiting, purging, and spasm of the muscles of locomotion, may be objects of attention in the one ; — in the other, our first and immediate care is the respiration. It has been remarked by almost every pract tioner of experience in the disease, that the pr portion of recoveries is infinitely greater amoi females than males. The physiological principl upon which this may be explained, afford an ax ditional proof, that in this epidemic the grc. proportion of deaths takes place from a palsy o the dilating muscles of the glottis. In the fcmal these muscles are shorter than in the male ; tl lips of the glottis do not therefore approximate & much : the voice is consequently less grave, an< she can, for the most part, remain longer in a stat of collapse — she can sustain imperfect respiratio for a greater period. I have known a woma remain in this state for five days, and recover. ISut there are yet other modes in which deat / take place from the same epidemic influence ideed from every other cause of disease, accor< to the particular respiratory muscles in whic loss of nervous influence may most prevail this will account, not only for the constan ation of the symptoms, but also for a different ppearance on post mortem examination. Bpasm of the constricting muscles of the throat produce a rapid asphyxia ; and the appearances, 29 CHOLERA. fth before and after death, Anil be nearly the same we witness in criminals who have been hanged. I When the debility is greatest in the pectoral and creostal muscles, the patient appears to breathe *tly, and seems to sleep; but when roused, he 11 complain of great weight, and will change his jture again and again. These muscles are in alth influenced by the will : when the sensorium iftectcd in this disease, the will does not stimuc them to action. The appearances on dissecn do not differ much, so far as the lungs arc icerned, from what we witness in the subjects lingering disease. Cramp of the diaphragm is a more rare symptom of the epidemic. A continuance of spasm in this situation very soon terminates life ; and the pain is excruciating. Dissection in this case exhibits much the same appearances as in the form I[ have known cases terminate fatally from cramp the heart. The following appears to be a case cramp of the left side of the heart : — I Vamp, Chitjiett, Bth June, 1830. — Corporal )berry, 11. M. list Foot, on route from Arnee Trichinopoly, near the termination of this rning's march was observed to drink at a ditch ; irtly after which he was brought up to the hosil tents in a state of delirium, with cramps of muscles of the legs and toes, pallid face, and perceptible pulse. Frictions to the legs and is, and the internal administration of diluted 30 skin ; which before was cold, became warmer; a feeble pulsation was also felt in the femoral artery. When asked if he had thirst, he answered, " No." Delirium again soon returned : the muscles of the throat could be observed in violent spasmodic action ; the breathing was almost interrupted ; the fingers were shrivelled and blue ; blindness and insensibility soon succeeded. From one eye there was a considerable lachrymation ; the other was quite dry. The pupils, at first contracted, became permanently dilated ; the cornea? were flaccid. Life was terminated in about two hours from the period of invasion. On dissection, the lungs suffered no collapse when the thorax was opened ; they were somewhat gorged. The right side of the heart was full of dark blood, which flowed into the cavity of the chest when the subclavian vein was accidentally cut, leaving the right auricle and ventricle in a flaccid state. The left side was so closely contracted, that, when bisected, there was not any cavity for the blood. I was led from this case to reflect, what woul< be the consequence of spasm of the thoracic aort below the giving off of the large arteries of th head. Would it not be a perfect Apoplexy When the epidemic raged in the 30th Foot, whil the Regiment was under my charge at Wallajahbac two fatal cases of Apoplexy occurred in Europeans within two days of each other. I imagined at the 31 influence : I am now strengthened in this opinion, for, knowing that the external spasms continually vary in their situation, Aye can analogically conceive them attacking internal parts in a similar manner ; and such a spasm as that alluded to would certainly produce apoplexy. The case just detailed, might by some be supposed to be one of coup de soleil ; but when it is observed that two other individuals were attacked with the more common symptoms on the same morning, and that on the preceding evening a female had the mild form of the disease, the reader will at once ascribe it to its true cause, the epidemic influence. In England, such a case would have been called simple apoplexy ; the more especially, that neither vomiting nor purging were symptoms. Epilepsy, also observed during the ravages of the epidemic, is a disease which often terminates in what is termed sanguineous apoplexy. I When the epidemic Cholera first appeared in ngal, its form varied little from the milder olera of Europe. Instead of diminished, thcr * increased arterial action; the pulse was fu I bounding, the skin hotter than natural ; th i, though sometimes absent, was for the mo t secreted in large quantity ; and there wa eh purging, with intestinal spasm. How di nit the patient's situation from one labourin Icr Cholera Asphyxia ! The danger of any disease is in the ratio which 32 proper carrying on of the functions of life. Diges tion may cease to be performed — the muscles i locomotion may be in a state of spasm or paralys for days — the patient may have profuse vomitin and purging for a considerable period ; but whi the breathing is free, and the pulse maintains th character of full and bounding, (which it coal not do were the respiration materially interrupted the patient is comparatively safe. In this form o Cholera, the respiratory muscles, external as we as internal, perform their office j and the langu< or lassitude, the spasm or paralysis of the res arc of little immediate consequence ; yet to thfia symptoms, so secondary in importance, have tli generality of practitioners prematurely directec their exclusive treatment, where the patient meai while was sinking from suffocation, which had n relation to them, cither as cause or effect. The simple difference betwixt Cholera Asphyxit and Cholera Mitior, or Cholera with fever is, tint in the first, the internal muscles of respiration an paralyzed; while in the second, they perform thei natural function, and partake not in the derange ment of those less necessary to the continuance o life. They are so far different forms of disorder. We have elsewhere referred all the diseases of man to one type — Ague. "What analogy is there between Ague and Cholera ? Tremulous and spasmodic action are the primary symptoms of both. In both, we have for the most part nausea c'J 33 I vomiting. The ague patient sometimes labours ier diarrhoea. Oppression of breathing differing ly in degree, and coldness of the extremities, s common to both: the increased flow of pale nc, so often a symptom of ague, is occasiony present in Cholera. In one instance of the ter disease which came under my observation, it secretion passed from the patient involuntarily hort time before death. Suppression of urine, common in the epidemic of the East, was a symptom of the Walchcren ague. When there no reaction, death is preceded by similar stupor i both. You have Ague, too, with hot skin an bounding pulse ; a state analogous to Choler Mitior, or Cholera with fever. When not fata Cholera, like ague, has generally a hot and swea ing stage. Lastly, when ague has terminated li by a single paroxysm, dissection slicavs the same appearances as in Cholera. Visceral disorder and inflammation are sometimes the consequences of Cholera, as of ague. We have already anticipated some of the cause of sporadic or occasional Cholera: Can Cholera b produced by inflammation, — by secondary disease Having shewn, that even the irritation of the ure thra by a bougie may, in a reflected manner, gh origin to the worst form of the disease, we ca Idily believe that the simple intensity of pai n inflammation of a vital organ may produc its symptoms; and accordingly, in entcriti tritis, and some other inflammatory diseases 34 CHOLERA. we see life terminated by a scries of symptom precisely identical. The symptoms preceding these however, remove all obscurity as to their cause That inflammation is not the cause of the ep demic Cholera, is proved by the general absenc of pain, except such as may be referred to spasn vitiated sensation, or flatus. Moreover, death hi been known to be the immediate and instai taneous effect of the epidemic influence. The rapi« recovery of the patient, when reaction takes place could not occur, Averc the brain or any other important organ, changed in structure, or even partially inflamed. The occasional evidences of inflammatory action in the intestines of those who have died of Cholera, may be looked upon as entirely accidental. In some instances, these have doubtless been produced by the treatment in life. The white viscid Ileus which Mr. Anneslcy dwells upon, in his jk on the disease, is mere excess of the natural lcus lining the intestine. May not this have 2ii produced, in some measure, by the large mtities of calomel which form so prominent a ture in his practice? The question has been •tly answered by himself. In his experiments ;h this medicine on healthy dogs, he found, that gc doses of it produced an appearance precisely lilar in the mucous membranes of the bowels these animals !*" The epidemic of the Penitentiary is an instance * See his Treatise on the disease. 35 in proof, liow many forms of disease may originate in the same cause. There, the united influence of confinement, impure air, defective food, and the depressing passions, produced diseases, which the nosologists have most widely separated in their systems, — apoplexy, epilepsy, dysentery, cholera. It was a favourite mode of punishment with the Indian Princes, to withhold from their prisoners, salt, and substances which contained it. The diseases consequent to this privation of a substance essential to the living solids and fluids, were identical with those of the ship-scurvy,* — ulcers, dysentery, fever, and cholera. From similar causes, occasional cases of Cholera occur in India, more especially among the poorer natives, whose food is almost limited to rice. We have stated, that the soldier on a march, has occasionally, by the incautious use of cold water, been attacked with all the symptoms of the disease when it happened to be epidemic. To this cause I have often also traced fever, and dysentery. We see these diseases daily produced by inebriety. From the same cause lam sure I have witnessed every symptom of Cholera. Case 1. — Captain M , generally of austere habits, drank deeply for two days, dining one of * The ship-scurvy proceeds not from the use of salt provisions, but from the want of vegetable food and fresh 'ill* ¦ Gvcli 1 si vo fliof *\ ni mil or vpfpfcililo will fri vp irlpn ti - 36 CHOLERA the ravages of the epidemic. On the third, he wm seized with the symptoms of the disease. He remained in a state of more or less collapse all that day and night j the pulse now faint, now strong, raising and repressing hope accordingly. On the evening of the next day, he vomited some matter like coffee (/rounds, became every hour more feeble, and sunk altogether about nine o'clock at night. The fluid ejected from the stomach and bowels, on the accession of the disease, was of the usual congee-like appearance. Case 2. — Lieut. B , several years resident i India, a few months after my disembarkation a Madras, sent for me in the morning to his quarter He had been indulging in deep potations for man days. He complained of mal-aise, for which I ga\ him some calomel and rhubarb. During the da he drank a good deal ; and about two o'clock, p. m his servant came to tell me his master was ver ill. I hastened to him, and found him with h face livid, the external jugulars gorged with blooc and his whole appearance that of a person suffer ing from strangulation. He was sensible ; said h was like to choke, and that he had cramps of h limbs, and had vomited. 1 immediately opened vein, but he died as the blood flowed ; which 1 did in a full dark stream. The substance whic he vomited resembled coffee grounds. On dissection, the blood flowed freely from the divided lungs. The liver was much gorged ; tin* 37 C II OLE It A. {mach of a dirty purple colour, being injected :h venous blood.* In this instance, 1 suppose lth to have taken place from spasm of the conicting muscles of the throat. Causes of the Epidemic. Cast your eye over the history of epidemic di eases, which of them all have we traced to its origii Had the Cholera confined itself to a small provinc only, we might have been led to ascribe it to som local cause of vitiation, or insufficiency of food o air j but when we have seen it simultaneously de populating the immense Indian continent and i isles j stretching to Persia, Egypt, and Russia, — anc rapidly spreading to every country and city o Europe; we arc compelled to acknowledge, thi neither of these could have been the constant cans of a pestilence so universal. The origin of this dis ease then must be atmospheric or telluric. "Tl " phenomenon most generally and closely con " nected with pestilence," says Mr. Noah Webste I This dirty purple appearance of the stomach and /els has often been observed on dissection of persons ) have died of Cholera, and has been mistaken for gaune. I remember having witnessed the same appearance, ;he stomach and intestines of some horses that died of ammatory sore throat. The veterinary surgeon fancied t they died of abdominal mortilication ; and as the disi was prevalent in his regiment, his treatment was jfly the application of hot water blisters to the belly ! had the good sense, however, to blister the throat, when true nature of the disease was explained to him. 38 "is an earthquake. From all the facts that 1 ran " find in history, I question whether an instance " of a considerable plague in any country can be " mentioned, which has not been immediately pre" ceded or accompanied with convulsions of the " earth. If any exceptions have occurred, they " have escaped my researches. It docs not happen " that every place where pestilence prevails 1 " shaken ; but during the progress of the diseases " which I denominate 'pestilence/ and which ru " in certain periods over large portions of th " globe, some parts of the earth, and especial! " those which abound most with subterranean fire " are violently agitated. By adverting to the fore " going history, the reader will find that all thos " years in which considerable earthquakes ha\ " occurred in America, have been rcmarkabl " sickly. These years are 1638, 1017, 1658, 166:. " 1 663, 1 668, 1 7.25, 1 727, and 1 783."— Sec the His tory of the Bills of Mortality. " Even the slightc " shocks have been attended with considerable " sickness, or have introduced a scries of epi" demies, being cotemporary with the measles, " influenza, or sore throat, as in 1669, 1720, 1737, " 1757, 1761, 1769, 1771, 1791, 1797. To cnu" mcrate the instances in Europe and Asia, would " be a useless repetition of the events related in " the preceding history to which the reader is re" ferred." — History of Epidemic Diseases, vol. ii. Mr. Orton's researches prove, that earthquakes 39 C lIOLICRA. ivc been more frequent in India from the first pearance of the Cholera as an epidemic. My n observations will not allow me to believe, that cse were mere coincidences. On two occasions, an earthquake happened at Bangalore, while 1 was stationed there, and among other intractable cases of disease, some of the various forms which the epidemic has been known to assume, were shortly afterwards admitted into the European and native hospitals of the place. On the whole, from all that 1 have seen and read of this Cholera, I incline to the belief, that telluric rather than atmospheric agency is the chief clement in its production. But mark, I do not exclude atmospheric influence — on the contrary, that influence has appeared to me, in numerous cases, to have contributed both to the spread and to the disappearance of the disease, — particularly thunder-storms, east winds, rain, and so forth. Still, even these, in a great degree, depend on the electrical and magnetic conditions of the Ith. The great majority of Cholera cases in the t have happened between sunset and sunrise, attacks have very generally commenced either ing sleep, or soon after getting out of bed in the •ning, and not unfrcqucntly on a march, which India is always begun long before the sun tes its appearance above the horizon. I have wn the epidemic confine itself to those who t on one side of a river — nay, I have seen it exively attacking those only who slept on one side barrack — though all the time the most per- in feet daily intercourse was kept up with the people on the other side of the barrack or river. How can you account for the escape of those last, but for the fact that they did not pass the night on the side where the epidemic prevailed. During the day, there was every kind of intercourse between the affected and the unaffected sides ; but as the people of this last did not remain the night on the affected side, the fatality must undoubtedly have reference to the place of sleep, and this, I think, is evidence of a telluric, rather than an atmospheric origin of the epidemic. The first appearance of Cholera, as a great epidemic disease, in India, took place when the Marquis of Hastings lay with his army before the fort of Gwallior.* In three days and a-half, of his native and European troops and their numerous camp followers, ten thousand were sAvept off. At the very same moment Sir Rufane Donkin, with a force of 7000 men, lay on the other side of Gwallior, without an instance of even one man being attacked by Cholera ; and when the Marquis of Hastings moved his camp twelve miles, the disease at once ceased ! Some years after, while the forces were in cantonments at Mcerut, the Horse Artillery being placed on the right, the 1 1th Regiment of Foot in the c^atrc, and the Bth Light Dragoons on the left, the Centre was fiercely * A violent shock of an earthquake was felt in his camp at the moment he was mounting his elephant to begiu his v tILLiIC IvC CI iJ v vlllo llltlltltl \ . 1111(1 LilC iVI Llllol*\' illltl Bth Dragoons did not lose a single man ! Such facts are utterly incompatible with the idea that the disease is caused by any malaria or effluvium in the air. Electrical or magnetic perturbations of the earth arc, to my mind, the really predisposing cause of the epidemic; — and curious enough, perturbations of the magnetic needle have by some been observed during its continuance. It has been asserted, even, that electrical instruments and magnets have in some instances been rendered almost useless, in places where the epidemic prevailed. Whether this telluric influence is, of itself, sufficient to produce an attack of the disease, or be predisposing only, 1 have my doubts. This much I am satisfied of, that while it prevails, any other cause of disease may at once set it up. A slight debauch, excess of heat or cold, an emetic, or a purge given for some other complaint, have appeared to me to be the immediately exciting causes ; and in one case, the prostration which followed a broken leg actually became Cholera Asphyxia ! How much the passion of terror disposes to the disease, I have had many opportunities of observing. I have already shown the effect of this passion upon the dog, and certain I am, I have seen persons with every symptom of Cholera from a similar cause ; females more particularly, among whom authors 42 pathy or horror. I have known the disease in the female commence with hysteria, take on the form of Cholera, slide into lock-jaw, and finally end in death. I The knowledge of the first link in the chain of isation, can make little difference in the mode of Treatment. I Let us not imagine that a specialty of cause [1 throw a mystery over effects; that Cholera m terror differs' in essence from Cholera proccd by a poison or a mechanical injury ; or that vcr from a blow is less a disease of the nervous item than the same disease occurring from loss blood. " The Fevers/ says Mr. Abcrncthy, n'oduced by local disease, (injury ?) are the very dentical Fevers which physicians meet with vhen there is no external injury." Are not eh equally subject to remissions or alternations? md do we not successfully combat them by the qc remedial means ? I What is the proper treatment of Cholera Asrxia — Reader! what can be the proper treatnt of a disease in which the door to medication, in most instances, all but closed by the early alysis of the gastric nerves ? When the pneuniotric nerves are artificially paralyzed in the dog, only docs digestion immediately cease, but enic and some other poisons have not their usual on the paralyzed stomach ! It is the same The stomach is early dead to the sustaining forces of food and medicine, while the lungs and blood in like manner are, at the same moment, prevented from receiving their proper pabulum — the atmospheric air ! How humiliating the position of the ablest medical practitioners in such a case ! The Cholera patient has been graphically described to be death-struck ; and the disease from its very nature, is, in numerous instances, from its commencement to its close, a mere death-scene .' Before the sufferer can even be seen by a physician, his case is frequently hopeless. One thing is certain, if medicine is to cure him it must lie quick. The physician must resort at once to a remedy having an instantaneous influence over the Brain and Nerves. — Has Calomel such an influence — calomel, the drug to which the practitioners of the East rush in all diseases ! — In the boasted calomel / have no faith as a remedy for Cholera. If I have proved, and I trust 1 have proved even to a demonstration, that the rapid dissolution of the patient is caused by actual palsy of the nerves of respiration, ought avc to trust to a substance which can only act upon them by absorption and that, too, only by a long and sustained use ? Over these nerves calomel has no immediate poAver. If it be said that it acts on the liver and secretory organs, I answer, it is the height of folly to direct attention to these Avhile the patient is sinking, not from the abundance or suppression 44 caused by palsy of the respiratory nerves, wi which, as already shown, the state of the secretioi has no relation, cither in the light of cause effect. Where these are disturbed they arc on coincident symptoms. Neither is calomel apr ventivc of the disease, as some have supposed, have witnessed fatal cases of Cholera, where tl patients laboured under salivation from calomel the time of attack ; and that too so frequent! that I have no doubt salivation rather predispose* the patient to the disease ! Calomel a cure f< Cholera — calomel, which so often depresses tl vital energy of every part of the economy ! 1 trusts to a reed who talks of calomel at such time ! Could we anticipate an attack of Cholera, 1 nineteen out of twenty cases, an Opiate, or a powe fill Stimulant, might save the patient. At the very commencement of the disease I have frequent seen each of these successful. Given at a mor advanced stage, opium appeared to me only t hasten the state of stupor which so often precede death. Its repetition then is decidedly bad prac ticc. In the earlier stages, I have found Brand and Ether useful, and were it not for their ii toxicating power, they would perhaps be the be cordials to which we could resort. More tha once I have seen them prove disadvantageous on that account. Like opium, in the later stages they only stupified the sensoriuni, and withdrew 45 I tory muscles. Ammonia may be given in all the stages, and it is better adapted to the later stages than either opium or brandy. In prescribing stimuli, however, we must bear in mind, that, when frequently repeated, they too often exhaust the very principle which it is the object of our most anxious solicitude to support. It is good practice to vary the stimulants — to alternate one with another. Intelligent practitioners have observed that where repeated violent vomiting was a prominent symptom, recovery more often took place than where this was either less violent or altogether wanting. Dr. Denman has made a similar remark regarding vomiting in haemorrhage :—: — " When patients have suffered much from loss of " blood," he says, " they will often have a sudden " and violent fit of vomiting ; and sometimes " under circumstances of such extreme debility, " that I have shrunk with apprehension lest they " should have been destroyed by a return or in" crease of the haemorrhage, which I concluded " was inevitable after so violent an effort. But " there is no reason for this apprehension ; for " though the vomiting may be considered as a " proof of the injury which the constitution has " suffered by the haemorrhage, yet the action of " vomiting contributes to its suppression, and to " the immediate relief of the patient, perhaps by " some revulsion, and certainly by exciting a more " vigorous action of the remaining powers of the 46 " of the pulse, and of all other appearances, im" mediately after the vomiting." Mr. John Hunter looks upon vomiting in nearly the same light ; although produced by debility of the Brain in the first instance, it has the effect to reflect strength back upon the constitution. I[ am disposed to entertain a favourable opinioi Ipecacuan in certain cases of Cholera. In nin cessive female cases where I employed larg ics of ipecacuan, I must ascribe the recovery ich took place in all, in some degree to th icdy. The similarity of the symptoms of Cholera to th phenomena witnessed in those who have been bi by the Cobra, or hooded snake, is very remarkable The same loss of the Brain's influence over th respiratory nerves, is the cause of the asphyxia i that case. Now, the natives of India treat thos bit by the cobra with arsenic ; and, in some pro vinces in Bengal, the Cholera has been met by th virus of a species of this snake ! Reflecting o these facts, I was led to give arsenic a trial i Cholera. Arsenic, I said to myself, can do wha calomel can not do : it can at least influenc rapidly the Brain and Nerves ! In the case of native, I accordingly gave it to the extent of two drachms of Fowler's solution at a dose ; the man recovered. An Englishwoman took a drachm of the same preparation every half-hour, to the extent of four drachms. She was then treated with 47 CHOLERA. stimulants, and the case also terminated succes fully. In other cases similarly treated, the paticn I regret to say died. Previously to these trials, employed the fumes of arsenic, which I made tl patients inhale from a tobacco-pipe. The re coveries and deaths were equal ; hut in most o ii cases, the patients were in a hopeless stat ore I saw them. On the whole I was not satisi with the results of arsenic as a remedy for I The Prussic Acid, from its positive power ovc pneumo-gastric nerves, and also from its n ity of action, might assuredly in the earlic iods he given with advantage. In my privai ctice, I find this acid the most efficacious reined spasm and palsy with which I am acquaints nee had occasion to prescribe it for traumati t-jaw in the horse. A drachm was injected int rectum, and the animal obtained twelve hour >itc from both the lock-jaw and the abdomina sms. I often regretted while in India that was so situated I could not obtain this acid, whe the Cholera prevailed there epidemically. Iriic successful experiments of Dr. M'lntosh am ers, of Bleeding in the cold stage of ague, hay 11 brought forward as a reason why the sam ctice should be adopted in the analogous stag Cholera. Dr. M'lntosh supposed success t tend upon relief of congestion : — To me, tha cf seems to arise from the excitement of a new rm through the medium of the Brain and Nerves 48 simply, — in others, the mere effect ol the applici tion of the ligature. The ligature alone, in the ham of Dr. Davis, was found to be singularly beneficia in the Walchercu ague, and in my own hands tl same simple application has frequently arrested tl epileptic paroxysm. Is not this explanation furtlu borne out, by the greatest and most certain relit having been given by blood-letting before or at tl very eomniencement of the fit? in other word immediately after the application of the ligatur and before congestion could have taken place t any extent?* Fortunately for the ague-paticn his physician can anticipate the period of aeccssioi Not so the solitary cholera attack— in which, froi the early difficulty of respiration, real debility ( I whole system so soon occurs. The patient lvi lmost in the identical situation of a person wh lost much blood ; for his blood is un-aerated the means of obtaining air is denied him by ilar palsy of the respiratory nerves. The ab ,ction of a few ounces then is often difficult if syncope follows, it almost invariably termi 3S in death. I have had too many opportunitie ,vitnessing the practice, to be at all sceptical as * Curiously enough, while this sheet was going through the press, I read in The Times newspaper of the good effect of the tourniquet in Cholera, -when applied to the legs and arms, by Dr. Wise of the Bengal Establishment. That gentleman, however, does not appear to be aware of the real manner of their action. ]) I the injurious effects of blood-letting in Cholera. numerous instances, where the event was doubtthe use of the lancet turned the scale, and ured an unfortunate issue. Mr. Anncsley, in work upon tliis disease, is loud in his praises ;he lancet ; but he would appear to be led into } laudatory language solely by his theory of gestion. Congestion is the effect, not the se, as he thinks, of the nervous derangement. \v " venesection," Mr. Travcrs well observes, '> "is one mode of relieving congestion ; but a more " pernicious one could not be devised, when the " congestion is the obvious result of a sudden " and extreme depression of nervous power." So perfectly do the symptoms of a Cholera-patient resemble those from loss of blood, were Mr. Annesley called to the couch of an individual suffering from haemorrhage, and not previously informed of the cause, mistaking them for Cholera he would bleed to relieve congestion ! By diminishing the Brain's influence over the pneunu gastric nerves, whether by their section, a blow passions, poisons, or loss of blood, a like congestio will be found after death, as in this disease. AY have shown the congestion which takes place i the dog from loss of blood. The same congestioi is an effect of haemorrhage in man. Dr. Abei erombic examined the bodies of two patients who died from loss of blood, and found the veins of the Brain gorged, as in Cholera, with dark blood. Mr. 50 How does lie reconcile this measure with the fact > that, upon raising the head of the sufferer, he sinks fainting in the attendant's arms? — He saya it is to get rid of dark blood. And why is this blood dark? Is it not because it is defective in its constitution ? It wants a constituent principle. By lessening its volume, will this principle be suppled? Surely defective nutrition is better than no nutrition at all ! It is not the presence of black blood in the Brain which destroys the patient, but the absence of arterial blood, without which every nerve is deprived of its energy. Why then rob the Brain of the little aerated blood which it may still possess? Many bleed, blister, and stimulate, in a breath, in Cholera Asphyxia. This is Mr. Anneslev's practice. Is it sensible or scientific ? But Mr. Annesley tells us that the lancet subdues spasms. T have already shown that spasm of a muscle is the result of the Brain's diminished influence over the nerve that supplies it. Even Cholera Mitior, where the pulse is full and bounding, has in my experience been changed into Cholera Asphyxia by the employment of the lancet ! It is unfortunate for the patient when the practitioner prescribes solely for a name. We have already pointed out the difference betwixt Cholera Asphyxia and Cholera Mitior — Suffocative Cholera and Cholera with Fever. Having their origin in the same epidemic influence, they receive the same denomination. The results of medication v 2 51 CHOLERA. B every kind arc widely different in these dis OS. E'hen I first read in Mason (iood, that Di •ell saved 88 out of 90 of his later cases, could with difficulty credit the assertion. Hi when, upon turning to the pages of Mr. Orton, found these were all cases of Cholera Mitior,- — Cholera where the face was flushed and thejpuls was full and hounding, my astonishment at one ceased ; for this form of the disease, though pro duced by the same epidemic influence as Cholei Asphyxia, generally terminates well under an mode of treatment. It Avas in such eases M Whitelaw Ainslic worked miracles with a fe grains of magnesia. When he proposed the san remedy for Sitffocative Cholera, he showed he ha( at least some faith in simples ! I "he warm bath may he used with impunity i Mitior : not so in Cholera Asphyxi; >re, in my experience, it was found to be th st deadly measure, next to blood-letting, tha Id possibly be pursued in the disease. Tl ick of the cold bath at the very commence nt might prove useful in Cholera Asphyxi Persia, however, when the disease raged thcr indiscriminate use would appear to have ii ascd the mortality from the disorder. Every form of disease, by whatever produced, has a tendency to disappear after a particular period. The ancients had some knowledge of this when they ascribed critical days to fevers. Sir 15. 52 death from poisons which caused a disease similar to Cholera, lie has by artificial respiration kept up life till the Brain had become accustomed to the shock, and the animal was thus restored to life under circumstances where it must indubitably have died without such a process. Artificial respiration most assuredly might be beneficially resorted to in Cholera. By thus improving the state of the blood, life might be kept up till the Brain recovered its powers over the paralyzed respiratory nerves. Contagion. The proofs of a disease being non-contagiou must be cither analogical or negative. As a example of the negative, I cannot do better tha refer the reader to what took place in the respe< tivc camps of the Marquis of Hastings and S Bufane Donkin, before Gwallior. In the Marqu of Hastings' camp, where ten thousand died of tl disease in three days and a half, neither amon the bearers of the sick, nor the immense numbi of hospital attendants, nor the soldiers or sepm visiting their dying comrades, nor among the sic in hospital (with the exception of the convale cents) were there more attacked, proportional!; than among other persons not thus exposed. That the identical disease called Cholera can be produced by loss of blood, poisons, passions, and local injury, may be Looked upon as analogical 54 CHOLERA. evidence that Cholera is not contagious. Smallpox, measles, plague, — each of these has some feature of its own which distinguishes it from all other maladies. It has something which cannot he produced by art. Every and all of the forms of Cholera may he brought on by artificial means ! Mr. Orton has indeed attempted to show, that the disease, after having made its first fearful ravage in the Marquis of Hastings' camp, spread in successive time to various other parts of India, as from the centre of a circle to the circumference. But this, be it remembered, is the law of storms. It is the law of many other telluric and atmospheric phenomena. Besides, as I have already said, all diseases have a tendency to propagate themselves by sympathy or terror ; and where the telluric or other influence predisposes to Cholera, any depressing passion will frequently produce every symptom of this disorder. Cholera, however, is not a new disease; nor would any one who thoroughly understands its nature, imagine that it is so. In India, it can be traced as far as medical records extend. In some places of the Peninsula, it has been endemic time immemorial. The natives, it is true, are fearful of taking up their abode in such situations when it is prevalent ; but this is not from fear of contagion, but because they know that they subject themselves to some hidden local influence by remaining there. The disease pre- K[ed in England in the time of Sydcnhain, who cribed its symptoms : they were exactly those Dr. Perston, of the lth Light Dragoons, shown me sonic manuscript cases which occurred in Ir« land among the 2Gth Foot, of which Regiment 1 was formerly surgeon. I recognized at once tl Asiatic scourge in all its features. These cast took place long before the Cholera made its ep demic visitation in Europe in 1831 and 183.2. It lias often been said, that one positive fact worth a hundred negatives. This is not quite triu a positive fact may be a fact wrongly interpreter but, at all events, the positive fact should be a vei stubborn one indeed, to convince us of the nccessit of closing our ports, stopping our commerce, am interdicting intercourse betwixt man and man. . gloom is in this manner thrown over the minds o the mass of the people ; and nothing, I am certaii conduces so much as panic to favour the ravages o any epidemic. The natural effect of such measure is to add to the poverty of the indigent classes their food becoming consequently more scanty an< depraved, contributes with the gloom of menta depression to extend the disease in all its horrors |[n all times experience proves that men speculate m the misery of their fellow-creatures. If the reliant, anticipating a period of scarcity, hoards the necessaries of life in his granaries, there arc ; wanting members of the medical profession o, eager to profit by the chances of an epidemic, itribute to spread alarms, most suitable to their lividual purposes. The public, as usual, panders to the interests of the selfish and designing, and Quackery and Folly go hand in hand to increase tin' misery they pretend they would alleviate. The question of Cholera being a contagions di ease, has not been altogether free from this ba principle. Long and expensive quarantines c; only be kept up with a certain medical staff — am the interests of these require contagion. To mcc the fact, that few medical men have fallen victin to the disease, even when constantly employed 1 attending on the sick, it has been pretended the have an immunity from that very circumstanc But of the many young medical officers who arri\ at the different presidencies of India fresh froi England, and who arc at once, and without ai preparation, introduced to the hospitals where tl disease is prevalent, has there been observed an mortality from this disease ? I never heard of single case. Can a similar fact be cited in th case of small-pox or the plague? The truth i there are few diseases which have not some tim or other been thought to be contagious. Ophtha mia, fever, dysentery, ague — each in its turn h; had this opprobrium fastened upon it. I shall no be astonished if bryken bones be added to the list for in medicine, as in religion, there is nothing s absurd but will be brought forward as true o miraculous; and, having been so, will find every where, and among all classes, its dupes and disciples. Useful innovation alone meets with opposition. 56 [f facta favouring the notion of contagion do comic before ns, let us view them dispassionately, and without timidity. Let us examine them in all their bearings, but be cautious how we construe them cither one way or other. An embargo upon trade betwixt town and town — the shutting up the gates of cities and of garrisons — are measures that can not long be enforced without giving rise to man miseries, and these too of a nature much mor painful than what in fancy we flee from ; — gloon discontent, and penury, can cause diseases of more disgusting kind than Cholera. Those wh are most disposed to view the disease as con tagious, arc yet fain to seek other causes to account for its spreading. Contagion then does not explain it. The best preventives of epidemic disease are serenity of mind, cleanliness, comfort in clothing, a happy moderation in the pleasure of the table, — in a word, a generous temperance, — avoidance of indigestible substances, heavy suppers, and gem rally, everything tending to irritate or debilitate th system — shut your ears also to rumours of th prevalence of the disorder. Daily bulletins am reports on the subject of the disease only keep v public alarm, and tend to make men selfishly alive to what God will take from them at his own due time — the existence which lie gave. i) 3 It is now, something like twenty years since the greater part of the matter of the above Essay first appeared in print ; — yet nothing I have seen or read during that long period, has in the very least tended to make me alter or modify the opinions of my early experience. The physiology of the suffocativc form of Cholera, I hold to be therein completely elucidated. As the reader has seen, it has primary reference to the Brain and Nervous System. Last in the number of fatal phenomena, is that immediate precursor of dissolution — the death of the blood, — though a recent writer of ability, Dr. Starr of Leamington, looks upon this as the first link in the chain of causation. Were such the fact, there could be no recovery. The disease in that ease would be invariably fatal. Reason and analogy, then, arc with me. To poisons, passions, and mechanical injury, which we know act primarily on the Brain, I have traced one and all of its signs and symptoms; while, by the artificial paralysis of the pneumo-gastric nerves of the dog, the reader may produce at will, first, the whole group of the dangerous or essential symptoms of lolera, in its worst form ; and, secondly, the ntical state of blood on which Dr. Starr rests case ! The deterioration of the blood proceeds v passu, with the wrong primarily done to the am and Nerves. Moreover, it does not take cc at all in eases of Cholera mitior, — those cases ere the pneumonic portion of the pneumo-gastric ryes escapes the paralyzing influence of the filial cause of attack. With regard to the Treatment of Cholera: — In addition to the remedies previously rccon mended, I would here suggest a trial of chlorofor as an anaesthetic agent in the earlier stages, pa ticularly when the cramps arc painful and severe, — that agent having in my own hands given spcec relief to patients suffering from other spasmod complaints, depending on a similar loss of nervoi energy. Taken in the dose of a few drops b the stomach, chloroform would, in some few case of Sporadic Cholera, appear to have been success fill when prescribed by others : but as this preparation, after all, is only one of many (ethereal substances, I do not apprehend that its exhibition, in the latter form, will be found more extensively effective, than were the nitrous and sulphuric {ethers when similarly employed during the epidemic attacks. In the outset of the disease they occasionally appeared to do good, but when given in the later stages, like opium and alcohol, they seemed 59 to me to hasten the stupor that precedes dent Hydrocyanic acid I have already mentioned wit favour ; — and here I would again beg to impre on the mind of my reader my very high opinion its value, attention being at the same time paid time and temperature. Let me also in this pla suggest the cautious employment of creosote, pho phorus and strychnia, — those preparations, part cularly the two last, having, in common wi hydrocyanic acid, proved of essential service me in various nervous affections, such as vomitin difficult breathing, spasm, palsy, &c, affectioi which avc find so often existing separately in tl subjects of ordinary disease, but which in Chole Asphyxia all enter into the aggregate of the syni toms that constitute that complaint. In this di ease your patient must, if possible, be favourab influenced at once. Try to do so, while yet tl gastric nerves retain their influence, however wca or partial, over the stomach ; and do not gui despair of your case, even where the stomach is completely paralyzed, for in numerous patients there would appear to be a natural tendency in the Brain to recover its lost influence over every nerve of the body, as is evident from the partial improvement which from time to time takes place in most cases, and the occasional perfect cure in some few where hope had been all but exhausted. Remember, that the danger of the disease depends on the state or the Breathing. Let your prin- 60 CIIOLKKA. ftuence over the respiratory nerves. In the earli< stages, the paralysis which takes place in thes nerves is intermittent, — partially intermittent i some, in others, the intermission is complete. No a knowledge of this fact is of great importune Keeping it in mind yon may, during the coi tinuance of the paralysis, relieve the suffocatio consequent on it, by inflating the lungs with a mospheric air, and thereby also give the Brain a better chance of regaining its lost energy over the whole nervous system. Spare your opium after tl first stage. If a good result do not immediate follow its first employment, do not repeat the dos In my experience its repetition then only haste the state of stupor which precedes dissolutioi and on no account practise blood-letting here any mode or manner. For myself, it is now mo than seventeen years since 1 have resorted to tl barbarous practice in any disease whatever. for calomel, cayenne pepper, assafoctida, &c., which you constantly hear so much, waste not your time — in this disease so precious — with such puerile and inert medication. You have powerful resources in hydrocyanic acid, phosphorus, and strychnia; of all the remedial means in your possession, none can so rapidly influence the whole human frame as these particular agents — agents which all, luckily for us, enter into the pharmacopoeia of every civilized country. Still, such is the energy of their action, such the rapidity with which they can influence the Brain and nervous system, 61 nobody but a physician perfectly conversant with their doses and possible effects, whether salutary or morbid, ought to be entrusted with their exhibition. Xo one who is ignorant of the duplex action of all medicinal substances, can possibly, but by hap-hazard, turn them to a good account in this or any other disease whatever ; for in this very disease of Cholera, as in every disease to which our frail humanity is liable, the medicine that will produce a salutary influence in one individual will do precisely the reverse in another. In certain eases, this depends on the constitution of the individual, in certain others on time and teniperahtr Without a perfect acquaintance with these fact how could you know when to continue and wh( to change any given medicinal force ? There is n " red-tape-ism" in true medicine, — no specific tin will always do the same thing in all persons and i all periods ! Before I quit this part of the subjec I would again earnestly impress upon you, the m (vssity for inflating the lungs during the state o Asphyxia, with their proper pabulum — atmosphen air. Eschew oxygen here; the lungs were neve made to inspire it undiluted. With regard to the supposed exciting cause o causes of the Epidemic Cholera, I question if th bulk of the profession is one iota nearer the trut than it was when the pestilence first broke out unless it be that in this country there arc no fewer terrorists, fewer advocates of the doctrine o contagion, than there were some sixteen or seven 62 teen years ago. With the great majority of well informed practitioners, I hold that COHLERA IS NOT CONTAGIOUS. When the disease first appeared epidemically in the 30th Foot in 1831, I was serving with that Regiment at AYallahjabad, in the East Indies. Nothing could equal the fatality — fourteen and fifteen deaths frequently in one night; yet for whole nights together did I, being then the medical officer in charge, feel it to be my duty to sleep, — if broke slumber could be called sleep, — within the hospita walls. Could place, time, or contiguity, be mo favourable to test the doctrine of contagion ? 0 every affected man, woman, or child, that lived ( died, I gave my own personal attendance, — takil the deepest interest in the success or failure of n remedies, making also numerous post mortem ex ruinations with my own hands, — yet neither myse nor any one of my numerous assistants in the ho pital, ever suffered from a single symptom of the disease. This one fact, I give as a sample of the general experience I had of this epidemic while serving in India. The experience of the best observers in other quarters of the globe, has been precisely to the same effect. I extract the following from a letter I have just received from Captain Scott, commanding Her Majesty's ship President, when the Cholera appeared off Halifax, in North America: — "Upon the arrival of the President at 41 ll'lllf*'l\ in A 1 1 0*1 1 Nif" 1 I Bfxnxa Aflooa f]t'l" 63 " curred on shore awakened a suspicion that that '• plague — the Asiatic Cholera — was about to visit ;' ; ' us. Nor were we kept long in suspense. The " troops in the barracks were the first attacked, " and a great many men died. On their retiring, " however, from the town, to encamp some fifteen " miles off, the disease ceased among them : no ¦' fresh case, so far as 1 remember, occurred. My " ship lying close to the shore, I gave orders " that in case the disease should show itself on " board, the men seized should be at once sent " to a temporary hospital, which I had in anticipa" tion, provided in the victualling yard. The first " seaman assailed, was a main-top man, while doing " his duty aloft in the top ; and so sudden and " severe was the seizure, he was obliged to be in" stantly lowered down. lie Avas then put into the " boat and taken with all expedition on shore to " the; hospital, where he died in less than five hours " from the time he was attacked. The disease " from that day became prevalent in the ship — " the number of seizures increasing gradually to iC eighteen and twelve men daily. I then, at the " suggestion of my Admiral, Sir George Cockburn, " ordered the moorings to be slipped, and the ship " to be run up into Bedford Basin, where we " anchored oil' Navy Island, a distance of three " miles from the former anchorage. Just as we " had made sail, a man was attacked on the " quarter-deck, and sent on shore. This was the ¦of our moving, not another case took place. It " appeared as if the cause of the disease occupied • the very spot we had quitted, and a very con- " traded one it would appear to have been, for of " three other ships of war anchored around and " close to us, not one solitary case occurred among " their crews." Were the disease contagious, do I think that after having been in such close tact with those affected, you could possibly ipe it by the mere removal of a few miles from place of the first attacks — the same thing taking je both on shore and at sea ! IV word or two as to what I myself saw of Cholera this country, to which by the way, I returned y a few months before it broke out in 183"2. 1 * at that epoch, quartered with my Regiment, i Royals, in Edinburgh Castle, and there, nothstanding the cordon sanitaire that was strictly iblished by the military authorities of the place, cw cases of the disease — the identical disease, . no mistake, — occurred. The patients were all ited professionally by myself and assistants with feet impunity to all of us. In the Cholera spital, established in Drummond Street, Edinburgh, I had also many opportunities of seeing the disease as it appeared there — some hundreds of lients having been treated for the complaint in t establishment. And what was the opinion those connected with this civil hospital ? Dr. ckintosh, the presiding physician, scouted the iof contagion. In a book which he afterwards 65 published, he gives a fact, which to me, even without my own experience would be conclusive :—": — " In " the Drummond Street Cholera Hospital, there " were two hundred and eighty bodies examined. " Two and sometimes three hours were spent in " examining each body. The room where these " examinations were conducted, was a miserable " place, eight feet square ; generally six or eight " persons were present — sometimes more; and in " an inner apartment, about ten feet square, there " were generally six dead bodies. Not one of those " who frequented this den of death, and who had " their hands imbrued in the secretions of the dead " for six hours out of the twenty-four, was affected " with Cholera, although their hands were irritated " and punctured daily." — Mackintosh's Practice of Physic, p. 3io. Yet in the tcctli of these, and thousands of similar facts, did the College of Physicians of London, in 1832, terrify the people of England out of their senses, by officially declaring the disease to be contagious ! A better appreciation of medical evidence, has since led the " Health " of Towns' Commission" officially also to declare the reverse. The reader can choose between two such eminent authorities. One thing is certain, " doctors differ !" IVmong the various hypothetic causes of this rible disease, an opinion lias been expressed that olera Asphyxia is animalcular in its origin, nigh Dr. Cowdell, who has more recently idled the subject, takes some pains to persuade 66 us, that its cause is vegetable or fungoid. The facts I haye 1 just detailed, are a complete answer to the inaintainers of either hypothesis. Where have you such escapes as those in any recognized organic contagion — in itch, or ringworm for example — diseases which we know, have, in one case an animalcular, and in the other a vegetable origin ? No, reader! Cholera is neither propagated by flies nor fungi ! The naturally rapid extension of a living generating principle, whether animal or vegetable, which could set up in man the series of phenomena you sec in Cholera, would produce such a constant and uniform succession of results, no opposer of contagion could possibly shut his eyes to the connexion. Before the microscope discovered the insect of itch, and the fungus of ringworm, few or none doubted the communicability of these diseases by touch or contagion. Vain will be the effort by similar means to detect any thing analogous as the originating cause of a disease which can be produced, as I have already shown, like any other constitutional complaint, by poisons, passions, and mechanical injury even, which in fact, — during the prevailing epidemic influence, can be set up by any other cause of disease whatever. Look at the history of other epidemics— erysipelas or yellow fever, for example. When either of these forms of disease predominates in a given locality, exposure to wet, cold, or heat, a transient passion, or a mechanical injury, which, under other circumstances, would be of no importance, may at once give rise 67 to the predominally form of disorder. Dysentery Id diarrhoea manifest similar phenomena, being up epidemically at a given place or period, by latever would set up any other disease whatever any other place. I have a strong impression that the atmospheric or telluric influence, in any epidemic, whether erysipelas, dysentery, yellow fever, or Cholera, is predisposing only, — that that influence merely determines the fonti, the more immediately exciting cause being one thing with one person, another thing with another. Take the case of erysipelas for example. When I served with the Royals in Scotland, erysipelas predominated for a time in that Regiment. If a man was flogged, he Avas sure to get erysipelas. A blister almost always set it up: and I have known a mere scratch bring it on, — particularly the application of a lancet to the arm. The late King of Denmark died from the erysiploid inflammation of a vein ; he died from the blood-letting practised on him when affected with the disease ; and no medical act can be so fool-hardy as bloodletting in that form of fever, termed erysipelas or rose. 1 hold fever to be the type of all diseases. Most assuredly it is the type of all epidemic disorders. The epidemic influence, whether telluric or atmospheric, whether local or general, would appear to determine the form simply. While in Klia, I had many opportunities of witnessing iemic diseases, particularly cholera, dysentery, ous remittent fever, and ophthalmia. When any 68 scarcely ever had an instance of any other acute complaint among the regiments stationed in that particular place at the same period. The form was almost invariably determined by the atmospheric or telluric influence at work. The immediate* causes were infinite. Drunkenness bringing on the given form in one, exposure to the sun in a second, being out during the night air in a third; while an extra drill in heavy marching order, woidd produce numerous cases where this was ordered. When an epidemic prevailed, whatever the immediately exciting cause, the form of the disease of the place and period was uniform. "Where Cholera prevailed, there was little or no dysentery ; where dysentery, little ()]• no Cholera ; where bilious remitting fever was the predominant form, you had neither dysentery nor Cholera, or at most, an occasional case. Look nearer home at the influenza, you will find where it prevails the influenza absorbs all other complaints. When predominant, you will find a perfect paucity of all other acute disorders. "The clearest and most striking general obser" vation which occurs regarding the prevalence of " the disease, (Cholera,) in different classes of " people is, that the higher ranks of society have " been found in India to suffer less than the lower ; " and this seems to hold good in all its branches, " military as well as civil, native and European." — " 'I 1I 1 ! i us we constantly find that the officer suffers " less than the soldier Or the sepoy ; that the 69 " superior description oi troops, as the cavalry, " (who form the elite of the army,) suffer less than " the infantry, and they again, greatly less than " the hard-labouring and ill-fed camp-follower. "So also is it as constantly found that the " Bramin, the supreme or priest-caste, and the " sleek Banian, (merchant,) sutler less than tlic " ryot, who pays often as much as half the produce " of his rice-fields for rent, and extorts from them " a scanty suhsistence, under a burning sun, and " still more remarkably less than the poor out" cast pariah, who carries a burden ten miles, and " returns the next day empty handed for fivepence " sterling." — Orton on the Indian Cholera. — This entirely accords with my own experience. The proportional difference in the amount of attacks among the various classes, depends in the difference of their social opportunities of obtaining comfort, regularity, cleanliness, good food, and rest ; and the consequence of all these united, — a healthful energy of Brain and body sufficient to enable their possessor to stand firm under the insalubrious circumstances that determine the epidemic in question. Now, a knowledge of these facts is of the greatest importance to us. From the vital nature of the nerves, principally implicated in the Cholera form of disease, that epidemic is necessarily a most fatal one, as indeed is any disorder where the breathing is seriously involved. The true method to prevent attacks of Cholera 70 causes of all acute complaints whatever. Mental depression, dirt, drunkenness, defective nutrition and ventilation, imperfection of draining and light, (the window tax !) arc assuredly exciting causes of general disease. When the Cholera first prevailed epidemically in England, who were its principal victims ? Precisely those exposed to any of the above causes. The friends of the few who suffered among the higher ranks may, for the most part, thank the College of Physicians for the attacks that Iried off their relatives; for to the terror in¦ed by the official declaration of those worthies, t the disease is contagious, I have no hesitation ascribing the loss of many a valuable life. ;re is no cause of disease, as I have elsewhere wn,* so certain and powerful as this depressing |)ne word, in conclusion, to the venerable Cole. Somewhere, about twenty years ago, 1 read history of "The Gold Headed Cane." There earnt how that cane had been Radcliffe's, and v it had passed from one great doctor to aner, till it came at last into the hands of Dr. illie, who made a gift of it to the College of ysicians. lielic of departed greatness, there it •> remained ever since. Like the busts of Linacre I Harvey, it is preserved in Pall Mall Bast with loly reverence, showing to all who enter the • See Fallacies of the Faculty, with the Chrono-therinal System of Medicine. Simrikin and Marshall, Stationers Hall Court ; and John Ollivier. Pall Mall. 71 College porch how highly, during their lives, these great men must have been esteemed by their fellows. Lin-acre, Harvey, Radcliffe, Jenner — these are the names that can never die within its walls. I" m see how the College worships science — how it uours scientific men. Such were the reflections my earlier years ; I had rather an exalted inionof the College then! Without its fostering re what, I asked, would become of science and cntific men '{ Not one word had I then heard the College beW^ a mere doctor's shop — a club — a coterie — a clique of small creatures who had always, where they- 'could, obstructed science. I knew nothing of the College persecutions, — how in his lifetime Harvey Avas treated by it as a quack, and how Radcliffe was called a quack too, and how it had refused Jenner its license to practice physic in London. Not one word had I then heard of all that. Out it came at last, however, that no man had ever made a great scientific discovery who had not lived to repent it. Eternally prating of the advancement of science, the only thought of the people of the College of Physicians Avas how to advance themselves. Science ! — What cared they for science ? As a cry, science answered their purpose; but as for Harvey, Hunter, Jenner, &c, science, according to their own confessions, had nearly been the ruin of one and all of them. And who Avcre the opponents of those truly great men ? Not the magnates of the College of Physicians at 72 |,o prominently from this body of imbeciles. Such persons would be ashamed to attack 'ue promoters of science — to call them quacks whisper away their lives in private and before nittces of the House of Commons — slander , and say they had no diplomas. College of Lcians ! put your house in order ! 73