CHOLERA: A SERIES OF LETTERS COMMUNICATED TO "THE STANDARD AND REFORMER," 





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FRAXK A. RAMSEY, Jl. D., 

LATE PROFESSOR OF MATERIA MEDICA AND THERAPEUTICS IN THE MEMPHIS MEDICAL COLLEGE. 

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KNOXVILLE, TENN: 

JNO. E. & WM, T. HELMS, PUBLISHERS. 

1819 



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11. V. M. MILLEK, M D., 

Prof. Obstetrics, Ac, TCcuipEiis ITJct!. Collejje, 

I i n^cri he this publication as a slight evidence of my regard for him per* Plly, my esteem for hti professional and general attainments, and my symy will) him a rid liis colleagues in their efF-tris to place on a duraole and eminently p'.s.iectible basis, a Medical School, in mv native Slate. 

Fimn'k A. Ramsey 

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LETTER I. 

Messrs. TTei.ms : 

Inasmuch as that dread pestilence Cholera, has again commenced its ruthless onward career, I have thought a few letters, in a secular paper, would tend to make the unprofessional members of society better acquainted with its nature, and lead them to act more reasonably than people ordinarily do, when threatened with an epidemic disease, or when such a disc-use is actually in their midst. 

I enter upon this resume — for such indeed it j can only be — the more willingly, because I feel | confident that it will serve, in some measure, to ! make your readers more careful and less credu» 

Pin the reception of opinions and avowed ciplesof practice! and specific prescriptions, j These are often dogmatically advanced, and j announced as being apodictically established by j individuals, bloated with pride, and arrogantly assuming before the unprofessional public a ! supremacy which their medical compeers do I not award.to them. The public need, therefore, \ to bo strictly guarded against such imposition. 

The asseveration of any individual, on any subject, should be received very carefully, when 

he dogmatically affirms or denies any fact, prin- j 

ciple, or point of a subject which is mooted by the great majority of men whose business — Ke interest — it is, to be fully acquainted every relation sustained by the matter in question. And more especially should the mind be alive against the too ready reception of any assertion relating to the diseased human economy, — whether it has regard to the cause, the course, the effect, or the cure of the disease — made in connection with opinions which arrogantly settle points on which the most phl)o*/iphic 

minds, in the possession cf well trained j 

analytical and synthetical faculties, have born, and n main undecided. It is, in fact, characteristic of pretence 1o seize upon ihe faith of tbo victims, by boasting of feats performed, of opportunities enjoyed, sufficient forever to establish certainty and destroy doubt, — end thns, as it were by evidence, impetuous and overwhelming, to induce a confidence which redound- to the pecuniary advantage, or to the fame of tho ostentatious vaunter. In the formation of a medical opinion, much and profound refli ction — on many and well attested observed facts— is necessary. And he is unworthy the position of medical adviser who takes even rx cathedra opinions, without rigidly submitting them to the touch-stone of well educated reasoning powers, which operate upon all the facts bearing any relation whatever to such opinions. And worse than useless is it — because it is very frequently the source of prolonged illness, and occasionally of death — to appeal for remedial aid to one, who unhesitatingly adopts the opinion of any individual whose professional capacity is unvouched for, by the respect granted to a well earned reputation. 

But though*the practitioner of medicine —if 

for no other reason, for the case of conscience — will most probably not be led astray by tho assumed perfection of any one man's views and treatment of disease: the unprofessional members of society, are prone to such a course. Consequently they often neglect consulting those to whom they ordinarily confide the care of their physical part — until the whole man has become so thoroughly imbued with tho generating poison and subdued by its energy, that the most skilful application of a profound 

medical knowledge will avail nothing. This 



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l«ing true, it would saem to bo a friendly act f»r any on i to place b sfore them such facts as will i' nd to prov 'nl thcidoption of an opinion — : ¦.; what son rcc it may bcannounccd — until Ii - re lived the sanction of tho iimu: nal minds to whoso investigatho tnsl< F have set beforcm , I or to coll cl the o\ inioi paper the i I n lections upon wdai they 1 red on clv lern. And 1 will I i n : ' ' , whose * ystem is in such a B!utc ns to l>e i Bonous inliiii nee, to w hich they ai when within the atmos| Ik re i I su b circumsci iii d boundaries. 1.,:: c wio diseases, ar ieta,< bi "j ul .;¦ andcommon di a m, wl <11 1 ¦¦ I'-ii-'-t- '!¦¦ * i fir-*t recognized by ; lar ;e number of individuals being attacked at the same lime, and in a similar manner, and taking its cour.se, it is not, and 

mosphericnl conJition*, it scorns ever to exorcise upon the atmosphere a controlling power, <)f tlic characl r i>! tli i nri v'Piliiicf oiiideniv. its mission is com| l< U d, ii disappears, some. mi 9 suddenly perhaps it,asa i . I'ratli, in commotion. Thougl the Epid mic influence exerta a controlling power,il i-. n verth ' ¦--. subjcctto modifica ion by causes of a locnl nature. Thu«, cl.nle. ra may rage with violence here, and in on ad lown ii"! - > don «ely populated, witl - ¦ ¦ i !:v ii' 1 cares of life, c ¦ of its n;i. icic-;. or who keep ili ir houses and c lots clean and frei ¦nerativo of disease, niv ¦ i i ¦¦ '. ¦' : 'ii' no I by tho correspon ,; ( a Londi .1 Medical Periodical, that ''wha .¦ :' i i .;¦¦'. ¦ ¦ • : ' srn ) in ono -t reel woul il iii , rjanJal Uieaarn? tirno brand ico n i ' arm jan se on tho individual wh ioiuly avers that amoJe of treatmen which a- ¦' i > cure tht dis, tre alike in all streets •71 v I c ire U n >to i 're . !': i ;; 'AM il il is I) > ':l Sli 1, it i-i ovi 1 tiint Sporadic and En tami • disoanes—for the inos part, — will bo orenerally much b 'tier understooi than opidumic di ¦ 'as ¦. Thus, frequently is tin pliysician called < n to alhi) 1 Pneumonia, or in the lungs. It is v sporadic diseasp n : : to which certain general prin • ial iii. ¦ been almost reduced to a speaii'l I'l.'il action, b sfore t!i3 physician can feel nn much self-possession, as when approaching a case of pure Pneumonia, unmodified by the 



it is that his whole soul, mind and body 1 ome di dicated t<> hi-, profession. And under the anathemas of a popnlnce d< manding too much, and in the face of the nssnming pretender, claiming to have found an infallible cure for the <!i temper, and with bombastic magnanimity publishing ii to the uninitiated, at the same time denouncing th" true mod cal philosopher; — th< ii it is, he calmly and perseverinjE Ij . pursues his enquiries, after an acquaintance with the new foe he. has to-combat. Th'- study of epithat often at tho beginning oi' an epidemic, the treatment required is different from that required at its decline. Since his day, the troth of the Bcrtion has been su well established that it is now axiomatic. And if bo, the individual who prescribes a set formulary, and designates — without condition too — the very number of hours that must intervene between each dose ; and with all the warmth of self sufficiency, affirms that the practitioner by following this 

Ruahconsid >red the firsl ten patienl b I to a pra :tition r in an epidemi :, sacrifici d on !:.:.• ) sake. Bui w i lias exy v, ahiii tii ¦ recem v principles ot ¦_'. n ral pathology, then no experim m t — no simple haphazzard resort — should I • • rij n should bo made in accordance with a i: ional empiricism, — :;-. is iption in ordinary pra itico by tho good physician. I havi ¦ b -! I o give, by way of Introduction to the letters ireatiibg in r ¦ of clv a 'ti 'ral Facts 'ed i:i tho remark* on Epidemic ; because they have a . bearing on what must : ¦ • ; to ia any treatise or epitome ol ¦ unions on ' cholera. An ! I haw nlso taken occasion to 'i>iri]i" ( fiii * 1 1* 'it i r nnmi) t¦ I" t^j • n v\ ¦ i 'i i*c^ I ntii m I or of being intimately familiar with the pathoN ogical nature of cholera, ;m>': to the hi Unction of having pro} >s d for it Any thing more on the general sul i r 



LETTER 11. 

By a reference to systematic writers, we lrarn that the term Cholera, was used even by the first observer of medical facts, who left the result of his labors for the benefit of his sue. cessors. Its literal meaning \$ Bile flux or Intestinal (lux. Doctor Good, makes use of it aa a generic term.— classifying diseases, presenting the general manifestations of ''anxiety, griping, spasms in the legi and arms, with vomiting and purging, or flatulent eructations and defections." — To this genus, he ascribes three species, viz : Bilious CHOLERA, characterized by frequent vomiting ai d purging, with a redundance of bile." Wind Cholhra, by "vomiting and purging rare or absent ; great and oppressive flatulence; retching: flatulent dejections and eructations.''' Spasmodic Cholera, " burning pain in the epigastric region; the dejections icatery ; ineffectual retching, ¦ r vomiting oj a whitish fluid ; spasms successive and violent, often extending to every organ; blood drawn from the arm, black and I viscid ; great despondency and prostration of strength." But Doctor Brown, modifying the definition given by Dr. Macann, says "every case really belonging to the genus Cholera may be thus defined ; vomiting, purging, | spas?ns, prostration and collapse, or any four of these symptoms occurring simultaneously, or in a succession more or less rapid." I have been thug particular in giving a defini- | tion of Cholera, that every one rr ight know whai force the term carried with it, and what the manifestations are, which it represents. And further, in this way to place the fact in relief, that the epidemic Cholera has been studied by physicians in accordance with the rules received, and governing inquiries into the nature of epidemics. 8003 rhaave, one of the very few names which, with their writings, will descend to all posterity, says, the first thing for a physician to ] do when he meets an epidemic disease, is, "to reduce it to some known disease which it most 

• resembles." Wlien the Asiatic epidemic first I attracted notice in latter times, it was placed by medical men in connection with diseases with which they were already familiar, and denominated with them, CHOLERA. It is true, as ffydenhatn taught, that "epidemic diseases differ from those which arc ordinary or sporadic, and) have the same name but are produced in another constitution of the air." But by fol- I lowing the rule — which it seems would be in; voluntarily done, — given by Booerhaave, the ! physician is enabled to have a foundation, to which lie can add from time to time, as the results of indefatigable labor may furnish him with svell prepared and selected material ; until j finally ho has the whole superstructure com| plcted, and is able to say, this is thu condition } ot the human economy induced by the poisonous influence of the particular epidemic ; and \these, the general principles of treatment to bo ! instituted to prevent the supervention of such ! condition. The Asiatic epidemic, then, most certainly belongs to a genus of disease which has been known almost since the first formation of medical opinions from observation. And indeed, it is more than probable that the identical disease, now generally considered to be a new epidemic, has been since a time whereof the memory of man runneth not to the contrary, affecting earth's inhabitants, and mshing them, almost without notice, from time to eternity. There are those who have gone so far into antiquity, as to have discovered proofs sufficient to convince themselves that a disease, identical with the epidemic under consideration, was known to the most ancient inhabitants o( China,— even those living before Hippocrates, — who died B. C. 301. And we are informed that "the Hindoo physicians assert that the Cholera has always existed in Hindostan." But whether the antiquarian and the Hindoo physicians bo correct in their opinions or not, it is very cortnin 



tint wolnv: at ih<s prosant day treatises thai miy ba con-mlted, written i) 1029 —by Bon tins, n Dutch j>'iv.-ii-i in wliu went to India ;- -in 177 \ by Paisley; — and from thut time on down to the y ar 1317, w!i mi it first attracted universal attention. In all these irea i-^s there ore pnHsagea whir-b, according lo the opinion of the very b >st nnnoiators, unioubtediy refer to tbe finma disease now in progress on its jonrfu y through the world. They speak of the violent vomi Ing*, the horrid npp -arances presented by the sick, of ihoawful cramps, — bf the sudden sinking »f the great rnortnlity, und of ita being pjiil?ini^. But in 1817 (ho epid mi. 1 , commenced a career uf m >r;Vi:y n 'ver perhaps before equalled, s; thai in lha coarse of seven yi ars it is saiJ to have taken of tlw inhabitants of India.six millions of the people. Confining Si « ravajroa lo the con titties adjaconj to the land ol itsorigln in- fourteen yearn, it at length rnndo its onset against England. Commencing its march in October, 1831, at SunJcrlanJ, on the eastern ahores (if K.i _ r 'a:i i, it soon inuJj ils appearance in Now-Cxstle upon-Tyno, Gateshead, Js'ortli Shields, Uoughton lo Spring, FloudJngton, I'etlington, Edinburgh, mid ii * i Fi bruary, »3j four month* a(W itsevilont arrival on the shores of England — at London. Early in the spring of '32, the principal towns of Ir"-|nn nn |, Dublin, n.'lfust and Cor!;. — wen: visi.ed; an i iii Apr I it allowed itself in Paris, from which pomt — as it w -r. I—it 1 — it -cm out emissaries to the savoral towns of tha kingdom. And on the Bth day of Jim?, 1533, the malady first appeared on our contin snt,al Quebec ; and ihonce visited the principal towns of the United States, as woll ari villaged of leaser uoto. Takjng the direction of tJjawitei'-'CourBeB,--"one branch ol tue epidemic p.ibs?d down the Hudson t> New York s another continued west along the grpui lukoi*,"— maintaining its character of "dirad pa^tilcncc" until the year lt-3 1 or 35, after which if. fimlly boenma exiinct.na an epi !eni : f. •' The p sstilencse stalk <1 fp>mdl strict ¦¦< dl trict, ani from kingdom to kingdom with a uniforraithoiigh 

travelling v iih remarkable rpguloyitj*i i!i" disease di.l not proceed i;i ail dircctu>n<i wtihont distinction or apparent choice ; !''it e.\-liiSited extraordina*y eccentricity at particular tttnges of hi progresii, Someticnva i' would !;.•!;¦¦ a ci mulete aircic round n villugr, ami Icavin** ii untouched, pass on a.s it wciv. wholiy to depari from the district. Then, fitter a lapse of weeks or evo'i months, it would sn 1 1 (illy re* turn, and Bcarcely reappearing in the |»rt^ which had already undcrgcim its ravages, troul I nearly dcpopiilnie the spot that had so lately congratulated itself on ita escape. Som irnrn, nfter running a long toiir-o on one -.:¦!<• i.; v river, it would, as ii iirrcsted 1 y some ii) I i ;&gt;_;'_ ii: 4 Htc»p at < ;] :e. ond lakipg a rupid swe< p ncrosa iho river, lay all vvastd on the oppobjie bulk." For i, early twenty yeara did pliysirinna havo this ill's- ase belhro thorn lor inspection, — and duriny thnt period) many hypothi tical opinions of its pathological con. ii' ion were advanced, an I many hypothetical plans of treatment propo-e,!. At some places the mortality wi)s greater than at others; — and t'ae practitioncM u!ir_' ihc mortality wa.sU.s-, were prone n< claim for tin msolvea mur.h credit for gri al o| inesi ami discrimination, niitil, perhaps nnoih* r risit in its might fron tLo \'o& wlioae certain subjugation they thought witliin their own power, convince;.! them, that before they were dallied with. And again, alter it had existed at n plnce ior a period, th 6 number of deaths became leas, and the people would aongnUulaia tiicoi* selves and their physician**, that at length mcdi« ?; ! ?, 1 1 had attained a supremacy over the di»« ease. But the medical men—those truly mioi | W (j no such pleasing unction for them elvca ( Thi v wi r • well aware that "ai t*io H.s' rise r 'f f|| i epidemic ppsti'pnPCi ,',,. p oporl .m.-.ti- mortality is ulwayn jrrciil : ,ni on the i i :ti iry, El the decline, whvtUft a ter ;— }Hittiii!» ciUir.-ly oni of v i w^tlio ... 

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themselves o t i tlr- decreased fatality attending the decline of an epidemic ; attributing the fart to an improved plun of trentmpnt. With this fact before them, and fully appreciated, is it probable that a board ol health would take occngiofl "to convey to a physician their nio>t (frateful acknowledgments for the eminent sorvioea be Las, under Providence, rend* red in c\ecking thru destructive disease which had rarrfl with such violence amongst them ?" The fact is, epidemic dl*ea«ea in ihcir mnnir»staiions arc ns mrtch the subject of rational practice, as sporadic diseases ;— but llie great commotion produced by the extensive and sometimes universal prevalence of the former, coupled with their general mortality, indncea plivsicians to leave the plain beaten track of investigation, and empirically to employ remedies in thn vain attempt to find a specific. II a case of plain inflammation of an organ of the economy, fills into tluir hands, they unhesitatingly employ certain principles of treatment, modified, as in their judgment the exigencies of the particular case may demand. If the patient dies, — thr re is no c r y of not understanding the disease, of not knowing what remedial <tgents i would have been proper. No, tho person died,because the inflammation was so vigorous, that the j agents though properly applied, could not alter ; th# condition of the economy which sustained ! the inflammation. Why not. then, after an epidemic has arisen, and the nature of its manifestations hnvo been so observed as to render them its intelligible as the manifestations of him- ; pic inflammation, proceed at once to give thrm their proper weight according to the principles of general Pathology. And bin- 

I Uoiml empiricism would indicate, instead of try* ing lir.-t tiii-, then tint, then iliis nn i ifiot combined, In the futile attempt to Itit on n treatment that will cure the di-eR.->e n'.lkc in ail places ? That thin is done by tho physician", proprrly >o culled, I am prone to beliavp, from the fact : thai we occa.-ir n i.illy find newspaper paragrn| lis i similar to tin*, which is taken from the Charlos! ton Mercury : " Dr. Eiaudyside, t!ie fir.«<t Ettgllali physician in St. Peter&burij, liur-siu, had. up to November \2S 1848| treated twelve hundred cast's of Cln>l| cm, in one large e§tab!i»hment, ami last only thirteen patiente. "In almost all cases prompt ' assistance and care succeeded in cjjecting a cure" Here la no bossiing of having nn infallible i " method of euro," but the sirnjilo fact ia expressed, tliat prompt assistance, — (and the mind , of the medicinal man is left to presume by tl.e application of such means aa an acquaintance uiiii tho history of Cholera, would point out : as rationally indicated,) — together with en re, f succeeded in afieeling a euro. It is with a desire to convince the public that the medical profession is grossly blundered, by the remark that physicians know but little of Cholera, and thru tbe people endanger their own safety, by confiding in the avowed infallibility of any set formulary for treatment, in place of the judgment of their ordinary medical adviser, that I perform the la> bor necessary to the preparation of those letters. And the remarks applied to the History of Cholera, are made with a view of turning the mind into such a channel, that it may be able to attach such weight to the various opinions and facts to b2 hereafter presented, as they intrinsically deserve. 



LETTER 111. 

In the rx fcrence mnile to the h ! «tory of Choiphi in my last !• tt. r, I mi_ht havn mentionedin c*M meet ion with the lv •( that it Imd long been endemic in India— that such was the extent ol iis ravages during iljr year 1764, in ll uppei Hindostan that it destroyed 30,000 natives, and bOu Europeans." Why the causes productive of this extreme form ol Cholera should bavo remained solony itioiicrariva on 1 1 1 > • inhabitants cf other oount: -¦> i'iiii of [niia, \-> :i problem \\iii.'!i musl rcMiiaiti unsolved, so !«ki^' as there exists an nia!)iii;v to detect and ex|X)-»e the nature of the a^'ial infltii nces productive ol ( v |iiil!'ini,: dtspases. That thure haa ever existed throughout tin 1 world siich a con lition ol the atmosphpre as under peculiar cirenmstancea — such as changes occurring within itself, or ('!•• iiiililjni.ia of a poisonous somo thing — would pro.lv.'.' Cholora, nii^lit \>c a»Kumud, from the very freqnrnt occurrence at almost every locality of Cholera-morbus— as it is usually tormt'd— vvltich is know.i tn 'manifest- itself in nearly tli • saiaa in. Timer, an. l occasionally ultimately i' 1 produce, immediately preceding di a ii, cli' cis approaching in character those ordinari!v preceding isath from tho pesiilonco. Ft might also be assumed !r<;i:i the oppearunce at such points of sporailic cases, wjiich aro in every respect — as far as th- intrinsic ni'inifestaii":i ol disease onJ consequent tfFtjets are conC r;i i!. — Qbsiin ilated i>> the cusca observed during !!¦'-• prevalence cf the bipulenu'c : nnd from the occasional appearance at such places ol bq endemic, in which the discs present no distinctive feature from those occurring during an cpidpmic. Li illustration of this latter statement, let \u^ introduce the recent consternation ol theciiiti»ns ( f New Orlcnns, produced by the appcartncuol Choli r.i in.evsry form — simplo diarrhea, choir ra-inovbus, and spasmodic Cholern — all] Mt.^uog M th» ud itiinp,-— nomJofUto BlT.cted 

having one form and somr another. This the ¦ ;&gt; 111 1 vs i < iar i h nt the ciiv con.-id< red RM in !< inir. ! The fact tint the epidemic Choi, ra existed at t!i " Northern part of the continent, nt ihe same lime, in no Way militates against that opinion, niili'»s the i'j.i:!cn;io now s with much eccentric* iiv Ijus abandoned hero its original modu of , progress, which — from accounts- -it has strict* Iv observed in the old continent. And two facts strongly sustain ti.e rpinion of the en- J.'inic nature of the New Orleans scourge ;— the existence nt the same time of distinct forma — distinct in the degree of violence, it' not in the kind of manifestations, — and the fact, that U operates the 161 6 with a mortuliiy, which hus not atli Dt'cd the hit • visitation of the cpijemio at any other locality. But • veil if this rca?oi.ing be correct, there yet i' inning to be told, w liy li u-e circumstance* Have never pn vaili tl nny \vh''iv else except in in, lii, until ;ii'i r the year I^l7. Since lhal tjime — locating ih.' very place, and designating tie day of the commencement of manifestations of the Influences thpy proJucod, — a fut't winch con not h s asserted of any other epidemic — the) have progressively prevailed from p«iut lo point, nn;il having almost encircled th»* (jlobe-— causiirg wails '•( Borrow t«> Ik- heard on tha right hand, an ! dm the loft, — tha concntonation was fina'ly di*strnycd,but to be ngnm r. 'inriiit (i. This, too, must remain unaimver* i ¦ '. until the tninU of man has acquired a knowl* i i.'.i of the whole univers", when it will be ena!>. j to i' 1 [• -i I any, even the slightest changti ol tho atmosjJicre, and appreciate the prosencs in it of any— however authorial — exirtiiiH)iM material. Indeed, in niv.'Bligutinj* tlie causes of epidemic i!i* uses, diSicullies, ur rather in* surmountable barriers, present, lo prvveot thw ii'ioptiun ol tin) conclusion. In the Jlwt pluce, iluuigh Cliciniitry has done much towards ui> folding tin; before unread |'>a:en of N'ttture'i ]?>'\ 'bcoh, hrr rperstions !;&vo jot \o bn r< Coqj 



L^foro 1 1 can wy whtthef an influence n aniiii.l •,! ty dUcaHf), ia the rasijll of B(mo#phcricftl ;,j . . -,-| ,;i,;i-, Simply Slich) IT \\ !) -'til'"!" !il >RCt, \'i' air roi tains a morhiJic material, — n poison ,• (> ( > gom-t!jtng. And until thbj refin mout itnplished, nnd tho doubt dosirovcdj furtht r i iq liry would but nucision tin Outlnv ol civ r.;y. worthy to be expended in more pniductiva la- It m';\ !)¦¦¦, that con! ! tho essential ntiuiro ol (i.r.,., eanses be understood, tho treatment ol 111 . ,' >¦ •:-...; octii tn they produce wi>nkl be w'm'.iv aiterjJ ; but thai is qnMtlomib!?. Fur yjara have m • iioal m.?n, fur tin mo-tpirl buce:H.ifulry, suWuod lha effeota reatiltiny; fron; t'l . ;,• ] i iic ion tlits human economy ol caii^ss „ .... ,| -.; ._•¦ [rich «f tli Ciiolcra, "aro connce- . j-y o f prevalence." Vet ihf*y know notliii'g i:urc ol the causes avo through ihe asstmi/: :i 0 .. , ; . i - pr ison ¦: by the human system, after having been eIT ¦' : ¦ J intpn ss d by them, — ttian when i 1:i 1 : • inuiiicstaiious (ti their operation \va? firsl pros B.ed for observj^ lon. But fi thi'ir essential nntures c^i.:. bb > xposcil, thcr i is no doubt thai mnch — nnJ probably tftjetual — aasistanco would bo ;_ r iv mi. enabling us lo discover iho mcum wiili \\iii»ii lod'3itroy tho cansos, or lo prevent their action on iho human system ; thus furovi r dc siroving the necessity of nmsdifil ngents, foi M-oli -f of thouo fcich with o| idemic disease tvuther i;'i 'stion pre« sntitig aimont as much difficulty, is, whether after having operated uji the human ec onotny, thp acti'-n conscrjii fil on nitch t per Uiop,gen Tiitegancw the cause — < rir other ww l- 1 , is the disease contagious ? Ji ievident t ! iut ths queaiion in sotnj degree in^volv.'s i'i^ one wl ich has just been consider) d. Wo mtv imQgino that alinosphefiral variuiions mfiy o.'cisiun diseased ac ion, which act'wn pti¦m! 's a poison that \\i!l csusa \}.c sinn .li-.-iv J action in llic economy of a bedis. 

1 . -if > every one knows, —but uhrthf r dimply uacli or whether the contagion m-iy bo trans* tnittc I through the atmosphere is another queatO i. Thr tniit r (it contagion is suiJ to he diluted so much when dissemiua..ed in tho air ns to be innocuous ; and yet we know tlwil discn tea known lo bti i oninjjious soirn times ol lyinato without any oiia l> mr able to say how or u'en. i';;i tliis, too, in nmm 'slion reltning to previ n ion, nol to cure. The majority of prac* ii;ioncM v\lid have observed the course, ol Cliol•::i. 1 bjlijp-v?, aacribo to it the character of a simple epidemic, without tJw contogious properly. Tho b^st evidence in support of such •' view is '." be found i:i i'-u-is wfntlnr t« the foi* (owiWi — tlio same tiling liming been observed by more than on 3 practitioner of medicine. It ii from Dr. Abbers 1 Rej>ort to tho Prussian ' lovcrnment : '• ! n Moscow , i» many h oilmen, il hsppened lh»t one indiviiiuul attacki d by Uhoierawus attended iiiclUcriiniuatc'.) In all the relatives, and yei the diseawc it.<! »ol spread to an\ of the iiunatt «. Ji WHS iiii.iliy fotind, iii.il not mil) the uuiw - c ¦:¦ tinned free from the distemper, bul a'.-«i i.,:it they proHii.'ciioiix!) attended tiie sick cliambcr, mil \isii'^l tin ir Iriends withotil in the Itnfi coniniuutußtiug the disease. Tiiorij are even cusci lutly ltiborinjr under Cholcm, I uve riiorvd tl:cii bci!s during tin 1 nii'i.t. ai, (l that they BotwithHtiiudUigi ii,i \ i- I•.-¦f;uii'il1 •.-¦f;uii'il 1 1 1 ! 1 1 ! t n r« ¦' ' . in llu 1 Btimo manner bh [ihyt<ic;uns in ho»pitnln have, without any bad couscqfietici', mndu use of tho warm water BBed a momeut before by Chclexa puUents for bath- But thcro nro som s of the best mm !¦> of the • profession, — mt?n whose whole lives hove bctti zmilonslv -;ir,i! in attempts lo advance the art : (; f mi dii iit. 1 . who tire very decided in the man* n i' of expressing thcmsclvi'K, c< ntendii l 1l 1 for a ,i different conriitsion. Tims, Dr. Copland) .¦in Engliuh physician, with wliose naino and standing every medical mnn — tit aH i.mii.i.r ; wiili t,o lit. ruir.ro of his profession,— is Well [U'qiuiiiitccl, says — - '•Those who argue ajaiust iti transmissiWc nature cvii uoi show asiii^u- iastauce »>! ii-s up* pe-irance in any place without tho previous 





('i:cal to sv.-tain the rMii.vJor.s chartctrr of Cholorn, is the history o' its visitation to the U\e ol WLht. On the C-Oili of August, 1833, ft womnn reached Newport, from Portsmouth, i at which placo the di^i'ase wn* constantly i<ecurri I*. 1 *. • 81»e beemed to ho in :_¦ <» •. 1 health, — I i:t wnsotinckrd with Cholfrn the tnon.ing sncceod'ng the day of her arrivals Twn duya ofter, tho woman wlio wcltpd on her was ntlockccl;—end beiwetn tlal time nnd the sth day of September, Bcvcral otlitrßwcro ti.ken with the disease, but happily applied early for rcmetiial uid, and were pr vented from b ins: Bcriotislj Kick. 'I'U:-^ all were in immcJiati routcct with the oiij;inal case, or dwelt in houa sip close proxiro t\ to the one wiiii i she inhabited. The r.urs< in the l.os|)ii.".l tow hi ¦ the crime's wi re nt:n t: cvi t! was :il oattm k( c; : •':'. dirty court where ii." % house was situated in v. hich the first case occurn d. his a matter i I question to whit extent tho filthy condition ol tho locality contributed !"i!i r> origin und con<:. .-. t,.. ? r ilin /!¦ .>'!..•> '!'.'¦" r'i^nnsc disan* ' 1 1 1. ' i »' I' I t y¦ I I II v Ul3v" - • ' ' '- * I peured finally after. Uie 6'.h ol September. A comtncntnlor on iVis history. Fponkin^ ol the j limited prevalence of the disease in the Wand uay 9 :— "At that period there was a vcrj i.i >' ¦ : : • ¦ population, scam ly any over crowding in ill' 1 towns, slpody cniplovmcnt ol a heahhf ul nature for the lal < linji | < \ ulutii n, end, as ;i etnsequence, linle or no Bl'jrct poverty: — Moreover, wo presume thnt rjf.cimit sunlturij 7 , cftst res had been adu\ ¦¦;." "In ti;is position n»w ri ma^nn tho ¦'¦'.!¦ d o) Chokra, Seme would refer it' cniirHy to ntmosplu ric changes ; others to a material poison, j requiring for its | ropngation cfrtuin loniliiioiw ot the atmosphere, but not reproduced by the human body; nnd a third rlass ol observers would make i I a poison reproducing itself hy transmission, like small pox, and merely influenced as this uisenseis, by atmospheric -taU'R, favorable to it« grrioratioii ;''— nnd ii hue reci ntprouncfi! 

u\ in' foil coidti «io nOl i»io winiii Truly i: set ms r » l> (> 8 v< ry pr found si»£gPM« lion, win 11 we take i:'-' 11 con>»id< ration tlic crew d( pill nt dense matter to bo pen in. ltd in * -; ci* r toßUcli investigation! But, a« !/>- Ic< n i< mnrki «'. the qu< eti< nof cause rc.lntCK tncfc to prevention then to curtj and in ono \i. w isct mere importance to tl:e ct Him tpmil world than lo Uiotlicul practitioner*. 'i'lie hiii. rlmvo to look to ill- inlrfnsic op rnflons of the 1 human *ystcrn — know them well when healthfully performed, — lLat they may rcadilv recognise the extent uf derung< menl in which -iheynro involved when the economy is affected hi ('.:-( .'t^c : nnd in ma constant Btu« ily u f Mich ng< n!- ns urornpncitnted to Impress ¦ !.i ¦ nysti in. r>ii ! wl i-'ii hnve sufficient inutcn •¦- \\ (o ;¦ • handled, i xnniJncd nnd uiil'i rstood, bo ;;: le toscii ¦¦! snch for rcmetllnl resort, ns the ex* j ii q\ ¦¦- i i circumsinnci s w ill admit. 'I oc< n* vej my m nnftiji hctt r. I will again illustrate with I'nctimoniflj o«" inllamnwtion ol the Ini gs. This i- know n by all to ho generally produci il hby the agenpv of cold. Dining the Bummer f'l iT.i'i: re occurred in my prneiicconeol thio ¦ wo'fnt C!i3cs of iufiommiition i>i tho 11 111 1 n iT~* I ever snw. 11,I 1 , wnsorra: ioned hy the impfeSßion ,-., the lunga of acrid pranimtiona given <ft from smarl weed, iHidcr pressure by the foet ol r large crowd of pen|lo. But this bring tho pause, h did not oectihii n ;i diffefi nt treatnw nt thnnr would hnve been instituted hnd tho in* flitmrniitiun hern the remit of t'nhh Thecu" m ntial manifesiatii ns, the iiihen lit condition, nnd the actual disease of tho system are iiiilc", whether resulting from cold or the acrid principle of the weed ; and of course diflen nee of cause would not induce ;i difK-Tt'tice ot trent* ment. So in Cholera, the essential manifeatasions, tho inherent condition, the iicmal disease of the -} -i! la. nnd not the catue, must be tlie ¦ sui ject t>f study, il lifo is 10 bo by ihc : inicrposiii( ;i f>l r< mcdii s. Having thua disposed of the history, thn cause, and qucstioii i f contßgiousnesH, of ChoN 





ttius to arrive ttt an i-ioa of iii- gi ncrul prin- I 

nut. 

LETTER IV. 

Onofact that woni i bo rea.'ily i-if-rr-.! (,c\,, many rcmnrkn rnsde in previous !¦¦ i:rr-. I have. I think, omitted t')Mn*e pspliriily. As in true ol rv.y epidemic or en leinic cliKbnnr, — cholera U a much more anive and tinmnnngcitbh f»>e, when the individual* tit tacked ;.r.' cnnxianili lir.vr.iiinj nti atmospher*! imprpgnati d >.\ i h p:na - n.-.iinns from <!t c iin|Kjsingnniuial and Vegetable matters, — instead of on nir uncontnminate-d ckc.'|>t with the generating cause ol the epidi mic. Tims,— mr town mny be syrroundi d with an atmosphere ivl.ich has pnrlaken of the inuinsi: change, or wlii jh is charged with tii" moS bific eloment, that cntisen the assemblage ai bymptoms culied Cholern: yet, because out citizens keep their yards, and cellurn, and ourhouseH free from filth; — and th? streets and alleys, and oullois in the vicinity of our cjty shuw the coD9tiißt attention of the Bcavengpr, Cholera. wiN affect i: . but little, ii' at all. Bui on tho contrary should th »se eonJitiona not prevail — and the epi Icmic in its hunt for victim*, fchoislJ full upon u«, — j..-~t in projiorlion to thi de^r.^o of unwholesoinenesa imp irtrtl !<• our air ! by filth, will l>o the degree of mortality atu miing its visitation. From data furniihed by the observations of| Curtis in India, Jackson in Paris, and BiiJdand Busk, at Dreadnought, it has been deduced that i symptoms of Mauqna>'t GiiDlera gonerailv I blow t|j« mselves lirst from sUniet to satirise; During the e-xistoneo ot ' the constitution of the air which is accompanied by ( Iholcra, mauv ! m.tsohs iiro with a diarrhea, or are ¦ troubled with the necessily of going to stool : more frequently than in ordinary health, Thin departure from hefcllh, if not promptly ny t in 

' most cns*s rflpii/'y U'rniinitti * i;i nn nsa< m!'!n<_*e 1 of manifestations.— dc«i<rnuted a^ Chi Icrim:--wlii h are pn cur*ory of, if not, Cholera itself. I'-.' in Chnli m ii iii" rs only in being li bk vi>>- Icnt ;--the diarrhcß, puin, and disturbance of the L'fii'Tu! sy.-ti in, being bfti the same manifestations in n minor degree, o'fihe influence of .' ihe ean*alive agent, — yvliicli arc rru.re positive* iv ( vi'N need by ihe vomiting, upasm, and prostration, attending ih'e di«nso when it ' rages in nil the vigor of its Any. Bui long before Cholera attacks a plac?, and before even the symptoms nssumo ill' 1 violenco 'if Cljolprino — during the prevalence of tho Choleric rj LI mie constitution, — there is nn increased v ndency to af!" etions rf the btornnch and bowels. The citizens of plnces never visited by the cholern, experience lliia lm<k ncy. • J3ut \vi;i n \'-r.Mi(h ni;;iii!i>i:!|i( us (ii-c (yl.scivi. (i (lllring tho progress of the epidemic, they should bo received "¦¦; certainly indicative ol i:s np« i roach. Hurt; indeed ii tha t n l L l no^>s of these attacks ofdigestiva derangement, as for the [)m-i part, noi to occasion alnrm enough to pw% - ii' the diaclmrge ol ordinary duties by the r,\:', (("(.', or to causo ihe practice of sanitary rnensurea by tfie well. Bu anon ! Cholera is in theft tuiufrt ! Then it ia tiict alarm is monifested — generally in un unmanly end unphi- Innthropical fli^Jit o£ the well fiom contiguity with with the mricken. Thus tha muny Kick are left to th ¦ cure uf n I- w r who ore conKtiained id remain by the force of circumstance*! which exert a stronger iufiuince than leer. Without doubt the hurried ami iinpul»ive Rttention, in this manner, forced to bo extended, in the j »co of resorts ant! mctaßurc*, wLicltrc ti.r rr?t;lut 





of a cam in^iry into, anJ rational appreciation of each individu'il case, iucroaaos ihe dngreo of mortuliiy attjuding a visitation t»f th .• mighty for. Tho mildness r>f tlte atta< ks of digostivo de« rangement U eventually luat in themoreobvous syinptouii of diarrhoi — which sotnttimea disappears find again recurs in fho sama individual. In -om ¦ ixistaiicca \'.'.< i diarrheu nppcurs tiiulitiilv, and in others comes on slowly. In many cases ii i* accompanied by s 'ii.sations ol pair, or weigh) 'it the pit ol the tttoiu.ich, or some portion of the abdomen; — ajid Iroqaently by head-nche, ringing of the eurn, cholicky pains, 6lx ; and sometimrs, indw d, tii" n nous systens seems to show forth the premonitions generally first manifested Irom abdominal organs. These area wan! of physical and mental activity, oppreHWoa, g> neral un asiaasa, neuralgic pains variously located, acd som( times couvulhionn. In sunie cases Choleriuc in ushered in by loss of appetite, — mieaniness after euting, rumbling of wind in the bo\vels,-»-aud torpor nnd intestinal fullness nre sensibly pxperienced. These constitute the mildi >t mßnifcKiationsof nn attack oT C!:ol(iine. In ca^es more severe, from the fir-^t, there are efforts to vomit. — rumbling of wind in the bowels accompanied ijv ptifficiently evident inflarrmatory manifestations in force an application of the general principles which puiue physicians in their i flbrts to subdue inflamniaiiun. In connection with tho efforts to vomit, and cholics, in those cases there nppear sweats, great lassitude, sudden sinking, and finally diarrhea presents. This then is the usual ushering in of cholera — diarrhea presenting suddenly, the discharges being copious, or creeping on more slowly, being preceded by other evidences of disease- -or occurring coincidcntly with symptoms ofgrenteror less severity, proceeding from other parts ol" the economy than the abdomen. The discharges *re at first Übunlly solid, but so profuse as to givo to the patient a sensation of most perfect emptiness of the bowels. They rapidly be'•orne thin and bilions, then serous, nnd eooh frestr.t \hc peculiar ehamctdr described as rice 

.fry deposit in Poor 1 n# tr.impir.?nt, mixnl will albuminous l! ikes. Sum tim •¦i no ;'<> m i* t !>i.t aL;;ii:i they buyi 1 ;t hint mcl ly >m 11, a«»iin« ilated by somo observer: — 'Ah.' 1 iirdeed u«cr»oo !d it l!i" di^ni'y of a ciuni/t ti -li ¦--:<> t!i> odour ol i'>!iti" or chloiine, Soon lifter tii ; i liquid discharge* from tho boweln tak ¦ in ruo-i instanci *, but no: in :•¦','. n:i intolerable sensation of wi nkiinsa ol tho l-nvor i xireiniti s irt experienced ; fainting is threatened on every MKiwtii Mit. ThU, the first stage ol Cholera, m *ometimes so slight as to give th.o pntL-nt tut piriiciilar udohmucss, an I toni 'lima occur* »' itli even greater intensity of i.i ; un:ii! .¦¦>titiciiiH than Ij;t> lc n d scribwl. If these symptoms nre no! iromptlv tn. > t, tho k( condstago with :I - rapidity proponimj fd t.> tii • violenco of the first evidence of diseqss, pre« 'iits. Tl»en cholera brgina to "exhibit the fiidoous lincnn\cntH of his phaatly visage." To tbe fri"]ncnt watery stc>ol.s,tirendtled vomiting*. .At first the contents of the stomacli nrc expelled iiud then follows the peculiar liquid niatt<T, mixed widj flakes, that has b<vn assimilated 1 to gruel or rice water; and which retietnblea tha manor discharged by stool so tnu< h as hardly to bo distinguished Irmn them. The discharges by vomiting are frequent, rui.l tiiero is pain at tho [lit of tha stomach. Cramp, more or lea seven; and painful sons succeeds. Commencing first in the muscles of the hands and foet, sever© neuralgic pain being experienced in the fingers and toes: and next ntficting the muscles of the logs and arms, they then proceed to | those of the trunk, until Bomatimes it seems that every muscular fibre of the body is involved in the spasmodic action. From ohsorv; ing G094 cases it has been deduced as a fact with extremely few exceptions, that (he man violent and general the cramp, the greater is the . clanger of the patient." The pulse becomes : rapid, thin and just perceptible. A clammy ; sweat breaks out. The urine is supprcsHed. The extremities become cool. The breathing if. laborious, with a constant sensation of suffo- I cation; the breath ii cool. Immeasurable sen« 





sn:i<ri of, tin 1 actual, prostrstion. Tho nose I l)v coiik's poitilt (I -the chin nppeara j'harpened — tin' cheeks -ink in, nn I ar- hollow; the I i j > -> thin; intense, in viiiitlilo thirst, generally; (onjjiie pasiy:'<"ycs bright; intellect unl functions unirn- I paired; and the voice .assumes a peculiar, wink. mournful nn i husky charm tor. Tht'se. in ill if Hcvrriiv, prevail but a shod i.iii ¦. w ii"ii Lliry {jivu vvny to col lips'* , or tbc bin • >m ir»". Tho pulse i.\tr ;a ly westis — imperceptible at the wrist— the surface bine or \ iuh t. ii u>r: ¦ c\ -i.l.'iit it) the face, liaurl.s nnd feel though prevailing 1 all over the- body; the hails \. rv !i!iu\ an I Kouielht) 's black; breathing v< rv hurried mid t-cnrcely pcrci ptible, or vi ry slow, • !¦. pnnd iiiterrupfjd ; breath cold, nnJ said by sins in •to have iho oJor b iforc ulluJjJ to as char- j acttiriitic of the dis une. 'i 'if voice* id ektreinely feeble, often inaudible; count, nance calm or inexpressive; tho 'ntell ctuul fucnltius remain, though :i cumplote nputhv <>r carolessn< ss aa lo the rewill is exhibited. The clammy : swont statida in largo drops on the smfac^jj which h cod—i nexpressibly cold. Tlie lir.s uo elasticity whatever, and when pinclifn np, remains pormarieut. Tlie tongue i< cold. The lim'i> bot'omo stiff, Tha eyes som 'limai^ [ glazed and inanimate, but often retain an ex-1 presHibn of intelligence, nn:l seem as thougii ' looking out of a corpse, Tnough often the in- ; telligonce remains, aa lias boon suid, clear and ¦ unnffected, not nnfrequentry a utnpor prevails for a time before death. Indeed in ihU stage bo much like a corpso is the living patient that death generally occur.-, without tho knowledge | of the attendants nnd (riohda. As the strength | gives way to extremo exhaustion, and Lhe an[iteasant manifestationsjuat dotnilcd make Un ir i nppcarance, the violence and frequency of the i cramps diminish; sometimes however they con- 1 iinue until the end — someiimps even after life j Uas left the body — but generally cease sorno time before d ,th. The earns is true of tfic evacuations. They some tunes continue until death, but often markedly diminish from the ! first appearance of the symptoms of. 'the blue 

; lion", ri action occur-*, Romoiimos from tho iiniwiro (iircciod by the nitrn linjx pfflclilkmer, nnd occnsirtnalty spontanpotifcfy. 'J'lii> In murk* '•(I by an increase of Ktfcnffih in the pul^o, nnd Its retnrn in the extremities; tho coldness of the .-iirliico (liiiiini^lics. and llip poculkir Imo given \vm\ lo a gradual return of the nniural ¦¦•(i!(>r. The Vdfco gnidiin»ly beenmps audible, nnd passing throui'h the tone peculiar to ilio disease bei'omos quite si lionms. A hicroirjjh presontfl, which ia at this stage Considered \'.\-voraLl''. The diarrhea, vomiting and cramp no longer pr: sent. Tho tongue and breath oc» quire ijieir natural warmth. Ami tho »ecrelions of miii" njld tonn ngsili present. In short, natural reaction is fully established, ntid the sick one speedily recovers. But in some cases, tho symptoms of the cold *tage are lag. jpird in their departure, and iho jmtient remains feeble for Home days, yoi ultimately geta tveH without the (iccorreiice of any consequent orpajjic afioi'tions. This is moat common when the blue Btage has been comparatively miid. Auain, perfojet recovery is often prevpnted sotii'.iiriifvs for tnonili 1 . by the presence ol irrltaiive ficlipn some wh< re in tho economy, generiliv hi iho l)ow< is am! Htomtch, consequoiil on the degree of spverity of the prerlous nymploms and on nther causes connected with the [niividual. Or the blue stage, or collapse is succcedci) by tho fifth btage of cholera, the secondary fever. Reaction, having prevented death from collapse, in 'ts violence is prone to produco congestion of the brain. If this do nut occur, with sufficient violence to produc immediate death, the stupor and extreme drow Bineoa will be accsmpanied by a suffused rec ness of iho bull of the c^c, dry red tonga flushed cheek, sliglt beat of skin, am! quic pulse. A !ov.-,or typhoid fever, in One occur in which stage in some countries, it has bee affirmed, raoro have died than in the precadin or collapse stage. In this .tage there ai 

TT 



twitching of the tendons, sometimes cnsvul- • bions or paralysis. Vsova tliis collation of symptoms, it scorns that ilkto arc five disii 'ct btage9 ni cholera. To preacpt tl»ia fact n\ >ro pp+itivi'ly \o tinminds o! those for wliOMe wpeeial ediricaticn thrae Lett srsare written, I will summarily state the char«cierifltiof«. TiiU is necessary, that tlie reinarliM heronftor to be introduced oti the trcatm 'in of the disease maybe and retool. For I I'onfi-s.s ,1 am anxiou-i tint thenpn-rnpdical j community ntay correctly appreciate the bom* bast of tii ) origin il c >m^o ta l-r of the ceUbratedantispasmodic mixture, in affirming thai that "which will not care cholera in <j;i ! street, will euro it no w!i Te," An I ngain "i'tesam ¦ rem •• diet are appliable i<> all farms of the ds- Fihst Stage. Diarrhea of greater or less ' Bcv ri.y; c.<ia:n^ on suddt nly or -lowly. Sum - j tim >* preceded for n gregtor or lean length oj j tiros by thy ordinary precursors of sickncs»i i sucii .is 10->, ol appetite, foul ton^u i , and gen- j oral mi 'a.Mii \-,s. Son^times accompanied or proc 'lioil by svitiptutn:*, hoadactio, wan- i dt'ri^:^ pains, convulsions; tb> *& too, differ in | volence in iii;F'r.:nt parson*. Discharged peculiarly wat 'i - c |) i-is?,l without p tin, an i caining J a fjL'iin^ of weakness. This h cullgd tho 

premonitory stgge. But thongii premonitory^lt is n 'vcrili'l '>s chnleru, in its mildest afid in<>st manageable form. Secoxd Stage. Dhtrrhei continues, nc(•limp i lied by oppressive nausea, with vomiting of tin name ihiu water) 1 fluid, mipiTiiddrd ; cramp* ol the < xtremiiies uucci '•(!. w Inch progressively mvnd ¦ the tntittdes of ilu 1 limbs and frank. l'n:stia;inn on*tie«, the pu)*o heroine* ur.hliiully more an I mora feeble ; the surface conl*; tiif skin pnllid. The voice husky. The breath njfd '¦ju^wo ctv?l. The face haggard. 'l'lie socretiniis of urine, tears, and bile nut** pended. The patient retime nnd tigituted; cramps and vomiting mark thin stage Third Stags. Dinrrhcn, and vomhincr, irregulur in this stnjjp; somclim^s present, iurain iwhollv nbsont, spmjtim.'s vi?pv sovero, (tgoin much cnit'gatod lo thejr vj'.Uepce. ' J. " i j c surface bine or viol t, tiii.' skin non elas i• ; tlie blood siflgnatof), none being jrifltlcd \\< \n an incision made into (ho s-kin; pulse vl most or wholly ifflperci ptihl ¦; the snrfuce, tongup »nd br 'Hth cold -vory i'ol I, t i c patient exhibits grtat apathy. Cold condition, nnd ci)rpse-liko nppft':iranca n' ' th • piti'iit, a:i ! groat prnsiration distinguish tliis stnge, whicli generully tcrminit^s in death. Fourth Stage. Enaction. FifiH SlAO£. Secondary fever. 

LETTER V. 

in mv last letter I ahowad that tiiorc arc five stages of Cbolera, di-ahutly marked by pecu> liar syin,)to;n s. But these stages are not reco^nis.U in evjry ciso. The diseaso frequent' ly makes a suJ lon onsjt, without any preinoni lory in irtifestalioris. In tii^ country originating this "voracious deitrofer of man-kind," per soiii have b:en kno.va to bo attacked "wbilftl 

! walking in the open air; and having fallen down, retched a little, an J complained of veni^o, biindn >.ss, an 1 doafuos-s, tluy expired in a few mo« taints." In tlu 1 most rapid and severe case*t I the onset is more or ie^,s sndJen. 'J'ljq patient j is suddenly affected with [)nin or sicktiosa at 





14 

reduced; the features morn or less shruuivcu i loul, unnaturally moist aihl some imes tremulous tongu, 1 ; ttuujuad voice; hauvy and suff^is -. eyes with dim si^lit. Thjs», tho characterUri features of thetollapaa stage, are occuaionallj to intense ;:s to ttiniiiuite in i.'ia h, witl.oul tl.t paiient having been vomited, puig 'd or crarn^ed — thus rendering the appellation ol Algid. Ilera appropriately doscnp.ivo of tiie maihitions presented. Generally, however, v i the first these muiniesta'.UKis are nut acpanied with, they are sooner or lifter I'd¦d by, vomiiings and diarrhea ; crutnpii, and ing abdominal pams suppression of urine, end cramps of the general muscular system. As vital exhaustion ailvatues, (he oppression at the pit of tlu stomach increase*; — the cramps, vomiting and diarrhea subside, the pulse becomes extinct, and the horrid aspoct of col lap*© is presented, lljre the 'irst and second stages present at once ; — or they run the one into the other with sudi rapiJity as to forbid iluir being separated into distinct stages. And they terminate so suddenly, anJ generally so surely in the third stagj as to m.iko AlgiJe, their proper no-iolngical, distinctive. Fiom the symptom* that have boen detailed it is plain, tint the principal manifestation* of this pestilential disease ar : * Watery dejections, or diarrhea: — watery ejec* us, or vo.ui saions; cramp; anJ sinking ut' tho al forces. Tb3M {jenarally present in tha succession in which they are enumerated; — but by no means is tlure uniformity ia this respect. And thai tho variations ia tlu presentation of symptoms may be the bjtu r aj)prociatjd I will give them a succinct statement. Ordinarily, Premonitory Symptoms present. These are various, as general uneasiness; pain of the limbs; burning sensation at the pit of the Btomach; &c.; wnic^i terminate in diarrhea. Duirrhea; almost a constant symptom: — rarely ! Ecasimallij altugellier übseiit. The dt- ! are watery, with flakes floating in nd are bonietimei inado without effort ; 

>:eu compared 10 ihe squirt of a nvrinjre! I hen follows comitiog.wnicn is a lesa constant •yinpiorn, than purging] tuoiigh a very yri/milerttcbstri'M in Ihe manifestations if the ilike.use. Hut iv many cttscs it docs not present at a. I. Next in order is Cramps which thoughgetier it- I y prexsu'ing is tnoreffejuent'y absent tl inn any >iv: other of tie prom nut man f '.stations of Cholera, ll is sai.l lliai man lurey, Women more frequently, and childr n generally, escnpe riainp. Then follows Cdla,[:s:, whiah is the must invariabli symptom; always presejifs mi- U'ss preveuied by medical iitreflts. Thi.-i i-> constituted ot loss o! elasticity of t!io .skin; coidi netw if the surface; sinking of the circulation; — complete proHtmti'jfli When this stage i fully fornud, blood cannot be drawn. Hut as it is being developed, it bluod b tuken from unv pan of the air.'cted system, ii will be found lo be notably peculiar. Varia i io.ss. Without any premonitory evidences of disease, diarrhea prcst-nls. In many cases the vomiting precedes the diarrhea. In some cases the first manifestations of an attack is übsK-rved lo bj n.'rvuua twitches of the muscles of tne face, or cramps of the legs or arms accompanied by the evidences ot' vital exhaustion, in other cases the first symptoms are convulsions more or less violent. And iu.somo cases wiihout diarrhea. VO tailing or crainj), t lie puUe rapidly sinks, the countenance shrinks, the skin becomes itielttslic, the urine and tears are suppressed, the whole surface becomes cold, and the individual assumes a corpse-like, condition;—from which state lie can seldom be reMiscitaied. The examinations of boJies, after death occurring before tiio otuge ot' rea uion, have roveaied no particular or uniform result of di-.-eased action on the brain or nervous system, the |fl nda or the organs of the chest or ab omen. But there aro two pathological peculiar^ dcs which are uniformly observed. The firsi of these is the rice-water or j>ruel-like matter, which are found in the stomach and bowels, and sometimes in ihe lungs, of bodies dead 

f 

> 



from Clolcra. These mntter* nrc in every rwperi identical with the matters ejected or dpjpctr(| | during life: and arc observed within in ra\iii!'s, whether vomiting or puryinjr h.-.d presented, or not. The second ppeulinrity in ilu nnrob'y pecnlinr chiirnptpr of tlm blood, beforp allutlrd to. When collapse, hns ntlvnnccd yen considerably, m blood can be obtained by opening the vpsm \a of affected ppirnna. But as ii is nropressiHg, if 1 iooil to drawn, it will Im' found to he much darker thnn natural, alnvmi <!? oid of its wniery portion, and devoid in e : | creator or less deprre of its coagulability. The blood of a person in health in composed of certain proportii us of <iiTt nni v a!ts of wxln, lime nnd potatih, fibrinc and other mineral and animal e'emenUtry KiiLstnncPH. IJut the blood 1 drnwn from a peiwon -ick \\ ith cholera is foimd.bv analv-is mnrieby expert chemists, to be devoid in a great measure of many of it* .saline constituent*, pirtieiilarlv of i'to carbonate of soda. — and to have a marked diminution of the fibrine. And chemical nna'vsis ill nionstrntes the watery portion of the matters found in the cavities after death, or pnssed I'm in ihelody (!min» life, to iip water. holding in solution carlonato nf Bodn and other salts thai Bre constitucntM of the blond, while the more Kolid j-ort i< nis cemposfd of lil i inc. or «;mp proteine rempound. Tin princi| l< a c< ntuinrd in the ilUrhnrpe^, nnd the principles wanting by tlje blcod,ol a person alFt'cted with cliolerH are the same, — are idenli' col! "'I he inf( !''nce is char that the licpwotcr di^charp pa are- rnrrr iy oj <¦ r i ii nof ihe blood itsc l!', little chanpi d by fccretion." Diagnosis, is the distinctive knowle<lffe of v disease ; or, in oilier won I*, 1 *, is the determining one di-iaso fn m anniher, by the sims or symptoms given off from the nffected economy. To seme it mi^ht seem to be an easy matter tt>determine die. correctness of nn opinion which presumed a pnrticujor ca*e of >i.-kness to he Asiatic, Bpidoniio or Algiile Cholprn,— uniog the appellations as svnonvtnoii-;. liiit lei the svinjitoms that have been very f-illy detaileJ in 

"holera will be liad. Of all the symptoms that iave bopii onnmorati d 1 one haw. 1 any portico* ar im| oitance attached to them as diaom stic.n »if A.-iatic cholera except the vniriifiujj nnd purging, cramp, nnd rctinpw. Eot the vcmitiurr, purging, and crntnp are hut of i«pr< ndary »alne, rven when known; and niidnulted cases or nleide ciioh ra have existed in the mmc afmosph( re with the cases | re« nting Kimply the >viu|)t( ms of vomiiinjr, purging and cremp. And wlirn sin Ii undoubtet) ( a>rs have (icciirrr d, the vomitingj p n r^. infj and cramp, presenting -invlv or in coijtieclion, afford but a prcM.mnlimi that the attack is mo of algide cholera. True, 1 1 to prpsuiipiien should always b( acted nn; — hut if the patient present no characti ristic feainres of the collapse stngp; no pli\>iemn can make an undoubted <!iai;ir>-is of Asiatic Cholera. Collapse is lite pntliognomonic, ot characteristic Kjmpti m of the p< >;ili ntial dinpaae. And this collnpse,— this sinking of the \iti:l j.ower, — liiifl inMncnsnrable loss of strength, mti-t be a a direct mniafcMßtion ofthe<ffect I'oUu'.vmu the imjr f-siiii' f the calmative n^n.t in the | re' : rciii i) of (he cholero. It ir.r.-t net !>;• sr( i ¦!!¦ ;iiy o oilier tnnnifotatii n?; — that is, it must not be i lie ( ffi dofff f jrfwustinn |r< c« c«'-ing fn in the ejections and dejection*, and the i Sorts made to r< n;it nnd j urpe. Ihe cbar- Qfi< ii«-i!e ill i .< in t » n of the < i H.-^pr of c\ elcrais<c '< re m>. 'I I c M-r'nce is < < h'; ihf i <*c is roiii: the breath i> cod 1;—tl 1 ;— tl c air tuki n ii 'o lho lurgfi he ing thiown cut (.withered. Ty Home the rice»wiUcr chamcter of the matti rs i>asscd from tin- Ktcmacli nnd BowtlnhaH I r.d attached to it the weight of a. diagnostic element. II (in iiiie; lly tested, and found to Le im secretion. 1 ul portions of the Liood itv If, probobly the t'ischarges should be regarded urn nndoubted (\i.'in(i' of Algid*) ('holera; — b»t tin ir \\aterv — limpid lecture can ntn t h(> mado p.'uhoniu ¦uioiiic. Copious '\hite f r.l.es Coating or HiispemJed in a watery fluid, in connection *wul> io-N of hent, or the general prevnl nciof ( ol.ines-, with failure to a greater >>r I. ss ( xt< ut of tho circulation, may bo regarded as charac 





16 

rffclfc; — and v liencver iticy appear, w!,' ther nil or a portion of the symptoms be lore enumcruted present or not, the attack will he r.oso'.o-pically algide cholera. Prognosis i-* a word «'X{)res.^ii!i.r the formation o[' an oj iiiion as to the probable fatality ol di.sea.se. A prognosis j.~ iy n. ral or particular. A generul prognosia is made fn m the compar-ative mortality of a given disease. A particular prognosis is made from the degree of severity with which an iu(.'i\ idi.nl is attacked by disease, a-. eviJenced \*y the inten-iiy of the manifcstatii ns, In.a former. lett<?r allusion was made to the fact, that in epidemic disf-ases the futality de- CfcaHPA from first to last. The disease under crn-ii!cra;iou fin ni.thcs no < xception to the fact, The general prognosis ol cliolcra in very unf n enable the hr-t few Lours i>f the OCCXim lice «.!' i!ie epid« micj — and becomes more and mere favorable dffring the continuance of the epidemic until its final disappearance, it prod of this assertion I adduce the observations made hy Alexander Thorn, which correspond wiih those made by oilier writers. To give tbe«p. o! Bervati< ns the imj orianee ih< y deserv< . ! \\ iil stale that 'J'boin was surgeon to 11. &J. 88 h Rogiraeni, in which cholera prevni.ed at Kurachee, in June, 1840; — and (hat his report was printed by order of tho IJou.sc of Ccmmonfe 21bt 1848. He 6aya — "Amonj the Grvt one hundred enj^s which occurred, runny died in ;i f w hours, and some in lets lime. *"* * * * Not a few sunk almost without much suffering of compluint, but lay down to die with an upathy scarcely erc'ililc. Ol" the first one hundred cases, seventy vine died; »f the second one hundred cases, sixty-six died: eni o( t'le third and fourth o;:y bundled custs. Simple statistic* however, are not a'ene sufficient to the formation of a correct general prognosis. The general healthy or insalubrious character of particular localities must be consid'Ti d. as well ns the habits, mode of life. nnd the degree of personal cleanliness, of the inhabitants, The impoitance of considering theso matters in tho formation of a general progno. i- is sufficiently proven by the much 

n.lity of chotfra in Now Orleans than in any oi hi r American ciiy. The variableness of the ntnv sphere nnd the great inattention lo ! lie Min¦(6fy Condition. of tlml city, are in themselves snffii ient d) cause the formation of ;i V< ry ui.la\ens or meater iniensity of the aloide svrnp* roma, — with the Ic^s or more completeness o* collapse. Again, it is favorable or unfavorable in decrees corresponding wi'h the blowopsb or rnjiidity of the passage oi one stage into another, nniil the appearan. o of collapse; then as collnp-8 is lea* or more complete, the prognosis in ftyon nr tesH ftfvorable. Tb'beoiore explicit: If the surface, tongue and breath are cool, tho features but little shrunken, the pulse not Mnkin<r With great rapfdhy, the prognosis will bo more favorable than it would he were the tongue, hrenth and surface cold, the features murh shrunken, iheskin inelastic, and the pnl.se rapidly disappearing or wholly pone. If the diarrln a er.mnn. nre nnd crriiirue fir several heurs Ich^re ihe onset of vomiiinjj and Kpnsms, and the pnrging and ppni-cns coniinne forseve* ral hours without any of the evidences (tliich characterise ihe Btsgeof collapse, the propuof-is will be more favorable than it would v\cre the dfnrrhea, voftifling and spa.^rn to follow ondh nth' r in quick Kiic cfssion; and the more unfavorable if the rapidity of succession be accompanird with any of the manifetitationN of collapse. In adciition, if diarrhea be the initiatory s:ageof a case, the progno^in will be lew* favorable U the disc ho rif en qufckly nssnme ific watery — flakry appearance than if ihey maintain !<;r a connideratle time the mere character of lax-«touls. If collapse be present, t(s di^appenrance rnny bo expected if the strface nnd breath becomes less cold, the pulse more perceptiLJp, and die other maiiif-siations of the stage less intense; — 



ble if ro congcutirnn wenr, aftd tlicrc bt but little t<r r.o ccnti qnctivf fey* r. 

pMr DfilM T( ftction is cK!nblisl,( d. Ulu n reaction i.s (s.ti:l.!i \*4 "lit 1 I rc>|ncbi* will Le ftrvora- 

LETTER VI. 

barrhg gitffl ihe fi»Cfß«»ry rrn-idi ration / to ] reliminary inntK rs, the Nntltre and J'natrnehi of Cholem m xl d< mond atti Hffon. These are Mibjccts of maen more imprest to inpmfeKsional readers t!: n .:i Bny which ftnvo iecn offered to their attention in these letters. — [3ut Rrt there are but few besides medical men,' -.vi o npply for -knowledge on this, and kiudn d subjects, to the proper source, — and nt course, Hit few who are correctly infofrned on such subjects, — it has been thought necessfc^y to lacothe matter contained In the preceding h trs, before them, that they (night correctly uprecinte the VUnvri nnd opininHs to bo advanced . nd defended in this letter. For sofne time after Cholera fir-t attracted tteniion, it regarded as a disease of the ¦oinacli nndbdtvehtl — presumed, or believed to ; c an irritalfon br affecting the ning ineniliiaiic of these organs, and by it^ : ction, Inviting to its scat the fluids of the body. /here are yet seme practitioners of medicine ! .ho, sati>t.ed in bimply havivg ah cq inion, per- | lit this view to influence their therapeutic*. — i is incorrectness is bttfficie filly established by xtensive ( xaiuitiaticns, made en bodies after 'eath from Cl.okro, revealing the fact, Which as been tncntioned f that ho uniform i fleets of 'iacOBO can be disccivercd On tht tissues of the -lomacli and bowels. Again. Upon hypothesis, the impression of !;e eausatiw Bgent was made Upon the iktvou-i ystcm. But io hiiifortn after death effects n ing objcrrcd on the brain, Krtnnl-roarrow, or 

nerves, — I6gethif with the very frfismt n&' gence cl" sj.a>ms, cir oilier positive in rvoutf manifestations, during t ho progress of individual ca>ps of the diseases, give a negaiive response :is to the COTrcClneaa of this opinion. — Tl.at it yet exerts an influence, is evid -nt from the confidence reposed by fur too many in antinpasm< die and narcotic »üb*tance« ;— ascribing lo their influence results which rationally, and therefore legitimately, art aitcribabla to thera- rgQntf which are usually emp'ojjed co'i cidentlv with such substances. That reliance on those substances is misplaced — an-l that the opinion regarding i lie disease as primarily A nervous condition is erroneous, the following facts testify. Aulispannodia or Narcotics alone, have never cured v case of Alfpde Cholera. Cases of A!y;iH° I'ho'era hiive been cured by other therapeutic agents, after Bntiepasiiiodifl And narcotic substance* had been found to be insufficient. Cutea of Algide Cholera hnve hern cured without resorting ut all to substances directly in - pressing the neircus sytlem, as atitii-patniodics or narcotics do, A beiit f tiir.t the ('isensc is essentially ncr» ve.ns neccsfarily Uada to mi unwarrantable use of anti>j asfnodir. and narcolic Hubslances, and the n suit of their influence is pernicious. — 1 I'roof of thi:> assertion will be hereafter, and ! more npprcpiiately than jost new, introduced- A view regarding th« nervoua niai.ifestaiioi.s observed in a large majority of the casts of Chdcra, as secondary in tluir origin, nnd in I their wil ur, may pc mil ibo wfiuenec of uti« 

TT 



• r**~'''c rr rsfrcotic fpents h> \r.g Koliciiedl under r-ropfT pircutnMrnnHj — tl i:s irnl-.ing t!.i m atviiv.'iiils. or nn in my io the remedial re.-oits |i:t in totlestroy thecondiiion of thi body < n which the uetvou.- mnnifcbtoiii-ns are dqw/i-dtnf. Arpin. The r% Went sinking of the cirrnla* lion made Kfrne to view trie I'tMtasess wi.-ikcned power of the heart, occasitn.ed by a dinet iie| n Bhion mae'e ( n 1 1 : c er^nn, by the causntfve B£i lit. Thr foctn are of thrni-ehi h, sufFn i'"i t to disprove tin' corn e:ne ;s o| )j,> pj inion. FJr»t,— th^w tire phen< n i na i l#em ri in every ¦Mack ot' the cholera, thut cunni t hy unj prnnm of roucci nation which at nil opprourhn to cornet niin.iiiiicr. be trurcd n* pn cVcdii g 1r» m v eakeni <! actirJn of the hfart. Si-mi il. — ti:.- mwt critiesl ncmrrti '"mi v.o> detect error in thn reasoning, which MFcrll'igi I<>s of power to other conditions, nrhicli :<'<• jiinii iiicr.i (?•utii'cs by tlfir manlfrMbticiiit, m bodiea really affected by the poison of cholera. Such is i ho intimate association and ee-r. laiive i!» peii'liince of orgnna in tlie complex formation of the htitiinii ecoiir mv, thai pre-eminent iniporini'ce i> hardly to be assigned to sny pnrtie* ular one. If this could be nndonlrfedly aceompli»hed, seh!om would i: be very difiirnli flh examination, to diwovfr whew the foult is located, when the ptpiilibiinm of the whole is de- Btroyed by the diseased nction of i part. Bi'iH there are some reasons why the blood should be regarded B8 more eminently necessary to tfie rontinuance of vital jimnifeptu lions than any one other of the essentials in animal organization. And in Bttempling to dt ci('e the inquiry the expression of ihoJewUli lnw«giver, th«i ihr blood in the life of the flesh, is not .o l;e overlooked, or passed by, as not op; ropriate to be cited. But tlie following! fac(« have a bearing which will Le appreciated ly all minds cnpaLlej of forming conclut-k;nß from analogy, and hy induction. Plantp have a circulatory upporatus, — hat arc whoilv destitute of o nervcus syptem The lower orrit'r of anin:u!s have a circulate ! ry apparatns. hut a nenuis c;.n not be demoiiKtrated. It ! rA if • * I ' ' 

AnxYerr; r r> orrrv.7: f m ;r rfrrrf V <'.() r cirdilatory nppHrntw noron i b n «re center, nrtd |( f i i ;-, . i ¦ n ><i !i ! ( r< n X 111 1 i '<¦,'!(' i; ,-<r t;i 11 - gible, iiu til in n an, it it rcfii fully dtvclf pi <!. 'J'l.i- c !'.¦'(• 's aßsrrl tln» panrntial nature 1 of the circulation to vitality, nnd the wcowity of 1 1 io nrrvf us Kyittcm to ihf pPrfc-Ctinn of vital rnnnifext niton*. And hliow tlint under pini? circiimsiancpH, cits ulution can I"* prp»prv< d, and the purity of the circulating fluid maintain" < [I, tvilliont the :i - > w*ji ii<^<- nf ;i ncrvon* nyjtfi tri ; while uprvous influence can never be exerted or ex peril nciul, without nnolmnpl uninterrupted Mipi'lv if circulaiing fluid. Frcm these con* -it'i rnii> n- tin 1 blood is of primfl'y importance to thr ni.iinnl p< rn< my. To li!i it.- pnrrcßP*, — it being n fluid holding in solution nnd kms« pen-ion, *olii's — i 1i 1 is necrepary that its cemponcntelrinrn'B be preserved ill <¦< r;; in proportion. That it may he dispensed to the whole system, and rcrnrn lp tho point from which it was I'.rst sent on!, ii is contained ill a certain se t of vetwM 1«. These nrpeni'ovvpd with h pnfac* it y to receive impressions Crc m ihn prfurnreof the blood, nnd to reppend to the imprr s^iisn no as to pffecl motion to ihe fiuid. It is the nntur;il stimulus to the ve<-sf Is. The p*( Bi orgnn of ti is set ol veww !a is the Ilenrt. If the enpacitv lo reci ive nnd respond to the impression from ihe prpw ncn of ihe blood, he loifl ly tliis organ the force of tise cirrulniion is nccpb^arily les»pncd in proportion with the depree of such loss. J"! ut it' the capacity ho k»> far (.'one ns in rnnsp n sndtien, or i vn prndual cp^ation of;i!l sieti •!) on the | art of the heart, blood, not mark(«!!v nlterrdj will on i xnmination, ! ; e discovered iirtlie cavitirs of tlip cr;rn. r J lis is not the < nse in clolern ; for obfenrra affirm i!,r.t t'le, capneity to rrcrive »m<l repfond to imprwsions positively exiMf. r i l.is is manifested ly tlio heart beniingtiil stopped by the want of bleed, i| : r> entire ti\f< noe of Ihe nnturnl stimiilnnt, on thr left side, and the accumulation on tbo rifht side, of llnru}, dentil ute of the rehitivß pro- I nrtit ti of t U nients. w hich U presi r\ed in that 





19 

Confidence i;i Hie opinion noconaarily lea's tn ,!,. us-uf Nttmo»«nr>, properly «o calhd, under eirenmstancca which rrquire r.aroful Ininhnm!-urj nl" nil ihj rapacity uf orjrarw la weeivr impression-*, nnd bfl c.v -iicd ;--;m I every hue- H7-i-.iv_! np;»lloition, a-; an iu?vifa!)le ron- ¦- nn ii -o, i i lue.-« d -Ijii'v an I !<>¦,¦; ofcipa'ity. comm -n^uraie with the drjrr "«Jofi xci»i in -ni piodnced. Un It pro;r:r cireuinst hi ,-cs as with (lie cli-is of ngent* la<t r fjrrjd 10, artetU' MtimUiiiitti, miv !)• employ • I as a ijuvinN. m decon Inry, to th" r*m'd.al resorts ptn in .•' I - v I.v-to il "ntrov th ¦ con li ii»n :.i which the want nl \\gnr in the h?arl auJ circulating vessels d_>- Tha lan^fl'ig"' °!" E. A. Parkes, strongly Matin*?* a.nin-ii th 3 correct nm of t'n hypotheses whic'i hiv • boon ¦ ! i - •. v wvl; an 1 i - appropri it'- Ii t', a- i rro l.i 'in * t'l • COT-«i 1 T ll ion i f an oiuii > i cjv\ ' Tiii n_r th > prim iry impr s<ion of t!i i choleriac poison, which is deJuced froii c.irr ict o')s irvaiion an I soun I ar^mn 'nf. Doct, I'.irkes, assistant-Surif>H)n in on • ol 11. M. R 'jjiin Mits in India, — pub!lshetl in IS 17 his "Researches into the Putholrgy and trootmeßfo'l Alfjide Cholera,"' the result of ¦ i observa!iun in id' 1 during two .severe epidemics of Choi wa, which prevailod in InJia ih ISI3 a:illSts." The in irk ¦!) ability displayed in tha " ir-.s.'arehe.s," testiii 's to the oinin i nt capacity of the aiulior ; and his intellectu.il anl professional qualifications nro vouched for, by the very impartial and favorable review ol his work, in the " British anl Foreign UaJico-chirur^ical Review " for In altJUl^tinjf to establish t'l3 B3at of the primary dis'ine,! condition, he says : " As, therefore, the m ic'.iauical pirt of respiration is pjrfact, and as there is no impiirmont iv the voluntary onnmd of the respiratory lauiclcsii a ..i .ij i..' .i • i.t evidjally li its in in tuy ca-ies, till flopped by the want of blood on t.'u left si.!.-, al l b.' its :ip/:;inuitii),' oa th* riij.'it Bide, r& arc cj.h;> 'Hod to look for ihu c.nw>of su^li urrcst of the circulation iv the only re inaiuiu r e!e;n Mit of respiration ; uutnely, in the BLOOD I I'SKLI'." 

' in'-'nt.*> in (.t. iinit? propeiuons. t iic"i ji ( ( orlioiitt being destroyed tin 1 rr.nlt muM uccf»wa« riiv, —be n.ai.ii >t.i! io:;-. of uUen^c. 'J lui^, if ili ¦ blood be rich, llic cl«»i n sS nl I lie n lulioni of i h i onxiitui niß < nhani ci!, nr th" proj-nnionii of Konri' <d its element* be iuiglitnud — tho effect will be nn i;i ;u n>:i -¦ ¦ of vijnr i:i the RCtion of lite heart, and pain and unniinirul ndnes.sof *omo pnriittiilur parr, or gnneml functional derangement, increased iical end qttickriud pnW, '11. esc, ever, on !.;.s <<h-i'i veil in uncumplicntcd ii i ¦ f " . 11 111 1 . 11 11¦.::1 1¦.::1 ¦ . : : « ¦ 1 1 - . nml ordinary i-imple II vor.>. Bul if the rlcweiw*** of ih ¦ relnftnn of the constitn ntn of the bl r-< 1 !> • w nkened, — the pro] ortion ol ••owe *¦'¦'• it* ci. n< mx lie Uttt' «-»nod, ilio reverno mken |>lnce. T\ve henrt — tho»gh in iirt"lf unnfK'ctfd, — bouts weak, the siirl'a (' i-. Pool, an I di^' as.'d aciinii (icciirs in iKiriicnlar p^rts, diflWiiis materiully from the loi'al ftffectiotw nct'tifriug wlien lii' 1 circulating flui ! is onricli.'J. Und t any circuin-stflnpe»i the evidencra of dJ!*oasp, wlirn proccediog from nn abnnriml "r umvnnte ! comlilion of ilu i bloo I. I) ;ir a ratio to lh.i i! p;roe ol dinturbancfl ol the rolafionn of its consiiiaents. The general opiiiiun of tlio nature of Cholera may bo llius expr»*s»eJ. Tug caiisatat; ngent, whiitt'ycr it may be, — rntera die economy,—-probably by inhalation, or Uiruii^ii the lun^s, — and by impression on the bluo.l causes an alleration of the relations of its constituent parts, and the effect in unhealthy in ¦miiestmions, proportioned to tli.' v ;gree of stub A want of knowledge as to ths character «f the causative ugont has boon affirm )d ; — and of c'tiirse there must necessarily be. a want of knowledge as to the essential nature of the impression Uin ikes on th > bloo]. In the absence of suc'i know I i IgO eiT'^ts in ist be. investigate.!. Every effjet itself, b-eouns the cause of liutwequent effects ; anil if the lirsi and tsscntial ftV'i't |>ro lice I by the action of the poisonous cms ¦, can li ; discovereJ an.l suecessfill! vco ii') uted the sub- 1 yi 'lit, d>p mi lent, or -eeon.larv effects are entirely prevented and 



-the universal coldness. It is not i:i nmbonl on tnn to discuss h ire the theories rotating to animal hint. Ft h Buffii'i ml ft.r tlte unprofesdinnfll reader to know, thai no m vlica! man will deny that the circulating fluid is largely involved in ir* production. Thin is eviJent from the facts mentioned wh 'n -peaking of the cnnseqiieno.ps npnn a clwnga of the rclatioiw of proportions of tlr^ blool-constiiuents. Tb« Immediate otfict in i!i; severe ntta '.ks, of tfw impression of the (Jholcriic poison y de- Btruction of the relations, — s,et.irrg loose, or uncombining the p| 'iTi"n(s, so as to prevent the motion of the llui I m:v«ss iry 10 the pro In • [ion of heat ; — and the Mm 3 wait of notion i:i fho fluid, prevents tbe hoart frunj receiving; the ttimulna constantly necessary to the product-ion of action in ih.it organ, and of coarse it slops, ns does the mill-wheel, when its supply of water is shut off. The extent and degree ofooldnew, nnd trie want of force ns manifested from ihe pulse, by the heart, are then, evidences 0/ the extent olth 1 disturbance of the relations of thblood-coiiKiituonts. T.iis is proviiii b} r th9 successive manifustalions observed daring the i progressive cour c of thos." cases which at first | nro miid. The disturbance of relations is evidenced, and tho evidences becoras m >re and more open and marked ; and consentaneous with their greater development i» observed « lessoning of the tomparature of the ba;ly, — first cool, then cooler, the-n cold, — and sinking of the circulation, — first weak, thon weaker, and finally wholly gona. Ths coldness, and loss of power by tho heart, are then ultimate effects. And that they are not secondary to intermediate effects, but result from the primary effect of the impression of the choleriuc poison, js evident from the fact, that cases occur — the severer cases iv which death takes place almost as soon as evidences of disease are observed. — which have no intermediate effects. But even in these worst cases more or L-ss retching is n manifestation, ai^d alter death a fluid iden>icn in appearance, and chemically the same, with the fluid passed by vomiting nnJ purging by 

, those less violently Attacked, is found in the ] stomach and bowela, ami aomctiraea in thelnnjjp. And th ¦ l»loo I in the circulating venseU U found 1 in le. de»titntc i:i a greater or less degree, vi ike wry ¦nbritnncen found in the cavitfeM of ; lie jriomßch, bouvls and lutijp*. Theae (act*, — the paenjM into the itotnacb, bowel-!, and lung*, fit' a flni;l foil iul to OS essentially the very (.leinriits vanting by the blool, — ai;d tho I evidence of retching, even iv the very wont 1 cn*e», ari- nbundani to prov, that disturbance of relations, an I a tendency of certain ctfthe blood I'oM.iiiiuvti'.jrf to escape by free snrfacen, are coincident effects immediate upon the impresmoii made by the choleri&C poison. The lo.ss of support by the tissues of tho stomach ppd bowels, in coamud with the lissui.'s ami organs tf il:e. syhole economy, Irom the abseßCi' of well and duly proportion -id blood and the impression which the constituents make in parsing from ihcirown vessels to the exposed snrliices, in contact v/itli which they are found, are sufficient to induce the unhealthy nnnife.i-lationa observod in a gradually developed case of Cholera, In such aiiaeks the first manifestation is looseness ol the bowels. Here the impression of-the causative ajj-Mit is slight, 't'na relations are but to a minor extent disturbed, and coincidently witli such a minor disturbaacc, is a slight tendency of elements to escape. Tl.;e tendency not being interfered with becomes Htrongpr and stronger, as does tlia leak in a gr«at reservoir, which bjcowos greater and greater, by the constant pressure exerted upon it, iiuLil U pours forUi a mighty stream. Tiieu preserU the vomitings, purgingn an J cramps. Tiw variety of the seconjiry manifestations,— t ha sometimes vomiting preceding purging, the somr times entire absence of on.« or th« other, and the intnet'mea purging before vomiting, aud the occasional absence of pain at the stomach, and its more ordinary preMUCe, &c, — are to be accounted for by the variety of susceptibility of different tissues and organs, consequent upon ntrinsic or cxtraucous predisposing causes exiil ited by different individuals, placed under «ce..iingly the same clrcumstancM. Tht 

• 

~~VU~ 



21 

...,,.. •¦. ~ . ¦ -¦ in |i . ! i ii «, placoJ unJ r Bftcminfflv the •:t::i > circunwtnnres. The (•,.., , ¦ ?r - . ¦, . r ,•]]• c! an irrcglilar nervous influence 'i ' ¦- ;: ¦'¦¦>' cx-Ttcd— -from tbe n r* ? [ ? y i,, r ;:i i ' fltii "i '¦ ' or !cj*h t. i ¦ . :' ¦-¦: 1 1 ' : l ' <> - In 3 \ " ¦ • * 1 the irnnien-i ¦ rush ol flui I to the c m re,aua m< . a ; all 'ration ol th ¦ flui I ' rom whir . t!i ¦¦.' prepare t!i ir 33crotio:is, arc sunisicni v 

account for !!;>> eniirc u!.^.lK•i of bcUoo i( j m , ;..,,, ? , , ?.] L , . ;,;:.¦•¦-:. An ! the I ndi ny o ? .; | n ,;, n , nts i I the blow), in i ihe am ; J it -1 -;t uctiun of the ji itura! rcfoll is ol il>< hid 1 1 constitui ntn arc ih only im ..¦ !i c ordi- KM (Mi I t!i r i ' try i :.'¦¦¦¦-. 'Vh :., : : tit, mi , ,: : in !y bo. a n I iheoth rl* hidden, the |ri ¦ I .... ¦? , f r r ms!i ¦ ¦ •¦. ¦' o; he fri ¦¦ f 

LETTER VII. 

. I ra are plain. Vet, uotw ilh ai !in th >ir clcarm --. there ;¦; very great t : i " 1 i :uliy attending mi att( tnpl to vi^ 1 them, und the 11 an,,-., jg which they ore filled, satisfactory amn in in :i tre ilis ¦• '.'..ii' n, as this i-, i-: and non«3e<|uitur,>), which rnusl i!y aj>jirt bended, n::(! aptly discrii ; : ii y '•*'¦ of his professional act*, cannot wo bo cis K r convey ¦!, us to bd c i|>i . ;¦ . ¦ ; by cally, is introduced the The itment of Ch ii eka. 

ly.nre li Hirlnno 'then! ?,; lupa : 3 , Thw i ' inv< It * n :r ?: ror 1c ml |i fr< n s&rfaces, is a i.i ¦ . - i (•oiisentaru'ouH ¦a ill lli' 1 dUturbnncj ol i ¦¦' ¦ ;&gt; i -. '¦¦ J : •' • I•:I • : ¦11 L a'--; h rapen icaily or . ;i h ,: inever 



be manifested, — nrvor discovered, nnd therefore, ii is fair to presume, will not exist. — And giving the same idea in diffi rent phraseology, if they are consentaneous 1 fleets, and the tend -nc.y to escape bo ov.t ome, — the natural m ition of tli • circulating fluid restored — its supply to ail the organs re-established — the disturbance of relations is destroyed, nnd the, blood-constituents reauißfl tbuir natural affinity. The indication then, of primary importance is : To apply tu;\ agents «' iri'l overcome ihe flow if in' circulating fluid toward* certain organt, mi. l rc-cs/.il>:is'i the noturalcirculatory mot'wn;— so that every organ will be supplied, and animal heal bo preserved, 10 an i xtent ifcossary to the prevalence of health, or the preservation of life. The indication may bo liilud by observing the following rules : J. Administer such substances as will, by their peculiar immediate impression, induce a condition of ihe vessels, with which they come in contact, opposed io the; passage of the bloodconstituents. 2. Administer substances which will cause, by an impression they nvik 0 , B general distribution of the circulating flui 1. 3. Apply such moans to the surface, as will, by the posi;;wness of their impressions, create an irritation. //"' irriialio ibi Jluxus. — Where there's irritation, thither is the tenJency of fluids, i« an aphorism with medical men. In selecting remedial agents, with a view to fill the primary condition, choice is lo be determined, by ths degree of viol nee. with which the tendency of bloot!«con*Utuentß to escape, is manifested. In the severer cases, in which from the potency of the poisonous impression, tha manifestations are hardly eviident before death 1 ccurs, no judgment is required. In ordinary ca*es, the degree of violence is appreciated, by the quantity, frequency, and character, ot the dejections from 'lie bowels, the ejections from the stomach, cramp, and bfdegree and greater or less prevalence oi 

I coldness, with tlic coincident prostration. — Thus, in ill? first stage, — characterised by lo>>e- Detu of the bowels, more or less xnddtuly, affecting iho pcrunn, and the character of the discharge ivt markedly diiF, rein from that which is natural, — the tondoncy lo escape is probably from a flight impression of the can ;ative agi*t:t ; — and ilie naiural tone or vigor of ¦he vessel hcl the orpnna receiving i ho lenden* cy is not, to a very great extent, altered, or impaired. During the existence of these evidences of disease, agents may bf selected, with tolemble confilenco of tlu>ir proving efficient, from the number of substances which net in accordance with tho rule first stated. Hut if ilif simple diarrhea is not checked, the calls to stool become mare frequent, the natural character id rapidly lost, each succeeding evacos;-lion is more and more lux, until they tinal'y are vratery ;--ilio greater laxness of eacli succeeding evacuation evidences a progressive loss of tone nnd vigor by ilio vessel .1, and an in,c 1 ease of ilio tendency of constituents to eacape. Thin is the very commencement of the ¦second stage. Soon vomiting, cramp, and other manifestations of the second slay, are i presented with more or less severity. As the watery character of the stools prevails, aa is ; their frequency, and as is the violence of retching anl vomiting and cramp, BO mv.st be the I energy of remedial efforts. Under those circumstances, substances which act in accordance with the second rule, should he admin; idle rod with a freedom commensurate with the lessor greater violence of the manifestations ; ! -nid coinciJenily, if the symptoms ara severe, ; mean* may be applied, In accordance with the ; hir.l rule. Not unfivqtiently substances act! ing in accordance with the first and second ¦ rulo, m ly be a ItninutL-reJ in combination, and ihe means pointed to by the third rule, applied at ! the same time with advantage. Circumstances [ not essential to bin influencing the cholcr manifestations, and wnich, generally, are peculiar to Ihe individual, must necessarily exert a modifying power over the mind of the practitioner in concluding between substances simply, or in combination. 



The cold condition, corpse-like appearance, and extreme prostration or the third si aw, are fearful evidences of the great want of due motion of blood through the lungs, heart, arteries, and the smaller vessels of the periphrrnl organs, and demand a very p< sitive use of such agents as are mo-.t prompt in their impressions ; and they are besl adapted to ihe treatment of this stage, which act in accordance with the second and third rules. Inthefou'th stage, the reaction, when not sufficiently positive, must So encouraged by a judicious use of stimulants ; — and restrained or governed, when iirtcessary, by such resorts as peculiarities of individual cases of reaction may demand. Ami the fifth stage, or the consequent fever, when it does occur, is to be treated with due consi lemtion of the circum-tanees in which the economy of the pati -nt has just been involved, together with the manifestations of disease prevailing at the time, in his person. ; Before proceeding to designate the articles of the Materia Medico, which may appropriately bo opposed to the manifestations of Cholera, in accordance with the general principles of treatment defended in this letter, permit a suggestion. However convincingly clear the opinions of a writer on a medical subject, however satisfactory his views, and explicit his directions for j the application of remedial agents, the unpro- ' fessional reader, — whose mind is unaccustomed to such investigations, — can not be made com- ; potent by the production of any single man »o J practice medicine. Am\ therefore, .should personal ailment, or apprehension of being attacked j i by a particular disease, lead any one to consult ; : the writings of a medical-man, he should never i have the temerity to apply himself the pic- i scriptions, or the boldness to test the views, * with which ho becomes acquainted. Ciretim- I stances occur in almost every case of disease, ( which can be appreciated alone by the physi- t cian and which lead to modifications of pre- j \ scriptions. of practice, necessary to render the j t administration of medicines efficient. The t suggestion is made from a desire for the physi- p 

3 finve by some moans become possessed of - .1 vtv limited amount of information on tnedi* , cnl mitte:s, ai to account themselves capable - of judging the weight of evltii tices <>f dUeaso i ;it a glance, which the physician w< uld ponder ; fur many weary hours, —and to consider them- I selves fully competent to decide si point of practice, which the physician In compelled to ncknowledgedoubtlul — that it would be but nouri [.thing hope to sicken the heart, to cherish a i desire to prevent them from committing on a< t, i directly or indirectly dungerous. Of ihem, it i may he truly -aid, a little learning is a danger* : oiis thing. Ignorance, hardly relieved of its ! gloom by n single ray, rushes head-long and impetuously, into difficulties and dangers, which ,-ire carefully paused, or judiciously enc.oun! tered, byan intelligence enlivened by the benef: icenl rays of the sun of knowledge. Of the rules given to govern in iho selection of agents with which lo fill the primary indication in the treatment of Cholera, the fir.->t has reference to the local < lT</s of substances : Admiuister tuch nibstaneca aswill, by their immediate impression, induce a condition of the vessels, with which they come in contact, opposed to the puM&geof the blood-constituent*, This rule is more particularly applicable to the first stage of Cholera, though frequently appropriate during the progress of an attack, and therefore, should be constantly, kept in I view. The first stage, of Cholera, when mild, I may sometimes bo overcome by .strict attention to diet, and the observance of perfuct mental j and physical quietude. But if such care fails . to induce an absence of diseased action, and the first stage not only continues, but the charncter of its manifestations becomes more decided, substances pointed to by the rule must be administered. They will be found j osscssed of a property to constringe, or to force the tissues of the vessels so to contract, as to prevent, to a greater or less decree, elimination of th( ir secretions, or of other fluids. They aro astringents. The several substances which produce this effect, when brought in contnet with living animal tissues, diffjr in the essential 





24 

iwturr of Hinr imprcs*ion«, Wii • precede llie fF.'d. This h suflicioutly evidenced by the act, that Bcma undoubtedly astringent sub, • -, will fail wiifilly to constringe, under i pircmnstancea which will not at all . ..;•:, ili > ronAtringp'nt property of other astrin-2 >nl -'¦<'>' in • Tlia adaptability of a pari..,, ir a ..;¦;;,;¦ nt snbstan c lo a diseaued r ,'.'.\'.] \ r\. \n j'.r ¦s;i:n mI from amfogy, and de>. r . n i, ie : [iy |i'iv i ob :n ati m;— b icause the s S Titial r ¦ Her of ilia impression ol individual Bubstun •¦on i - j •> ri condite to permit beng explain 'd. C H ili • astringpnl projn rty is ...I itm n iy on > possesse Iby tli • ¦' ¦-'<¦>'¦'• ' »• ¦; | ;,,,., inrJe J, il dvi r, can a i ••. • ; bo (in,!oyi'd which is in ; ; ; ¦ p is>«e.ssion of but one m !y prop rty aJ.-iptotl i ' n^ct living animnl JSSUm; t : , y-': IsO in <'.-• t:fi!i o'l V!r Ct. HoW 0 ( ?:,;; ie th ir action to tho prodti tion of a K -, n r | ¦ i?' !•', wh n they are posa (saed of proi B | o produce ot!i r effects— i--*. not unfre,,....,,.,.,. .j m-itterof fflieh trial tothi physician. V| rs , f.| C ta aro addirional cvi lenc •of the cul,,,',!¦ n»s of nny n11 " wll °- nnacqnaintad whh r, .m my circu n<tan :'«: '« Lo ba considered, in detcrmuiing the nla.ion i-f medicines to a diseased .i 'tion, n jvertbsl jhs, a Iminister withou i profisoiionai advice, aetiv ¦ th (rapeutic agents. r l". ; > sub«t:>n s¦- poisessfld of th ¦ astringent pro? er,y,nndwlil3hßr9bMta<wpteJtoUiopiir. p .»»Hof thaphyxi ianin treating the first stng.e rvf dhnlsra are rlu-übarb und opuim. Oiliers, 1 , Chnlk, in-1 Kin^i ' • ::ri n " t>f ! ' ! ' r ! " :; '' ' l, BYe been n*ed. But rheul Rrb n I opium, as ,•,.. m-tii inal ngn.nt*,«nd frawJotn from impr< - , r (| iet , w itli pprfccl <••: nl n;ind and body, W l|j p mrally bo f.vinJ *:i. f ficiatU-to check the preliminnrj 'diarrhea, nnd pat a stop to the approach of [ha more fonnikble nymptomsofth rem..inin 3 stages of the di.caw. The best j-,. ; ,,,, C |" tho rbcuburb, are toe aromatized T j |flurt or Syrup, of ihef Dispensatory ;~the oneor the* nUior, as indicated by circumstances wh'.ch will by nppre^iuted "by tha practitioner in ?,:... v¦ , ¦ bst form ol the opium is ¦ \y < nlled L.aur. ; .¦..,-¦,,• i sion nrvnde 

that is desired;— and not the impression of tho rheubart), which effects purgation; or of the opium which effects evidenl stimulation, sub* -I rniion oi pain, or unnatural nervoua mani('.¦ itrtiinii-, and reluxation of secretory vessel*. The astringcncy of Rlieu'onrb is exerted moat certainly when tho substntvifl \» admini *t< n d in small quantities, larger doae iof tho medicine will produce pur jntion, which efibct la ordinarily follow 'd by evidences of an aatring nt in;],,. ?(•. .. Bui in ilie di irrhea of Chok'ra, the purgative action of any medicinal agent is nn-11 sees r;y. ami therefore, t li i Binulli r <!<.s(s of tho V.'i 'übaib arc sufficient lotho attainmeril of the i 11 1 fn vii w,— the cure of tho diarrhea. And Die s»ina U true of opium. In very small doses the firs! cvi.-lent pffVt is that ofastringi n,..-. i n ?.,:. :s y a lar«rpr,bui still comparatively small, opium produces BHtringency, with evi,l . n ,-, s of a stimulating inflnenco, as observed in i ;¦;:•¦ of froqu ney of pululiun, and :,.. |or quicki ned nn-ntnl a-:lion. But if g yen iii doses relaiivcly large, or if tlio small dosca bj? continued for a greater or less length of timevand rep atedly,.atvd rapidly od.:: ;1 i-tnc], tne etfecta wUlbo a leusning of n >rvoua energy, relaxation of tho vi ¦-¦!- and tissues of the orgariization, and a decrease in the ir ••;¦:¦ ncy und force of tho pulsations. Tha smaller dosea of opium will be sufficient to tho attainment ol the end in vii w,— tho cure of the diunh i. But the astringent effoct will be, Smost probably, produced by the odminUtni. tion of the two Dg< nt» iv c( mliination. Thun a ; a spoon rul of tho Rheubatb preparation, ?;;;, fi Y e dmpa of Laudanum, adminifitered every four six, or eight hours, accordii g to the I urgency of tho liarrheo lor remedial ogenis. Dut the 111 1 lient must be made aware of ihe fact that even in the first stage of Cholera, W.r. r.c-tion of tho opium must be watched and its use ji r , nlifloed soon ns it evidently affects the nervona systt-.n. For very soon after it« benumbing or deadening influf-nce is experienced by tiie ii irvous syati m, if continued, the relaxinsriffcct will I MnanifVst d, and probably tho 



of Opii '¦'-'<' ii <¦''¦ r\i'-'. <vin to tin' r.v nt o l . t , ;i •¦• '? .i. ¦\ i: pri '' ; ('ing the mark( v \ • M> , ff , • 1)0 [he 8i bstonce. Bomi limes Calomel will 1"" hce usary to the efficiency ol the mi dication Gr»l prescrib ii lor the firsl stape. Th >re ore olh it aatrin ¦ i rii'es not innnnropriate lo th E tsi ( '• I m, as has lt'ti ppin*irkcd before Thov Rcem, ho vvi ver, ;¦ . ii ( nsid )• d as of ' nt - icon !ury ¦ -.| v r ¦ '-.;¦ Ito the ' n i r. quisite 10 , ¦, ¦ ! ii'^i.i' p» ou uc t ion vi wii*i~ tring nt i ff ¦¦ t. I'h ¦ c tul rule has reference loan impres- Bion, ¦>¦ ' eh ¦'•'.' ts t uch mi lion of live cm u!,-,.i: :i .r ;¦ [d, ns i <¦;¦• osed to the t.i ndi Bey givi n i ,; ;] ;,] by the impres^ou \\!.i. h tiiecholeraic Administer ßul»tancca which v.-i!l catme by bb ibey make, tt geuerul distribution of In Cholera , the tendency of the blood is to certain free surfaces; and as is tlint tend -r\ •;¦, o supply lo othe.r parts of the economy i-.: ¦ ary to their renewal, and to the m;iinteni n c ol the vitality of the whole organization. It, therefore, an ngeni can I"" 1 obtained which will era:.-::' a gi ti( ral distributii n of th ¦ circulating fluid, d •¦ nd< ncy of the fluid lo particular parts will be overcome, the tissw b will b ¦ n n wed, nnd the vitality of the whole organization i 1i 1 re served. This rule, though it mny sometimes bo very ndViintflgcouHly op| iicd to the treatment (i f the firbt Btßge, is more particularly njpropriate to the treatment of th ¦ Becond and third stages of Cholera. Ordinarily, in the first stage the tendency of the fluid to the stomach nn.l bow* Is is so mild, as to be resisted by the condition • . -rt 

opposi I to t hii t manifosMCu inroiigni :ourseofihcd;teji>c. Ami in the th rd tage.ihia opposing direction •r t« ndoncy, wliicii <ii ¦ ' s :i supply of bloo ! lo the whole organiz ition, i^ t i- < tnl i-h iho functional i: ( ions of its several parts, which hnvi tx en interfi n,l with, i r sn ftp d for the time being, by iho absence of the circulating fluU. The substances which, are best a Inpted Jptlio purpose* i f the pro ititionerin trei ling the « ¦ond and third stHges ol ( 'bolera, in necordunco with the >'¦( on ! ml ¦. are the m Tcurinls, The m rcnrinrls nre nil caps We in d'\. renl (JporcoH, •!' prorln ing the same ultimate effects on Iho human i c.a lomy. And this being Iru •, it U legitimate to ¦¦ i ¦¦ . the i hams ol cause .'tt!'l effects, h adiug to the same ultimate results, aro assimilated. Bui though tho mcrcurinl.s ii common, produce th ¦ >:•. ru ;&gt; ultimate pff! cts, tli ¦ fmpressions made by the various preparations differ, nnd in accordance whh-thal tiiffrr nee U the diffrrehee in degree, bul probably not i kind, of the inti rm 'diate effects. Thus, of iho most ai live of the preparations of this mineral, Mercurial, or Blu ¦ Pill is tho mildest, Calomel is the next l.ighcsi in the ncale,and Corrosive Stiblirnai • h jot high »r; — but they ; i!l sev (rally, cause nn increase of glandular action, am! will if continm d long i Rough, sooner or lal< r, 9ali« vate, and it is most probable that iho samo 11-fects are proilucc'd by tliem all, preceding 1 1 1 : » proUuclion of salivation. Such is the nut u re of the impression made by Corroaivo SublU mate, that it can not be employed, in cli seises which require th ¦ remedial eff cts produced by mercury, to be suddenly evidenced. ItisPO rapid ii>. their pnxiuction, that irreparable injury result*. The Blue Pill, can noi be used in the same class of coses, because its efl sets i'o not follow its administration with sufficient promptness, to prcv< nt tho disi a.-^i il action from '..¦., ? ¦ • • !,! • Pi t' lo I ; ¦ ¦¦ 





26 

i* especially adapted to the treatment of such diseases as require quick mercurial remedial Tli' 1 first effect from an efficient iiipresMon mnde by Calomel, is an equalization nf the circulation, which consists in the blood being distributed ti> many surfaces at the. same time, in larger quantities than common. In the language of CtilK'ii, "Mercury is a stimulant to every sensible and moving fibre of the body.* — \ By some, the remedial effects of an efficient impression made by Calomel, has been confin- I ed to the production of increased secretion. simply ; — and that it is manifested more posi- Uvely by the larger glands. Those who have observed disease subdued by the action of this Sampson of the Materia Mediea, have seen the J first obvious indicator), of its remedial energy, in the increased discharge of bilious matters j from the bowels. Bat always, close observation will discover, that so soon as, if not before, the influence of the mercury upon the liver is evidenced, there will be increased discharges of sahva, — (not the effect of mercurial ptyallam, — freedom of the breath from the want of 1 moisture before manifest, — a natural softness | of the surface, before absent, — and indeed a marked tendency of all the normal functions of the borly to take the place of unnatural and dis- ! eased conditions. This being some times observ- ' ed before the influence of the mercury is evidenced by the bilious character of the alvine discharges, is sufficient proof that they are from the direct influence of the agent, and not sec- 1 ondary to the influence experienced by the ! liver. It is evident that the secretion from an : organ, would be increased, in proportion to the J increase of the supply of the materials entering into the formation of the secretion. And an agent which effects an equalization of the j circulation, manifestly can not arTect the relations of quantity demanded by larger and i smaller glands ; — if so, the equalization does! not prevail. Hence probably the reason why j the liver of all the secreting organs, is the first pbscrved to give evidence of the reception by 

i *izc, — ordinarily weighing ihree or (our p'nintls, | — and the nature of iU (like, — being one of ibe most extennivp depurating channria of the i econony,and miniatered toby many and large • vfssfls, furnishing the dements of its secre¦ t ion t t — sufficiently show to un ihe reaw n, why tlie i impression of an agent which proporlionubly ¦ aliects all scenting surfaces, more obviously < | affects the liver. It is true, :is before affirmed, • that as ftr aj can be observed, when an individual Ins been efficiently impressed by a mer! curia], every exhaling and secreting vessel of ', his economy i is in tlic more active cii. -charge of its appropriate office. There mu>t then ! be furnished them at the same time, a larger I amount of blood ;-r for no oilier .-ource than ! the blood has been proposed for furnishing the materials from which the elaborating ','iieryy nf ] organs form their socreiions. These proposi; tions ore therefore sustained : — An increase of secretion necessarily involves an increased 1 supply of blood to the secreting vessels, withlin a givon time. And all the seer tions being : increased at the same time, involves an increns-1 ed supply of blood to the vessels concerned, at i the same time. And these being the effects proceding from an efficient impression (if Calomel, it is obvious, that a tendency of the blood i to particular surfaces, would be destroyed by such an impression, and the results consequent , upon the prevalence of such a diseased tendency wholly and radically prevented. And . these being the effects of an efficient impression I of Calomel, it is obvious, that if such an im! pression can be made, when the results of the ¦ tendency of the blood to particular surfaces are j observed, the results will be removed, the tendency prevented from again cau.-.ing them, and the sick man restored to life, and measurably j to health. Calomel then is the most powerful ngent which the practitioner can employ against the ! vigor of the second, and the efii-cts of that vigor j as observed in the manifestations, of the third ! stage of Cholera. But it is the impression of I the agent, which i fleets a Genera! iliiiributiou 



of tho circulation, that is solicited. If carried beyond Chin, it inilur.es oilier conditions, which nre truly dangerous in a patient ju»t out of the most alarming manifestations. ol cholera. \\ Ik n speaking of Opium it was n marked that its peculiar n»tringeni effect was all that would prove valuable t<> pracdiioneM in the treatment of Cholera; and beyond that, its narcotic effect, with the ii i exsarily attendant relaxation, would bo pernicious. So with Calomel, — its peculiar stimulating energy, which, when the drug is properly administered, is the h'rst exerted, is all that can he beneficially employed against the peculiar features of Cholera. Beyond that. it.< action will be pernicious, — particularly p'Tiiicious. Mercury is employed ogaUt inflamma* tory action, for the purpose of destroying, to some extent, the protelue elements of tlie blood-which sustain the inflammatory action. A person extensively under tho peculiar ultimate effect of mercury, is pale, — bleached, — because of an extens've absence fiotn the blood of proteino elements. The destruction of these elements is an effbet usually following increased glandular action, produced by the morcuty; — and cannot fail to retard, if not prevent, the attainment of health, by individuals who Imve reacted fromi collapsed state, that was produced fro'n a want by the organs of the pabulum of j their vital manifestations. How far this mercu- j rial influence has acted in producing the secon- j dary fever of Cholera, 1 leave for others to an- : swer, who hive seen so many die in this stage of the disease. The adaptability of Calomel to the treatmert cf Cholera is not sustained l»y reasoning alone, but has been extensively tested in practice. It has always entered largely into the prescrip- j lions made by the practitioners of India; and I the great majority in England give it their con- ' fi.lencejand in tho (Jailed States, no physician has been eminently successful in treating the disease who did not use Calomel. Thus, see the prescription of Doctor Cartwright of Natch- Ks., published by Sec. Walker; — of Prof. ' published in the Memphis Herald; and | t. McCormack, of the U. S. A.,— pul- | 

] : lished in t!ic Nashville Whig. Trur, those all i ' had other substances in cotnbinatiuu with the d Calomel; — bin if the positions defend ;i in these 1 1 letters be sustained, the narcotics when us^d, - were beneficial only, wh> v n Jmidi -.(•• rtd to but 9 a limited extent;- -and ii • probability is, ihe-Calf nm 1 would have produced all tlit* good pfflcts , ilon**, thai were consequent on its administra* 1 lion in combination. It is som.-what strange, r that for the most part, those forming these com* i j binationa, and u*ing thorn advantageously, have I i ascribed the principal ben. ficial agency to the > I substances, no odds what they were., which 1 were in combination with the Cnlomsl; — {jiving • to the Calomel the influence of a mere adjuvant. ¦ , Two instances will serve to illustrate. Dr. i McCor naek, in concluding his letter to the - Nashville Whig, particularly culls attention to • tho fact that Opium rntered extensively into his > ' prescriptions; and given it pre-eminent remedial > j value. Ford, a British practitioner, communi• ' eating to the London lancet, tho successful 1 '¦ use of Calomel, and Capsicum, or pepper, says, I ¦ -'The calomel, &c , were doubtless useful ad.! juiicts, but as there was no brandy or opium used . | in the treatment of them, it is but fair tonscribe i | to the cap«i>;um great power in restoring the I I circulation to ttie extreme vessels." Others fj have combined calomel and camphor, and give • j the latter the confidence, which is in lact meritjed by tlie former. These substances may at the • i discretion of the practitioner be combined with the calomel, — but judgment is necessi ry to decide, how far they shall be carried. If the nar. colic influence be induced, the already tot) great , relaxation is enhanced; — and if the stimulants make an impression, it is to the production of 'complete exhaustion of the heart's capacity to lac«, already greatly lessened by the absence of the blood, which is necessary to the existence of that capacity, as well as to its manifestation. There is no doubt but that these effects have been produced by such combinations; — nnd it is, therefore, a legitimate inference that greater ' mortality from Cholera lias attended the practice I of those who, using calomel, confided in the | remedial agency of oth( r substances with which 

' 





28 

. stut'ined as the main therapeutic m ian?,rHthpr than as a simple adjuvant,— an Hgeet of but •«cou lary an ! non-cssoßtia) importattce. The quaniity of Calomel wUich is proper, U a matter for tV discretion of the attentiing prncthi »ner. GoneraHy, daring the bi cmJ Xl ige, a dfls ¦ relativ sly largp^ according to the y -winy of the purging, vo nhiiig, an I en mp — repeated as circumstances m iy direct, — wi I ba found sum" -I nt to the subjugation of these Hymptoms. If, however, two or ihree do« ¦¦ ftiil, the adminittration of tho drug iv smaller duses should be com in 'need. Why very small and frequently repeated doses of in 'du-ino should produce more positively b indicia] results, than larger <lo.*i s, under some circuniHiances, I am nnablo to decide. — Au hypothesis might b? advanced, but at rcsenttha fact is all that is necessary. Doct Jos. Ayre, of Hull, England, in the introductory remarks of his communication to the London Lancet for February, IS 19, says : '• .rustin",as I implicitly did, to the powar of c ilom •! to romo/o the si ige of col laps \ I foreb ir ¦ n - ing all collat iral or auxiliary m *ans, and 1 did . ¦a from a full consideration of th ¦ valu ¦ of preserving my cone! u lons from th ¦ ontangl m 'nl of those errors which result from a mixture of means. Calomel, therefore, in tho minute doses of one or Uoa grains, giesn evry j'vor' ten minutes, was my sole rein dy in the stn : • ol collapse." Doctor Ayre occasionally added one ; or two drops of laudanum, which serv I to I cause a retention >ftho first dosos of caloinol. Even that small quantity of the narcotic was soon discontinued. Tho success attending this mode of "treating the collapse of Cholera, was truly pleasing. Out of 219 >uch patients, 180 perfectly recovered, and 39 died. Of tho latter, i 122 were son ar dead, when first seen by the Doctor, as to rond ir ill- 1 administration of m idicine, out of the question ; and yet by the rules of the board of II ittlth, tiny wera required to be number* d amongst tin 1 cases ol Dr. Ayr, 1 . — And there were sufficient reasons to account 

without at oil d trading from the o'.W :icnt cv pacity of the Calomel, -evidenced by tin 1 18i cured, when the medicine was administered L, Doctor Ay re. But r gari!in<xthe dose of the sub ;:i-r <\ nm its in )Igol n [mini <traiion, it ; r'.s already '¦¦¦ c saii!, th? practitioner, who is presumed to 1> acquainted with the nuturo of diseased innni fe&taiions, as well as with tho ndaptabilit o f tho ngont ha employs against them,— mv.it exorcise hi* discretion. And the remark of Ricord are us appropriate ju.nl hero, as the are to tho conn iclion, in whLh they were or ghially mad*. " Sorno people are very casil brought under the influence of m rcury, whil channel-it may be introJticed into tho system. ft * * * * ~f * Tin doses are slricily reUlivs — tho susc iptibiliiy of in livi laala sh >uld bo studied, and tho amount of mercury regulaalwnys h-jin with n doso which ia not likoly — [having du3 reference to th s aaturo an 1 a >v tity of diseased manifestation*]— to proJuca any unpleasant effji t." Th iso positions b iing correct, it U evident that some cases ol cholera collapse, will not ba rolieva 1 by calofraotory to it," and with othord ill- 1 dose will nst be relatively correct The third rule hns roforeneo to external ing; an impression on tho vosaaU of the sur face, the 11 >w of the (hi U of th ¦ boJy is mv ted tothem,andin Cliolara, it' this i:npreasio bo effective, tho tcnJensy of tho blood to it ternal organs will bo prevented or ovorcom and the diseased manifestations consequent o such atondency p irfectly do truyed. The m sans used to tnak i the necessary in pression are various; — liff.-retit substances,-and variously combined, — capable of irritatii the surfuc •• or aoimpressing its vessels, us 1 give the tendency of fluid towards them. Of these substances, mustard, blister-flios, ammoniaand Spts. of Turpentine aro probably 



29 

the most energetic. Heati nooilds now .pp is an agent belonging to this rule ; and in accordance with it, ia bleeding indicated, if bleeding i 9 ever proper after the earliest evidences oi an attnek of Cholera. With these agents properly applied, with a strict observance oT the rules laid down to govern in attempts to till the one grnnd iudicttJon which presents for treatment, every rase of Cholera that can be relieved, will be made to terminate favorably. And until the unwise search after a specific agent, or an infl xible plan of medication, with which to oppose Cholera, is abandoned, and the ordinary method of treating disease, a rational empiricism I" 1 observed. — will the mortality fi om the pet»tilence be undiroinish 1 <J. The names of many individuals might be introduced here, to support the efficiency of tho therapeutic measures which are ad via !, but a few will suilk'c. Prof. Cross, gives his confidence to Calouvl. though generally he combines it with oilier substances. Doctor Searle. formerly cf the Madras establishment, E. I. Co. "s service, who claims to have "had as much it not more, experience ill the treatment of this di-ease, than any other individual in the [British] kingdom," uses the following language :—": — " If any single remedy merits the name of specific in th 1 ' cure of disease, calomel is tho remedy in Cholern , judiciously employed — that is, early employed anJ in doses comen 'usurate with the urgency of the symptoms — a fact which is well attested by the experience of Ayre of Hull. It will be a-ikod — how is it. then, that this remedy, which has been employed from the earii isto icurri nee of the epidemic in India, has not acquired that confidence which I would repose in it ? For this good and sufficient reason — that, when given, it has been the constent practice to annul or supersede iti iniwn-e by the conjoint administration of a large dose of opium." Prof. Eve, of GeOi, many years ago, gave dcr our third rule, and presented observations 

few who rely on iheii alono;— they generally aseagentH under cur second ami third rules, concomitnntly. Thus, Doctor Cariwright, (excepting tho combine] stiostances) gave calomel, and at the *amo lim ¦ u*cd trillion, and a stimulating unction to ihe sun.. ¦¦¦•. l»ul the treatment pursued in the military hospital at Krasuc-Sclo, Pour m lea f'n >vi Si. Petersburg, where 79J000 men were assembled, ia in>r.j ia pomt ;— the og nts used mv! r our third nil •, being in wt confi lot! in. "Al nil ihe oiher hospitals the mortality averaged between 3') nnd tjo !>¦ rcent., ai this hospital, out ol 1 3J ttten c uses occurring from the* 10th of July to the Uih of August, onlj I4sd*ed,ornttho nite ol 03.5 p ( ,- cent. So »oon nso patient waa in the Al,ij,'i< -:,r.'i>. Yl ruppiii! ''' were placed aloii ¦ i!i" -: i.i : in 1 ly wrw strongly^ rubbed with n uiixiiir." 1 of ] id d ice and sail ; ?. ? r ,.;: ie( to ¦¦¦ ¦ pnrt --^ ih< n the pnti nt wm envi loped in «o< lien r< v< riri|r»*, and drnnk every hour a glassof water, with fromono to two lea-sponnsful of ro •!; -tilt dissolved inji ; — and according to circumstances, in addition calomel wasgiven with or without camphor. — If, after these measures, warmth did not return in from oneni d a hall to two hours, the frictions w 'iT 1 repeated — once or twice, "rncrnlU sufficed, but occasionally they were repeated Jhrec or four timw. In conclusion, I thank yon, gentlemen, for the use you have permitted nr*, o1o 1 your col* mnen , — and 1 Mnceroly trust that f have not wholly failed in tin- attainment of tlio result for which I have labored. At the lima theaa letters wtre commenced, the newspapers wi>re teeming with recipo for the euro ol Cholera ; and the Nashville Press, in particular, wen; (jiving issue to a treatment i>f the diseaw, which, in all honesty, I felt sure would prove a*full\ inefficient, if no! positively injurious. -- Those frequent appearances of discordant rc(•oiiiriiriiilution-, wore not only calculate.! to, but actually did, engender an unwonted want of confidence on tip.' part of the people, in J their medical advisors ; and often was ilia 



28 

it was c(mii, in id, ilia n it tho caloni i lia I u.eii it vntm mcd as the muiu thefajwutic m janß, rather « than at tf simple adjuvant,~an ngeet ol' but p secouJary :iI) ! uon-esseHtial importaaee. The quantity of Calomel wWch is proper, U a matter fur tho discretion of the attending . ( praoHiinner. Generally, daring the second g k| ige, a d«*»e relatively largr, according to the n ity of iho pnrging, voiniiiiig, and cramp. repeated as circumstances m-»y direct, — will v h? found suffici 'tit to the sulyujfation of these | symptoms. It, howevßTi two or three doses ( t'.il ihe admini'itra ion of the drug iii smaller . dosi 9 uhi >ul i b c Ic l 'in;;i 'need. Why very small and frequently repeated i!'j-es uf medicine should produce more poai- i lively b mcficial results, than larger 'loses, under < some circumstances, I am enable to decide. — An hypothesis m.ight ba advanced, but at pres- ' cm tho fact is all that is necessary. Duct Jos. > I Ayre, of Hull, England, in the introductory 1 remarks of his communication to the London ; Lancet Tor February, 18 19. says : '• 'rus!- , ing,as I implicitly did, to th i pow3r of calora •'. to rom >.-¦ the stage of collapse, I forebore ns- ' ins all collateral or auxiliary m«ans, and I did i bo from a full sojwideraiidn of the valueofpre- Bervins my conclusions from tho entanglement of those errors which result from a mixture of means Calomel, therefore, in the minute doses of one or ttoo grains, givsn cv ry fv> or ten minutes, vm mysok rcm dy in the singe ol I collapse." Doctor Ayre occasionally added one or two drops of laudanum, which served to i cause a retention of the first dosos of calomel. Even that small quantity of the narcotic was soon discontinued. Tho success attending this mode of'treating tho collapse of Cholera, was truly pleasing. Out of 219 *nc!i patients, 180 perfectly recoverod, and 39 died. Of the latter, j •J. 2 were so n ar d »ad, when first seen by the | Doctor, ait) rond ir thj administration of medicine, out of the question ; and yet by the rules n( tha hnnrA of ll>altii tluv were renuired to 

without at a'l J strueting from tne Bill iieni < ••- cured, when the medicine was administered Ly Doctor Ayre. But t gardiwjthe do»eof the sutwtanrc, nnd its modeol admini-itruiion, it bus nlrcady been said, the proctiiioncr, who h presum ¦(! to be ucqu.iinlcJ with the naturo of diseased manifestations, as well as with tha ndaptabP.ity o f til.- ;:.: tnl h • employs against tlr.m,— mv.it exercise Ills discretion. And the remark* vi' Ricord are an appropriate just hero, as they are to tho conn iction, in whbh they were originally mad«. " Some people are very easily bruu«'hl under th i infl I mcc of in rcary, whilst others arc quite refractory to i: by whai ver channel -it may be introduced Into tho system. ******* Tin doses are strictly relitios ths susceptibility ofinJivi laala should be stu I'red, and tho amount of mercury regulated thereby. * * * * "''' * s '" ni '^ always bsgin with n dose which ia not likely — [having dua reference to th) aaturo an 111 1 v »r-ity of dUoasoJ manifestations]— to proJuce > any unpleasant effect." These positions being correct, it U evident that some cases ol chol[era collapse, will not be relieved by calomel • because som3 individuals will ba "re; fnictory to it," and with Othora tho close will n«l ! be relatively correct. 1 The third rule has roforenco to external I m -dicalion, and fuUy explains itself. By making an impression on tho veaaela of the sur\ face, the flow or the fluid- of th i boJy U invited to ihem, and in CUolara, if this i:npre«sion be effective, tho tcoJensy <>! tho blood to internal organs will bo prevented or overcome, ' and the diseaa3d manifestations conset|'»ont on '; such a tendency p srfectly destroyed. , I The means used to mak i the necessary im¦ | pression are various ; — diffjrerjt substance*,— ¦ and variously combined, — capable of irritating s the surface, or so impressing its vessels, as to ) ' n-ive the tendency of fluid towards them. Ot 1 , [is ? er .fli > a atn« 



29 

is an agent belonging to this rule \ and in accor- j dance "with it, is bleeding indicated, If bleeding 13 ever proper after the earliest evidences of an attack of Cholera. With these agents properly applied, with a strict observance of the rules laid down to govern in attempts to fill the one grand iiidicttion which presents for treatment, every case of Cholera, that can be relieved, will be made to terminate favorably. And nntil the unwise search after a specific agent, or an infl xible plan of medication, with which to oppose Cholera, is abandoned, and tin; ordinary method of treating disease, — a rational empiricism be observed. — will the mortality f»om the peaiilence be undiminUh' d. The nam?s of many individuals might be introdnced here, to support tho efficiency of the therapeutic measures winch are advis d, bir, • few will suffice. Prof. Cross, gives his confidence to Calonvl. though generally he combines it with other substances. Doctor Searle. formerly of the Madras establishment, E. I. Co. "s service, who claims to have " bad as much it not more, experience in the treatment of this disease, than any other individual in the [Bri'.iah] kingdom," uses the following language :: — M If any single remedy merits tho name of specific, in the cure of disease, calomel i-* tho remedy in Cholera , judicious!) employed — that is, early employed and in doses commensurate with the urgency of the symptoms — a fact which is well attested by the experience of Ayre ol Hull. It will be aslipj — how is it, then, that this remedy, which has been employed from ihe earliest occurrence of the epidemic in India, has not acquired that confidence which I would repose in it ? For this good and sufficient reason — that, when given, it has been the constant practice to annul or supersede its influence by the conjoint administration of a large dose of opium." Prof. Eve, of Gco., many years ago, gave his preferenco to the employ ment of agents under our third rule, and presented observations 

few who rely on then alono;— they generally use agents under cur second and third rules, concomitnntly. Thus, Doctor Cariwrioht, (excepting tho combine I Buoaiances) gave eal(»mc!, and at the hams time uned rricjion, and a stimulating unctinn to the sun': ¦¦>. Hut tlic treatment pursued in tho military hcwpftal at Krasuo-Soloj four tmlea from Si. Petersburg 1 , where 7i».ooo men were assembled, is more id point;— the ng ins used under our third rule, being m»t confi led in. "Al all the other luwpitalx the mortality averaged between s'> nnd Go per cent., at ;his hospital, out ol -132 severe cusea occurring from th ¦ lOtli of July to tin- 1 ltfa of August, only 145 dted.orat iho rate of 33.5 per cent. S*-<> »oun sso patient wasjn the Algride Mage, 12 cappiii) '• s were ptactd along the spin ; in ¦¦ ivl ly wa« strongly » rubbed with n mixture ol , : • ! ice and salt j (two parts ici to one part pah) lh( n the pntii nt mv enveloped in noollen covi ring**, and drank every hour a glass of water, with from one to two tea-spoonsful of rock salt dissolved mii ;—; — and according to circumstances, in addition calomel vrasgiven with or without camphor. — If, after these mennareji, wfirmih did noi return in from oneai d a hall to two hours, the frictions wryw <rv repeated — once or twice, generally sufficed, but occasionally they were repeated three or four times." In conclusion, I thank you, gentlemen, for the use you have permitted me, o1o 1 your colume» j— -and I sincerely trust that I have not wholly failed in tin- attainment of tho result for which I have labored. At the time those letters were commenced, the newspapers were teeming with r (cipjn for the cur.) ol Cholera ; and the Nashville Press, in particular, were »ii \" i n r jf is>uo to a treatment of tho disease, which, in all hot). -sty. I felt sure would prove utffulU inefficient, if not positively injurious.— Those frequent appearances of discordant recommendation*, wore not only calculated to, but actually did, engender an unwonted want of confidence on the part of ihe people, in I their medical advisors ; and often was ihe 

<,1, 1 



pliv^Jf inn romp< lied to submit with clinjrrin to | tn- sii.' ritii r mirk that Doctor* kii"W nothin^ alioin ("hoi m Tliia could not ht; coinbatnd. liecituitc iv ill • opinion of s ¦•M'-snilicieni wi vioin. ti> know tli ¦ n ii ure i»f a i!iseas'\ is 10 b»ablH tor tire it. NotwitliMtanditi^ thry iliily rfithzt' the t:ici, tnai d«ath mii-t need 1 * occur, ihes vci take iiie re^ponMibility from he (hit to ! w'lich it belong* and <¦< iisiire iheir mcdi.a! ad* ' viHorx with want ol Wierjfy and of know'edgp t ati I a. th • sain ' lim ' l> wtow all confidence in iheparciitl iw rocuinni iid.nions sent o'lt by tfw weekly pro**, or in thi' h.isty conclu*ionn <>f some over-nin'iitious practilioiv r, who renidi v they km>w ma wh re. in view of these ihingK, 1 tell disposed to place before ih;'m the faci> which they now have in t.ieir ])Oo*csisioiJ, with 

thr hop"* th»l t?if«y wotiU «cs tint prijMciantf do noi an wi I ly dUagr ¦", nmw 't'iMan'Hnsf the fir qu> ni hypothetical Miffsjrsiioiis wlii 'h are beiiiji n ml*' hy iiK-.ii ;t! m >n, a» retiar.ls th" na- 1 Hire of Choi ra. It is a f.icl, that do odds how evid< nt to ihe sen «•¦ or 10 roa*on, a point inny be, iliitc are yet t!lo^e \v'io will try 10 <!i-i<nt, niter or abrogate it. With the>e I have not ronsulit (I. Th* nam 'h rpf rnnl to in ntti mpting to HtiMa'n any Important point rt'latingto Ihe inn ii re or tr^nimc/it nf Cholera, are the niim s of nr n, whoio int^ll 'cm il cipacity is pvidenced by the p'oduciionH of th- ir pc«n, and whoso prcifew*iunul Kianding is vouched for l»y the editors of the joii nsU noi icing th ir work-s, or hy the po»i ion-, which they aro called iv till by their governtnenti*. 







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