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                                  THE
                           CHOLERA GAZETTE.

       VOL. I.      _WEDNESDAY, AUGUST 1st, 1832._      No. 4.




_Injection of Saline Solutions into the Veins._


The following documents relative to the treatment of cholera by the
copious injection of a saline solution into the veins, communicated to
the Central Board of Health of Great Britain, are of so interesting
a character that we hasten to lay them before our readers; though we
are far from participating in the sanguine estimate of the curative
powers of the remedy, entertained by Drs. Lewins, Latta and others. The
measure has been resorted to in New York, and on the whole, with but
slender success, and the results of trials of it, in this city, so far
as we have been able to obtain authentic information, have not been
very encouraging. Some of the symptoms have been relieved, but we know
as yet of no cure effected by it.


No. 1.

    SIR,--I conceive it to be my duty to let you know, for the
    information of the Central Board of Health, that the great
    desideratum of restoring the natural current in the veins
    and arteries, of improving the colour of the blood, and
    recovering the functions of the lungs, in cholera asphyxia,
    may be accomplished by injecting a weak saline solution into
    the veins of the patient. To Dr. Thomas Latta, of this place,
    is due the merit of first having recourse to this practice.
    He has tried it in six cases, three of which I have seen, and
    assisted to treat. The most wonderful and satisfactory effect
    is the immediate consequence of the injection. To produce the
    effect referred to, a large quantity must be injected--from
    _five to ten pounds_ in an adult--and repeated at longer
    or shorter intervals, as the state of the pulse, and other
    symptoms, may indicate. Whenever the pulse fails, more fluid
    ought to be thrown in, to produce an effect upon it, without
    regard to quantity. In one of the cases I have referred to, 120
    _ounces_ were injected at once, and repeated to the amount of
    330 ounces in twelve hours. In another, 376 ounces were thrown
    into the veins between Sunday, at 11 o’clock, A. M., and this
    day (Tuesday) at 4 P. M.; that is, in the course of 53 hours,
    upwards of 31 pounds!

    The solution that was used consisted of two drachms of muriate,
    and two scruples of carbonate, of soda, to sixty ounces of
    water. It was at the temperature of 108 or 110 degrees.

    The apparatus employed in injecting was merely one of Reid’s
    common syringes, (the fluid being put into a vessel rather deep
    and narrow,) with a small pipe fitted, that it might easily be
    introduced into an incision in the veins of the usual size that
    is made in bleeding. It may, however, be well to keep in mind,
    that, in the event of the operation being frequently repeated,
    it may be adviseable to inject by different veins.

    I forbear at present to enter further into the particulars;
    nor have we had sufficient experience to speak decisively on
    the subject. I may, however, mention, that the idea of having
    recourse to this remedy in cholera, occurred to Dr. Latta,
    from being convinced, (which I am also,) that the evacuations
    upwards and downwards are in reality the serum of the blood;
    that it is the duty of the physician to replace it, as speedily
    as possible, by injecting a fluid, as similar to the serum as
    can be formed artificially, directly into the veins, which
    has been done here with wonderful, and, so far as we can yet
    judge, excellent effect. An immediate return of the pulse, an
    improvement in the respiration and in the voice, an evolution
    of heat, an improvement in the appearance of the patient, with
    a feeling of comfort, are the immediate effects. The quantity
    necessary to be injected will probably be found to depend upon
    the quantity of serum lost--the object of the practice being
    to place the patient in nearly his ordinary state, as to the
    quantity of blood circulating in the vessels.--I have, &c.

                               (Signed)

                                               ROBERT LEWINS, M. D.

    TO W. MACLEAN, Esq.
        _Secretary to the Central Board of Health._


No. 2.

    SIR,--I did myself the honour to address a letter to you
    lately, on the effects of injecting a saline solution into
    the veins of a patient labouring under cholera. We have not
    frequent opportunities of trying this, which I denominate,
    admirable remedy, as the disease is decidedly less frequent
    here; but I have seen it employed in two other cases, in the
    course of the last two days, with the same excellent effect.
    Sixty ounces are generally thrown in at once, and repeated
    at the end of three or four hours. In a case to-day, where
    I saw fifty-eight ounces injected, (being the third time
    of performing the operation,) the patient’s pulse, at the
    commencement, was 180, very small, and very feeble. She was
    excessively restless, with a feeling of great weakness and
    tormenting thirst. Before twelve ounces were injected, the
    pulse began to improve; it became fuller and slower, and it
    continued to improve until, after 58 ounces had been injected,
    it was down to 110. Before I left the patient, (a woman,)
    her condition was altogether amazingly amended. There was a
    fine glow and a slight perspiration on her face; the veins
    on the back of her head were well filled; the restlessness
    was removed, the feeling of excessive weakness gone, and the
    thirst ceased. The pulse was under 100, free, full, and soft!
    Verily, sir, this is an astonishing method of medication, and I
    predict will lead to wonderful changes and improvements in the
    practice of medicine! I have addressed you upon the subject, as
    the organ, from your high official station, of disseminating
    a knowledge of the extraordinary facts referred to. It will,
    of course, give me great pleasure to enter further into
    particulars upon any particular point on which you may require
    information, in reference to the cases that have come under my
    observation.--I have, &c.

                               (Signed)

                                               ROBERT LEWINS, M. D.

    TO W. MACLEAN, ESQ. &c. &c.

    In the hands of a man of ordinary dexterity, the common
    injecting apparatus alluded to in my last will be found to
    answer the purpose perfectly well; but if the practice I
    recommend is, as I hope it will be, generally adopted, it will,
    I conceive, be expedient to advise that a regular and perfect
    transfusion apparatus be used; at all events, to warn those
    who inject to beware of allowing air to get into the vein. The
    tubes, of course, must be filled with fluid, as well as the
    pipe in the vein, before commencing, and considerably more
    fluid than it is intended to use ought to be in the vessel from
    which it is pumped.

                                                              R. L.


No. 3.

                                            _Leith, May 23d, 1832._

    Sir,--My friend, Dr. Lewins, has communicated to me your
    wish for a detailed account of my method of treating cholera
    by saline injection into the veins, with which I now most
    willingly comply. My scope for observation, since I commenced
    this treatment, has been too limited to allow me to be very
    copious on the subject, but I think I can adduce sufficient
    proof to the unprejudiced, not only of its safety, but of its
    unquestionable utility. I have never yet seen one bad symptom
    attributable to it, and I have no doubt that it will be found,
    when judiciously applied, to be one of the most powerful, and
    one of the safest remedies yet used in the second stage of
    cholera, or that hopeless state of collapse to which the system
    is reduced.

    Before entering into particulars, I beg leave to premise, that
    the plan which I have put in practice was suggested to me on
    reading in The Lancet, the review of Dr. O’Shaughnessy’s report
    on the chemical pathology of malignant cholera, by which it
    appears that in that disease there is a very great deficiency
    both of the water and saline matter of the blood. On which
    deficiency, the thick, black, cold state of the vital fluid
    depends, which evidently produces most of the distressing
    symptoms of that very fearful complaint, and is, doubtless,
    often the cause of death. In this opinion I am abundantly borne
    out by the phenomena produced on repletion by venous injection.

    So soon as I learnt the result of Dr. O’Shaughnessy’s analysis,
    I attempted to restore the blood to its natural state, by
    injecting copiously into the larger intestines, warm water,
    holding in solution the requisite salts, and also administered
    quantities from time to time by the mouth, trusting that the
    power of absorption might not be altogether lost; but by these
    means I produced, in no case, any permanent benefit; but, on
    the contrary, I thought the tormina, vomiting, and purging,
    were much aggravated thereby, to the further reduction of
    the little remaining strength of the patient; finding thus,
    that such, in common with all the ordinary means in use, was
    either useless or hurtful, I at length resolved to throw the
    fluid immediately into the circulation. In this, having no
    precedent to direct me, I proceeded with much caution. The
    first subject of experiment was an aged female, on whom all the
    usual remedies had been fully tried, without producing one
    good symptom; the disease, uninterrupted, holding steadily on
    its course. She had apparently reached the last moments of her
    earthly existence, and now nothing could injure her--indeed,
    so entirely was she reduced, that I feared I should be unable
    to get my apparatus ready ere she expired. Having inserted a
    tube into the basilic vein, cautiously--anxiously I watched the
    effects; ounce after ounce was injected, but no visible change
    was produced. Still persevering, I thought she began to breathe
    less laboriously; soon the sharpened features, and sunken eye,
    and fallen jaw, pale and cold, bearing the manifest impress of
    death’s signet, began to glow with returning animation; the
    pulse, which had long ceased, returned to the wrist; at first
    small and quick, by degrees it became more and more distinct,
    fuller, slower, and firmer, and in the short space of half
    an hour, when six pints had been injected, she expressed in
    a firm voice that she was free from all uneasiness, actually
    became jocular, and fancied all she needed was a little sleep;
    her extremities were warm, and every feature bore the aspect
    of comfort and health. This being my first case, I fancied my
    patient secure, and from my great need of a little repose, left
    her in charge of the hospital surgeon; but I had not been long
    gone, ere the vomiting and purging recurring, soon reduced her
    to her former state of debility. I was not apprised of the
    event, and she sunk in five and a half hours after I left her.
    As she had previously been of a sound constitution, I have no
    doubt the case would have issued in complete reaction, had the
    remedy, which had already produced such effect, been repeated.

    Not having by me the number of THE LANCET containing Dr.
    O’Shaughnessy’s analyses, I adopted that of Dr. Marcet, only
    allowing a smaller proportion of saline ingredients. This I now
    find to be considerably less than natural, according to the
    more recent analyses. I dissolved from two to three drachms
    of muriate of soda, and two scruples of the sub-carbonate of
    soda in six pints of water, and injected it at temperature 112°
    Fah. If the temperature is so low as a hundred, it produces an
    extreme sense of cold, with rigors; and if it reaches 115°, it
    suddenly excites the heart, the countenance becomes flushed,
    and the patient complains of great weakness. At first there
    is but little felt by the patient, and symptoms continue
    unaltered, until the blood, mingled with the injected liquid,
    becomes warm and fluid; the improvement in the pulse and
    countenance is almost simultaneous; the cadaverous expression
    gradually gives place to appearances of returning animation,
    the horrid oppression at the præcordia goes off, the sunken
    turned up eye, half covered by the palpebræ, becomes gradually
    fuller, till it sparkles with the brilliancy of health, the
    livid hue disappears, the warmth of the body returns, and
    it regains its natural colour--words are no more uttered in
    whispers, the voice first acquires its true cholera tone, and
    ultimately its wonted energy, and the poor patient, who but a
    few minutes before was oppressed with sickness, vomiting, and
    burning thirst, is suddenly relieved from every distressing
    symptom; blood now drawn exhibits on exposure to air its
    natural florid hue.

    Such symptoms, so gratifying both to the sick and the
    physician, must never allow the latter to relax in his
    care--the utmost vigilance is still necessary. At first the
    change is so great, that he may fancy all is accomplished, and
    leave his post for a while. The diarrhœa recurring, he may find
    his patient, after the lapse of two or three hours, as low as
    ever. As soon as reaction by the first injection is produced,
    mild warm stimulants, such as weak gin toddy, mixed with some
    astringent, should be freely and assiduously administered. An
    attempt should be made to fill the colon with some astringent
    fluid. That such is requisite, is evident from the watery
    diarrhœa returning with violence, and if not restrained, death
    will ultimately make sure of his victim, therefore, so soon
    as the pulse fails, and the features again shrink, the venous
    injection must be repeated, taking care that the fluid in use
    retains its proper temperature. The injection should be carried
    on very slowly, unless the patient is much exhausted, when it
    may be used more rapidly at first, until a little excitement
    is produced, after which it should not exceed two or three
    ounces per minute, and now is the time for the exhibition
    of astringents by the mouth, which will be retained; for in
    general the sickness entirely leaves during the operation.

    Such remedies must be persisted in; and repeated as symptoms
    demand, or until reaction is permanently established. I have
    witnessed no violent symptoms accompanying the rapid injection
    of the fluid; but I have thought that the hasty repletion of
    the system was followed by great increase of the evacuations,
    and, consequently, a more sudden depression of the powers
    of life. The quantity to be injected depends on the effect
    produced, and the repetition on the demands of the system,
    which generally vary according to the violence of the diarrhœa;
    the greater the degree of collapse, the greater will be the
    quantity needed, though not uniformly, for a very slight loss
    produces much depression in some systems; hence there is often
    great collapse, without much vomiting, purging, or cutaneous
    discharge.

    Although in every case, even the most desperate, the cholera
    symptoms were removed, some of my cases failed, which I
    attributed to one or other of the following causes--either the
    quantity injected was too small, or its effects were rendered
    abortive by extensive organic disease, or its application was
    too late.

    I have already given an instance where deficiency in quantity
    was the cause of failure, which I will now contrast with one in
    which it was used freely. A female, aged fifty, very destitute,
    but previously in good health, was on the 13th instant, at
    four A. M., seized with cholera in its most violent form, and
    by half-past nine was reduced to a most hopeless state. The
    pulse was quite gone, even in the axilla, and strength so much
    exhausted, that I had resolved not to try the effects of the
    injection, conceiving the poor woman’s case to be hopeless, and
    that the failure of the experiment might afford the prejudiced
    and the illiberal an opportunity to stigmatize the practice;
    however, I at length thought I would give her a chance, and in
    the presence of Drs. Lewins and Craigie, and Messrs. Sibson and
    Paterson, I injected one hundred and twenty ounces, when, like
    the effects of magic, instead of the pallid aspect of one whom
    death had sealed as his own, the vital tide was restored, and
    life and vivacity returned; but diarrhœa recurred, and in three
    hours she again sunk. One hundred and twenty ounces more were
    injected with the same good effect. In this case three hundred
    and thirty ounces were so used in twelve hours, when reaction
    was completely reëstablished; and in forty-eight hours she
    smoked her pipe free from distemper. She was then, for better
    accommodation, carried to the hospital, where probably, from
    contagion, slight typhoid symptoms were produced. She is now,
    however, convalescent.

    The second cause of want of success is the presence of organic
    disease; this, probably, renders the possessor very liable to
    attacks of cholera; and the latent evil, which previously gave
    but little uneasiness, suffers aggravation in all its symptoms,
    more especially after reaction has been produced, and has
    evidently, in many cases, been the cause of death. A delicate
    young female, of strumous habits, who had been for some years
    subject to pectoral complaints, was rescued from a state of
    collapse by the injection of sixty ounces of the saline fluid,
    administered in separate portions, within the space of twelve
    hours. After lingering for ten days she died; the heart was
    found in a state of atrophy, covered with strong evidence of
    the existence of ancient disease, and floating in eight ounces
    of pus. In another case every internal organ was diseased; some
    of them so much so, that it was astonishing the individual
    lived so long.

    The third case of the occasional want of success, is the late
    application of the remedy. Hitherto I have had opportunity
    of injecting only in extreme cases, after every other means
    had entirely failed, cases which apparently soon would have
    proved fatal. Here the obstacles to be overcome have been of
    no ordinary kind, notwithstanding the result of the practice
    is of the most encouraging nature, and the number of cases now
    convalescent or doing well highly gratifying. In every fatal
    case we have had an opportunity of examining, independent of
    organic disease, I have found a large quantity of fibrine in
    the cavities of the heart, especially on the right side, where
    it had extended from the auricle through the ventricle in the
    pulmonary artery. Such deposition must have formed a certain
    obstacle to recovery, and is, no doubt, from the interruption
    it gives to the pulmonary circulation, the cause of the
    heavings of the chest, and the inordinate action perceptible in
    the centre of circulation many hours before death. Now surely
    it is reasonable to suppose, that if this, the most simple of
    all remedies, were applied early, before the blood drained of
    its water has collected in the larger vessels, in fact before
    such fibrinous depositions have taken place in the cavities of
    the heart, is it not reasonable to suppose that such would be
    entirely prevented?

    But not only is early injection adviseable on this account,
    not only is stagnation of the blood prevented by it, and
    the laborious breathing, and the præcordial oppression, the
    intense sickness, the burning thirst, the extreme depression
    of the vital powers, and the chances of aggravating chronic
    disease, or of producing new organic lesion, in a great measure
    avoided: but it is rational to suppose that the consecutive
    fever will be rendered much milder, and that this is the case,
    is supported by my own experience, even though the remedy has
    not been applied earlier, indeed the fact is very evident.
    In an ordinary attack of cholera, much fluid is lost; and if
    the individual is so fortunate as to get out of the stage
    of collapse, if consecutive fever of typhoid type comes on,
    the system, left to its own resources to replace the lost
    serum, must be but ill fitted for the task, for the debility
    is extreme, absorption goes on slowly, the fever will be
    much aggravated by the irritation of internal congestion;
    local inflammation will thereby be produced, and the chance
    of recovery will be but small. Much of this evil is to be
    mitigated or entirely avoided by injection into the veins, of
    which circumstance I can adduce living instances; and where the
    patient, who had been injected, has sunk under organic disease,
    the usual marks of congestion are not perceptible.

    The apparatus I have used, is Reid’s patent syringe, having a
    small silver tube attached to the extremity of the flexible
    injecting tube. The syringe must be quite perfect, so as to
    avoid the risk of injecting air; the saline fluid should never
    be injected oftener than _once_ into the same orifice, and the
    vein should be treated with much delicacy to avoid phlebitis.
    The wound should be poulticed and carefully watched, if it does
    not heal by the first intention.

                I am, sir, your most obedient servant,

                                                THOMAS LATTA, M. D.

(To be continued.)




_Origin and Progress of Cholera at Albany._


The following report made by the medical staff of Albany to the
Board of Health, furnishes some interesting information relative to
the origin of the epidemic, and the character of the diseases which
preceded its appearance in that city.

    “In presenting to the Board of Health the following tables,
    showing the bills of mortality of this city from the 22d ult.,
    when the board directed the deaths to be recorded, up to this
    day, we deem it our duty to make some remarks relative to the
    health of the city during the above period, and likewise in
    relation to our future prospects, and the measures we consider
    useful to accelerate the departure of the pestilence from among
    us.

    “We stated in our last report to the board, that immediately
    prior to the breaking out of the epidemic, our city was
    unusually healthy. Until about the 20th of June, few diseases
    prevailed, and the mortality was less than common. From the
    22d of June to the 3d of July, only eleven deaths occurred--of
    those, six were children. In a population of twenty-six
    thousand, an average of less than one death a day for near two
    weeks, indicates a degree of health almost without a parallel.
    From the 30th of June to the 3d of July, _not one single death
    was reported_. It was, however, but the calm which precedes
    the storm. All other diseases gave way to the silent but the
    irresistible march of the epidemic.

    “Although but few deaths took place from the 20th of June
    to the 3d of July, there was considerable sickness; and
    experienced physicians foresaw the coming danger, in the usual
    prevalence of diarrhœa, and common cholera morbus--hence it was
    that your board was urged to make all ready--to be prepared
    with hospitals, physicians, nurses, &c. and to this timely
    warning, and the preparations made in consequence, we may,
    under Providence, attribute the limited ravages of this fell
    pestilence.

    “On the 3d day of July, the epidemic assumed its malignant
    and characteristic form. From that time until now, it has
    maintained its residence among us. For the first week it
    gradually extended, and during the second it has been rather
    stationary, the number attacked varying a little from day to
    day and but little.

    “It is now a fortnight since the first deaths took place. The
    number of cases reported within that period is two hundred
    and forty-five, and the deaths seventy-two--or a little over
    one-quarter of the whole. It must however be recollected,
    that during the same time hundreds had been attacked with
    _Cholerine_, or the slightest influences of the epidemic.
    None of these have been reported, _because by timely aid, the
    disease, in its more formidable shape, was prevented_. We can,
    we believe, say with truth, that few have entirely escaped the
    influence of the disease.

    “From a consideration of all the circumstances connected with
    the visitation of Providence, we think our citizens have great
    cause for thankfulness, that we thus far suffered so little.
    Compared to our neighbours of Canada, we have suffered less
    than we had cause to anticipate. The disease has been among us
    for a fortnight; has passed all over the city, and in one form
    or other has affected more or less persons of all classes, and
    yet the deaths have not much exceeded five in a day, whilst
    at Quebec and Montreal, in a population not much exceeding
    ours, the deaths some days exceeded one hundred, when the
    disease had not been so long among them as it has been with
    us. From the history of the disease in other countries, and
    the circumstances connected with its progress in this city,
    we would fain indulge the hope, that it has already spent its
    venom, and that we shall ere long be free from it entirely. For
    the last two days, notwithstanding the number of cases reported
    and the high state of mortality, we are inclined to believe
    that we see, in the character of the prevailing disease,
    indications of returning health.

    “We have as yet, had no cause to change our opinion
    respecting the nature of the prevailing disease--we consider
    it essentially epidemic. It continues to attack people in
    different parts of the city, and had not been traced from one
    person to another, as might have been done were its progress
    dependent on contagion. It is true, in some houses, several
    persons have been attacked and died; but this only shows that
    similar causes produce similar effects in individuals placed
    in like circumstances--all were equally exposed to the local
    and general causes which engender this disease. The disease
    _may_, under certain circumstances, be contagious, but no very
    striking instances of the kind has yet come to our knowledge in
    this city.

    “We cannot reprehend in too strong language, the cold-hearted
    and inhuman conduct of many of our people, to the unfortunate
    victims of cholera. They are too often abandoned to their fate,
    even their friends being afraid to do to them the ordinary
    offices of charity. Were they labouring under the plague of
    the Levant they would not be looked upon with more dread. All
    this is folly. The risk of taking the disease from the sick is
    little or nothing; much more is to be dreaded from foul air
    by which the disease is engendered. The first care of friends
    should be, not to run away, but to take the sick into more
    healthy and airy lodgings.

    “We would also protest against the indecent haste with which
    the scarcely cold remains of the dead are hurried to their last
    abode, without a neighbour to follow, or a friend to mourn.
    Such conduct is discreditable to the character of a Christian
    people. We trust that we shall not again have to complain
    of similar indifference to the performance of the duties of
    charity and humanity.

    “To the members of the medical profession, and particularly
    its younger members, we willingly award due credit for their
    attention and diligence, under circumstances of no usual
    difficulty.

    “We would again most earnestly entreat our citizens not to
    neglect to apply for medical aid the moment diarrhœa, or sick
    stomach and head-ache take place. We have not yet known one
    instance in which the disease in its malignant form, was not
    preceded by one or more of these symptoms, for some hours, if
    not days; and we have not seen or heard of a single instance
    where these premonitory symptoms were properly attended to,
    an attack was not prevented. It cannot be too strongly or too
    often impressed upon the minds of our citizens, that cholera,
    in its early stages, is easily cured; but that when neglected,
    in a majority of cases, no human aid will avail. Almost all
    the deaths have occurred in persons of intemperate habits,
    and of broken constitutions. A few estimable citizens have
    fallen victims to it, but these were either aged and infirm, or
    had neglected the premonitory symptoms, or had tampered with
    medicines, without proper advice.

    “To our constituted authorities we would recommend the most
    assiduous attention to cleanliness in our streets, along
    our wharves and docks; to our citizens, strict attention to
    cleanliness in their houses and persons, to pay due attention
    to dress, avoid exposure to the night air, and observe
    strict temperance, not only in _drink_, but in _food_. We
    would caution them against the free use of _fruit_, _ripe_
    or _unripe_, and the employment of Glauber or Epsom salts
    as medicines. Several cases of cholera have been brought on
    by their operation. If due attention be paid to all these
    precautions, we have every reason to hope that the epidemic
    will soon cease to prevail among us.

                                          “JONA. EIGHTS, Chairman.”

    _Bill of Mortality from 22d June to the 7th July, 1832._

    June 22, 2--1 poison,
                1 small-pox.
         23,    ----
         24, 1 pneumonia,
         25, 1 convulsions,
         26, 2--1 convulsions,
                1 marasmus,
         27, 2--1 convulsions,
                1 consumption,
         28, 1 scarlatina,
         29, 2--1 consumption,
                1 unknown,
         30,    ----
            --
            11 deaths from 22 June to July 3.

    July, 3, 2 cholera,
          4,   ----
          5, 4 cholera,
          6, 2 cholera,
          7, 3 cholera,
          8, 4--3 cholera,
                1 intemperance,
          9, 5 cholera,
         10, 8--1 apoplexy,
                7 cholera,
         11, 9 cholera,
         12, 4--1 consumption,
                3 cholera,
         13, 8--6 cholera,
                1 congestion of the brain, after cholera,
                1 typhus fever,
         14, 7--1 hydrocephalus,
                6 cholera,
         15, 7--1 debility,
                6 cholera,
         16, 7 cholera,
         17, 8 cholera,
         --
         78

    Cholera           72
    Other diseases     6

    CHOLERA REPORTS.

    July 3, Cases 2   Deaths 2
         4,       1          0
         5,       7          4
         6,      12          2
         7,      10          3
         8,      11          3
         9,      18          5
        10,      22          7
        11,      28          9
        12,      10          3
        13,      28          7
        14,      27          6
        15,      17          6
        16,      29          7
        17,      23          8
                ---        ---
         Total, 245 Deaths, 72




_Board of Health, New York, July 20th, 1832._


TO WALTER BOWNE, Esq. President, &c.

Sir--I have the honour to transmit to your Board of Health, an
additional report of the Committee appointed to inquire into the
history and origin of the disease at the Bellevue Alms-house, &c.

                                 ALEX. H. STEVENS, M. D. President.

    The committee consisting of Drs. Bailey, Macneven, and A.
    L. Anderson, to whom was referred the inquiry into the
    origin of the malignant cholera in the Alms-house and the
    different institutions connected with it, further report:
    the Penitentiary, situated about five hundred feet from
    the Alms-house, and containing three classes of criminals,
    have no communication with one another; but the Bridewell
    and Penitentiary prisoners have a common stairway to their
    apartments; and the yards of the Female State and Female
    Penitentiary prisoners are separated by a high open picket
    fence, near to which the Penitentiary prisoners pass to and
    from their work-house, and on the opposite side of the Female
    State prisoners yard, and at a little distance is situated the
    Cholera Hospital, first opened on the 5th or 6th of July. In
    this building were confined, on the 1st of July, fifty-four
    Female State, about one hundred and twenty Female Penitentiary,
    and about fifty Bridewell prisoners; and the first person who
    had malignant cholera in that prison was Ann Smith, taken up at
    the Five Points, and sent there July 2d--she sickened on the
    5th, and died the next day, and on the 7th, four more Female
    Penitentiary prisoners had the disease. On the 8th of July, all
    the remaining prisoners of this class were sent to Blackwell’s
    Island, and put into a fresh white-washed building prepared for
    them. The removal of those persons to a healthy residence, and
    an unrestrained exercise in the open country air, appear to
    have checked the development of that disease among them, for
    not until the 10th did any of them sicken, when four of them
    were taken with that disease, and since then seven more. Dr.
    Spring, the physician stationed there, informed us that the
    disease had become milder since their removal to the Island,
    two only having died of thirteen patients, and the remaining
    eleven, visited by us, were doing well, except one.

    The first State prisoner had that disease on the 9th of July,
    and eight more on the 12th and 13th, four each day; and since
    that time five more, the greater part of whom have died. They
    are all in one very large apartment, having three tier of
    windows on one side only, but the three stories are one open
    space from the top to the bottom of the building.

    The first two cases occurred in the Bridewell class also on the
    9th, the next on the 11th instant; since then, six more have
    had the disease.

    When at Blackwell’s Island yesterday afternoon, pursuing
    our inquiries respecting the Female Penitentiary prisoners,
    sent there from Bellevue, we considered it appertaining
    to the duty assigned to us, to extend our inquiry to the
    occurrences relating to the same subject, which happened on
    that Island, the institution there being a part of the Bellevue
    establishment. We were informed by Dr. Spring, the physician
    stationed there, that the first case of malignant cholera which
    occurred on the Island, was an Alms-house pauper, who slept
    there, but worked on the Long Island farms; he was permitted to
    go as far as Brooklyn, July 1st, but he frolicked in the city
    all the next day, returned at night to Blackwell’s Island, and
    slept out of doors all night, and sickened and died July 3d--no
    other case took place there until the 11th, (three days after
    the Female Penitentiary prisoners were removed from Bellevue,)
    when three persons sickened and died the same day; one, a very
    feeble black man, aged sixty-five; another, a black lad, who
    had been much reduced by medical treatment for rheumatism--both
    patients in the hospital, and able to take exercise out of
    doors. Their building is about one hundred yards from that
    occupied by the Female Penitentiary prisoners. The third, a
    white pauper, aged sixty-five, who worked on the Long Island
    farms, but slept on Blackwell’s Island, formerly in the
    shanty now occupied by the sick blacks; but some days before
    he sickened, he slept in a small building at a considerable
    distance from his former lodging place; but he not being
    under confinement, would go to any part of the Island when
    unobserved, and without hindrance to the outside of the Black
    Hospital.--Since then, three blacks have had that disease.

    We were also informed by Dr. Spring, that no case of malignant
    cholera had occurred among the two hundred and eight male
    Penitentiary prisoners--that a lad, aged sixteen, who
    frequently complained of being unwell, died on the 13th inst.,
    after three or four hours sickness of common cholera. Those men
    are employed in the open air, and their prison is in the most
    perfect order; the air within was as free from any impure smell
    as the atmosphere without. We were informed by Col. Woodruff,
    the superintendent, that it was in contemplation to remove the
    Bridewell prisoners from Bellevue to this prison--and asked our
    opinion as to the propriety of the measure; we give it as our
    opinion, that as there was already a large number of men now
    confined there, and room only for about thirty more, that the
    crowding of the prison at this time, and especially from places
    where the malignant cholera existed, would be exposing the
    health of the prisoners to some hazard.

    We were also informed by John Targee, Esq., one of the
    Commissioners of the Alms-house, that a boy, whose parents had
    both died in Laurens street with the malignant cholera, was
    sent from there in the beginning of July, to the house on Long
    Island Farms, where there are a large number of pauper boys; he
    sickened and died of that disease the day after, and no case of
    that disease has since occurred.

    The foregoing being all the facts which have come to our
    knowledge after a strict examination, are respectfully
    submitted.

                                                       JOS. BAYLEY.




_Magendie’s Treatment of Cholera._


M. Magendie’s success in the treatment of cholera has been vaunted
in many of the journals, and we have been repeatedly applied to for
information respecting the remedies prescribed by him. His treatment
consisted in the administration during the cold stage of the
following:--

1st. For common drink--℞. Infus. chamomil. ℔iv.; acet. ammon. ℥ij.;
sacch. alb. ℔j M.

2d. Half a glass every hour of the following punch--℞. Infus. flor.
Tiliæ Europeæ, ℔iv.; limon. iv.; alcohol, ℔j.; sacch. alb. ℔j. M.

3d. From time to time he gives half a glass of the following--℞. Vinum
calefac. ℔ij.; tinct. cannel. ℥ij; sacch. alb. ℥ij. M.

By these stimulants, reaction was sometimes induced, and it was at
once concluded that the patient was cured. But violent reaction is not
less dangerous than collapse, and M. Magendie’s patients relieved from
the latter condition by internal stimulants, soon exhibited evidences
of congestion of the brain or digestive organs, which resisted, for
the most part, general and local bleeding, cold to the head, and the
most active revulsives to the feet. The patient became delirious, coma
supervened, and death closed the scene.

It is shown by authentic documents in our possession, that the result
of M. Magendie’s treatment was not less unfortunate than that of his
colleagues; he lost more than one-half of his patients.

A careful examination of the results of the various modes of treatment
adopted in India, Russia, Poland, Germany, Great Britain and France,
has satisfied us that the internal administration of powerful
stimulants in large doses, in the collapsed stage of cholera, has been
eminently injurious, and such appears to have been ultimately the
conviction of nearly all the practitioners who resorted to them. Panic
struck, with the utter state of prostration of patients in the collapse
of cholera, physicians appear every where to have at first been led to
administer the most powerful stimulants in large and repeated doses, to
rouse the action of the heart. Recovered from their first surprise, and
admonished by their ill success, and by the violent and uncontrollable
reaction sometimes induced, these remedies were subsequently abandoned,
or only applied externally, and with incomparably better results.




_Health of Philadelphia._


Bowel complaints continue to be the prevailing diseases, and within a
few days several cases of cholera have assumed malignant characters.

    July 27th the Board of Health reported 2 cases of malignant cholera.
         28th                              6
         29th                              6
         30th                             15
         31st                             19

The whole number of cases, as near as can be ascertained, is 52, of
which, 30 have occurred in the districts, 6 in the Alms-house, 1 in the
Arch street prison, and the remaining 15, in the outskirts and dirtiest
parts of the city.

Report of the Board of Health for the twenty-four hours, ending August
1st, noon:--

PRIVATE PRACTICE.

    CASES.             RESIDENCE.                                   DEATHS.

      1   No. 94 Dillwyn street, N. L.                                   1
      1   No. 1 Clymer street, Moyamensing.
      1   No. 3   do.    do.       do.
      1   No. 16 Vine street, City.                                      1
      1   Between Race and Vine and Tenth and Eleventh streets, City.
      1   Corner of Bedford and Twelfth streets, Moyamensing.
      1   South side of Cedar above Twelfth street, Moyamensing.         1
      1   Peach between Green and Coates’s, N. L.
      1   Parham’s Alley, Southwark.
      1   Queen near Passyunk Road, do.
      1   Second below Carpenter st. do.
      1   Frankford Road above Bedford street, Kensington.
      1   St. John above Poplar Lane, N. L.
      1   Shirker’s Alley, Moyamensing.                                  1
      1   Third st. above Globe Mills, Kensington.
      1   Otter st. near William street, do.
     --                                                                 --
     16                                                                  4

    Hospitals.       Physicians.   New cases.  Died.   Cured.  Remaining.

    Alms-house,      H. L. Hodge,       1         1       1        0
    Jones’ Alley,    Parrish,           1         0       0        2
    Locust st.[1]    Chapman,           2         1       0        1
    Moyamensing,     Thomson,           1         1       0        1
                                       --        --      --       --
                                        5         3       1        4

    [1] A white woman was brought from the Alms-house in a dying
    state, and expired soon after admission.

                      NEW CASES.  DEATHS.

    Private practice,      16              5
    Hospitals,              5              3
    Alms-house,             1              1
                           --             --
                           22              9

                               By order,

                                                WM. A. MARTIN, _Clerk_.

The following table exhibits the whole mortality, and also that from
bowel complaints, for the 4th week in July for five successive years.

    1828.--4th week, ending July 26th. Whole mortality, 127; of
           which, the deaths from cholera morbus, were, adults, 3;
           children, 26; Total, 29.--Diarrhœa, adults, 0; children,
           3; Total, 3.--Dysentery, adults, 0; children, 3; Total,
           3.--Total from bowel complaints, 32.

    1829.--4th week, ending August 1st. Whole mortality, 100; of
           which, the deaths from cholera morbus were, adults, 1;
           children, 23; Total, 24.--Diarrhœa, adults, 0; children,
           4; Total, 4.--Dysentery, adults, 1; children, 3; Total,
           4.--Total from bowel complaints, 32.

    1830.--4th week, ending July 31st. Whole mortality, 183; of
           which, the deaths from cholera morbus were, adults, 0;
           children, 38; Total, 38.--Diarrhœa, adults, 0; children,
           2; Total, 2.--Dysentery, adults, 2; children, 2; Total,
           4.--Total from bowel complaints, 44.

    1831.--4th week, ending July 30th. Whole mortality, 123, of
           which, the deaths from cholera morbus were, adults, 0;
           children, 32; Total, 32.--Diarrhœa, adults, 0, children,
           6; Total, 6.--Dysentery, adults, 1; children 3; Total,
           4.--Total mortality from bowel complaints, 42.

    1832.--4th week, ending July 28th. Total mortality, 147; of
           which, the deaths from cholera morbus were, adults,
           5; children, 27; malignant cholera, adults, 8;
           Total, 40.--Diarrhœa, adults, 3; children, 4; Total,
           7.--Dysentery, adults, 2; children, 5; Total, 7.--Total
           from bowel complaints, 54.




_Liability of Negroes to Cholera._


An impression appears somehow or other to have got abroad that negroes
are not liable to be attacked with cholera; such a notion, however,
has no foundation. In New York, it has been observed that they have
enjoyed no greater immunity than the whites, and the natives of India,
whose constitution much resembles that of the negro, were more liable
to cholera than Europeans. There is ample grounds for fearing that the
disease will be productive of terrible mortality among the slaves of
the southern states, and proper measures of hygiene should be promptly
adopted; and on the very first symptoms of derangement of the digestive
organs, remedial measures immediately resorted to.




_Cholera at New York._


It affords us pleasure to notice that the cholera is abating in our
sister city. During the last few days, the number of cases have
considerably diminished, and though accidental causes may occasionally
interrupt their constant decrease, it is manifest that the epidemic has
reached its height and is on the decline.

The report for the twenty-four hours, ending Tuesday, July 31st, at 12
o’clock, announces--

    In private practice, new cases, 59, deaths, 23
    Hospitals                       52          20
    Bellevue                         1           3
    Harlaem and Yorkville            9           2
                                   ---         ---
         Total                     121          48

The number of interments during the week, ending Saturday, July 28th,
were 879; of which, there were from cholera morbus, 10; malignant
cholera, 689; cramp in the stomach, 1; diarrhœa, 3; dysentery, 4;
cholera infantum, 18; inflammation of the bowels, 4; inflammation of
the stomach, 2.




_Montreal._


The following is a statement of the cases and deaths from the
commencement of the epidemic to the 14th of July inclusive:--

                     Daily cases. Daily burials. Total cases. Total deaths.
    June 10th to 15                                 1328          175
                 16      381            86          1709          261
                 17      474           102          2183          363
                 18      261           128          2444          491
                 19      337           149          2781          640
                 20      165            94          2946          734
                 21      151            76          3097          810
                 22      109            52          3206          862
                 23       83            31          3289          893
                 24       51            21          3340          914
                 25       44            33          3384          947
                 26       27            23          3411          970
                 27       21            26          3432          996
                 28       22            20          3454         1016
                 29       37            21          3491         1037
                 30       32            22          3523         1059
    July          1       23            17          3546         1076
                  2       13            20          3559         1096
                  3       11            14          3670         1110
                  4       23            17          3593         1127
                  5       22            13          3615         1140
                  6       19             4          3634         1144
                  7       13             9          3647         1153
                  8       14            11          3661         1164
                  9       10             9          3671         1175
                 10        7             6          3678         1184
                 11       14            10          3692         1190
                 12       15            10          3707         1200
                 13        9            10          3716         1210
                 14        8            10          3724         1220





NOTICE.


_The American Journal of the Medical Sciences._

The August No. of this Journal will be delayed a few days in
consequence of the illness of the Editor. The No. will contain copious
details of the cholera of Paris by two American physicians who were
in that city during the prevalence of the epidemic, a review of the
principal works on cholera, and the Periscope will be enriched with
various documents relative to that disease.


PHILADELPHIA--CAREY & LEA--CHESNUT STREET.