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                                  THE
                           CHOLERA GAZETTE.

    VOL. I.         _WEDNESDAY, AUGUST 8th, 1832._           No. 5.




_M. Petit’s Treatment of Cholera._


The principal indication which M. Petit, one of the physicians of the
Hôtel-Dieu de Paris, proposes to himself to fulfil, in the treatment
of cholera, is to keep up a constant impression upon the spinal
marrow, and to change the phenomena of innervation. To effect this
he places over the whole length of the spine a strip of flannel, wet
with a liniment composed of an ounce of the essence of turpentine
and a drachm of aqua ammonia, and passes slowly over it a very hot
flat-iron. An instantaneous evaporation of a great part of the liniment
results, which acts powerfully on the skin over the spine, and induces
very speedily vesication. The heat returns to the skin, the cramps
and vomitings disappear, the circulation is reëstablished, and the
patient feels much better. The effects of this remedy are assisted by
hot bricks to the limbs; by frictions to the body with a decoction of
mustard, to which some aq. ammonia is added, and the patient is also
made to drink copiously of balm and mint tea. A table-spoonful of the
following potion is likewise given every hour:--℞. Aq. distil. Tilleæ
Europeæ; aq. distil. melissæ, āā. ℥ij.; tinct. opii, gtt. xx.; syrup.
ether. ℥j. M. Finally, the patient is rubbed all over with a liniment
composed of camphorated oil of chamomile, ℥ij.; laudanum, ℨij.; liquid
ammonia, ℨj.

M. Petit is said to have been more successful than most of his
colleagues in the treatment of cholera. In a communication to the
Academy of Medicine he states that under the above treatment two-thirds
of his patients have recovered.




_On Density of Population._


Density of population in cities becomes a matter of extreme importance
connected with the visitations of pestilential diseases. A too crowded
population may of itself engender a pestilence, and must inevitably
aggravate one should it prevail from other causes. Hence the necessity
which occasionally arises of thinning the inhabitants of certain
districts--an exigency which, like that of war, often subverts civil
authority, and demands the exercise of the most arbitrary power. We
have recently seen our New York neighbours compelled to thin the
population in some parts of their city, and we may yet be forced to
have recourse to a similar measure. Upon this subject there are some
interesting calculations furnished in Hazzard’s Register, (Vol. VIII.
No. 5,) where may be found an interesting table, exhibiting the number
of square feet in each ward of our city, together with the population
at each census from 1790 to 1830, and the number of square feet to each
inhabitant. From this table it appears that the increase in density
of population throughout the city plot, has been in the following
proportion during the forty years embraced in the estimate.

    In 1790 there was 1 person to 1755 square feet.
       1800     ”     1     ”     1216
       1810     ”     1     ”      933
       1820     ”     1     ”      986
       1830     ”     1     ”      623

Viewing the wards separately, we find that, in 1830, there was one
inhabitant to every 313 square feet of superficies in the eastern
division, and one to 979 of the western.

    Eastern Wards.

    New Market ward had 1 to 236
    Lower Delaware      1    243
    Pine                1    248
    Upper Delaware      1    318
    Chesnut             1    341
    Walnut              1    398
    High                1    402
    Dock                1    416
                             ---
                  Average    313

In the western wards, where there is a large proportion of unoccupied
ground, the density varies from 840 to 1354 square feet to each
inhabitant--the average being 979.

The propriety of legislative enactments limiting the maximum density of
population, and the space allowed to be occupied by buildings, so as to
ensure sufficient ventilation, &c. seems to us to be manifest. We shall
take a future opportunity of offering some further remarks on this
subject.




_Injection of Saline Solutions into the Veins._

(Continued from page 55.)


No. 4.

_Letter from Dr. Lewins, to the Secretary of the Central Board of
Health._

_Results of the Injection Practice in the Drummond-street Cholera
Hospital, Edinburgh._

    SIR,--You will receive from Dr. Latta, the details of two or
    three cases treated by saline injections. We have both been so
    much occupied to-day, that we have not had leisure to get our
    communications ready to be sent in the same envelope. We steal
    an hour from the time usually allotted for rest to write to
    you. In case Dr. Latta should omit to mention the circumstance,
    I beg to mention that his patient, Cousins, the woman who was
    injected to the amount of three hundred and seventy-six ounces,
    and who promised to do well, for a considerable time, was a
    person of very dissipated habits.

    In the Drummond-street hospital six patients have been
    injected, and three recovered, or are recovering. In the three
    that died, extensive organic disease was found on dissection;
    disease that had existed previously to the attack of cholera.

    I send herewith the report of two cases, treated by Dr. Craigie
    of this place, which, at my request, he furnished me to-day for
    the perusal of the Board.

    I intended to have sent an account of an interesting fatal
    case, the only one in which the venous injection may be said to
    have fairly failed where it was fairly used; that I shall do
    to-morrow.

       I have the honour to be, sir, your most obedient servant.

                                               ROBERT LEWINS, M. D.

    _Leith, May 27th._


No. 5.

_Details of Two Cases of Malignant Cholera treated by Venous Injection,
by Dr. Craigie, of Leith._

    _No. 1. Case successful. 15lbs. injected at intervals in nine
    hours._--Martha Smith, aged thirty-eight, a noted drunkard,
    thin and debilitated, in sixth month of pregnancy, admitted
    into the hospital at 8 P. M. May 16th, 1832.

    It appears she had had vomiting and purging since Sunday
    morning, 12th inst. Cramps came on about four hours ago in both
    legs; great evacuations both upwards and downwards like dirty
    water. The countenance is now collapsed; eyes sunk; tongue
    cold; pulse imperceptible at wrists; very small in brachial
    artery; 124.

    ℞. Muriat sodæ, ℨiij; Carbon sodæ, ℨi; Aq. calid. ℔vj. solve.
    Ft. Enema statim injiciend. Sinapisms to spine and epigastrium;
    let her be placed on heated tin mattress.

    Nine A. M. Has a good deal of vomiting; is getting warmer;
    pulse now perceptible in right wrist; tongue warmer; she
    allows the enema to come away without giving notice to nurse.
    Saline enema as above, with the addition of white of eggs, to
    be repeated every half hour.

    Ten. Vomiting and purging of watery fluid, with slimy matter in
    it.

    Half-past ten. Cramps have returned severe in left leg; pulse
    again imperceptible; urgent thirst, and constant vomiting.
    _Rep. enema et pulveres effervescentes._

    Half-past eleven. Breathing becoming much affected; extreme
    restlessness; cramps severe in legs, and every symptom of
    sinking. Let the following saline solution be injected into one
    of the veins of the arm.

    ℞. Muriat sodæ, ℨi; Carbon sodæ, gr. x; Aq. calid. ℔iij, solve
    temp. 105° Fahr.

    Noon. When about ℔i. had been thrown in, the pulse was
    perceived to flutter at the wrist, and gradually strengthened
    as the injection was proceeded with. By the same ℔iiiss.
    had been injected, the countenance, which was before quite
    death-like, now beamed with the appearance of health, and she
    began to converse freely. Pulse 96, moderate. To have ℥i. gin
    in warm water with sugar.

    Half-past one. The gin was immediately rejected. Pulse has
    again gradually become imperceptible, and respiration quick and
    laborious.

    Two. Let the venous injection be repeated to ℔vij.

    The effect of the injection, as formerly, was very striking.
    To see an individual who seemed _in articulo mortis_ brought
    back, as it were, in so short a space of time to an apparently
    tolerable state of health, could not but astonish the beholder.
    Before the injection was finished the pulse had returned to a
    healthy fulness and firmness. Expresses herself much relieved;
    no purging, but vomits much serous matter.

    ℞. Muriat sodæ, ℨij; Carbon sodæ, ℨi; Alcohol. dilut. ℥i; Aq.
    calid. ℔iij. M. ft. enema statim injiciend.

    Four. Enema retained about an hour and a half; surface of body
    now comfortably warm; she has not passed more fluid by stool
    than was thrown into the rectum.

    Six. Has slept softly for an hour; the first sleep she has had
    for many days.

    ℞. Subm. hydrarg. gr. v; Pulv. opii, gr. ss. M. sumat stat. et
    rep. 3tia quaque hora.

    Nine. Complains much of vomiting and sense of weakness;
    countenance rather collapsed; breathing rather difficult.

    Let ℥lxxx. be injected into the veins again gradually.

    After the first few ounces were thrown in she complained of an
    acute pain at the epigastrium, and faintness, probably arising
    from the fluid being thrown in too fast upon the heart, or
    from the passing of a bubble or two of air, which may have got
    in from the inaccuracy of the injecting apparatus used. Be
    that as it may, the circulating system was so much affected,
    that the pulse, from being distinct though feeble, became
    quite imperceptible, but on stopping the injection for a few
    minutes the pulse gradually returned, and the pain abated. She
    expresses herself as always getting relief from the operation.

    Eleven. Vomiting continues urgent.

    App. emp. cantharid. epigast. Effervescing draughts
    occasionally.

    May 17th. Has passed about ℔j. of urine, of natural appearance;
    this is the first she has made since she was brought in.

    From this time she went on gradually to improve, but stomach
    continued very irritable, and the matter vomited was bilious.

    21st. Labour pains came on, and she was delivered of a
    still-born female child.

    22d. Symptoms of phlebitis in right arm came on, proceeding
    from the wound upwards, but this yielded to the ordinary
    treatment, and she may now be considered out of all danger,
    though she is not yet reported cured.

                                              THOMAS CRAIGIE, M. D.

    _Leith, May 26th, 1832._

       *       *       *       *       *

    _No. 2. Case fatal--appearances on dissection._--George
    Cousins, aged ten, was brought into quarantine at nine, A.
    M. 13th May, on account of his mother being ill of cholera.
    About an hour after admission began to vomit and purge, and it
    appears he has had diarrhœa severely all the morning. Pulse
    102, extremely weak; complains much of sickness; countenance
    collapsed; areolæ rather dark under the eyes; voice very weak.

    He had hot air-bath immediately, and got the following dose:--

    ℞. Ol. ricini, ℥ss; Tinct. opii, gtt. xv; Aq. menth. pip. ℥iss.
    M. ft. haust.

    Half-past eleven, A. M. Draught retained; sickness has gone
    off; complains of heat of bath; let it be removed.

    Noon. Has vomited some watery matter, with undigested potatoes
    in it, and again a rice-watery fluid with flocculi. He has
    now a considerable degree of jactitation; countenance more
    sunk, and great desire for cold water. These symptoms went
    on increasing in severity in spite of sinapisms to spine,
    effervescing draughts, calomel, and Dover’s powder, warm
    water, enemeta, &c., and head symptoms were now making their
    appearance.

    Half-past two P. M. Pulse quite imperceptible, and has been so
    for an hour and a half; he lies quiet and drowsy, with eyes
    turned upwards; face bedewed with cold perspiration; hands and
    feet cold and very blue.

    My colleagues, Drs. Combe and Lewins, saw him with me at this
    time, and concurred with me in thinking him not only beyond all
    hope of recovery, but likely to die _within an hour or two_.

    From what I had seen of the resuscitating powers of Dr.
    Latta’s treatment on the boy’s mother this morning, by venous
    injection, I determined on giving it a trial, though this was
    a case rather likely to bring discredit on the remedy than
    otherwise. The following solution, at temperature 102° F. was
    slowly injected into the median basilic by means of a common
    silver blow-pipe attached to Reid’s enema syringe:--

    ℞. Muriat sodæ, ℨi; Carbon sodæ, gr. x; Aq. calid. ℔vj. solve.
    T. 102.

    Three P. M. A few minutes after the injection was commenced
    the pulse returned to the wrists, the blueness and coldness
    of the extremities gradually wore off; the countenance was
    much improved; and the whole fluid was injected within twenty
    minutes.

    Half-past three P. M. He has now a healthy, blooming
    appearance; is sitting up in bed, and looking about him as if
    awoke out of a dream. Pulse 110, natural; extremities of good
    colour and warm; voice much stronger.

    Half-past four P. M. Pulse has been gradually falling off since
    last report; is getting listless, and dislikes to be troubled
    with questions, breathing becoming laborious, and head symptoms
    more marked, with squinting to a slight degree superadded.

    Seven P. M. Pulse again imperceptible; respiration quick and
    laboured; countenance collapsed; tongue and breath cold; says
    he is dying.

    Let the venous injection be repeated to ℔iij.

    Half-past seven P. M. Pulse immediately returned, of natural
    strength and fulness, and continues so.

    Nine P. M. Lies very quiet; pulse good; breathing more natural;
    surface of body covered with warm perspiration.

    Ten P. M. Large watery evacuations from the bowels came on soon
    after last injection; the quantity cannot easily be guessed,
    but must have been considerable, as it is running through the
    mattress on the floor. Pulse scarcely perceptible; screams
    loudly like a child in hydrocephalus.

    Eleven P. M. Pulse quite imperceptible; is sinking fast; venous
    injections attempted a third time, but desisted from as it was
    not productive of the first good effects. Both pupils much
    dilated. Died at two A. M. 14th.

    _Dissection fifteen hours after death._--On exposing the
    brain and spinal marrow, but before opening their investing
    membranes, the least pressure with the fingers on the middle
    of the hemispheres of the brain caused a remarkable undulating
    down to the middle of the back, showing the existence of a
    fluid beneath the membranes, and on opening them about two
    drachms of pure serum flowed out.

    The surface of the brain was rather vascular, and the blood in
    the most minute vessels particularly bright. A few ecchymosed
    spots on its surface. All the other viscera were found healthy.
    The urinary bladder contained about half an ounce of urine.

                                              THOMAS CRAIGIE, M. D.

    _Leith, 26th May, 1832._


No. 6.

_List of Queries addressed to Drs. Lewins and Latta, by the Central
Board of Health, London, relative to the preceding cases, &c._

                     QUERIES BY THE CENTRAL BOARD.

    1. Were any of your patients bled previously to, or after the
    saline injections into their veins?

    2. Were the evacuations by purging, vomiting, or perspiration,
    increased by the injections?

    3. Did any of the patients submitted to the saline injection
    plan die; and if examined after death, what were the
    appearances?

    4. Had the pulse at the wrist absolutely ceased, and for how
    long; or had blueness of the surface taken place, and to what
    extent, in any of your patients before the injection of the
    saline fluids; and how many of such patients recovered under
    that treatment?

    5. Had suppression of urine been _perfectly_ established, and
    for how long, in any of your cases previously to the saline
    injection, and what effect did that practice appear to produce
    on the urinary secretions?

    6. What effect did the injections appear to have on the
    temperature of the patient?

    7. Were the blood and evacuations analysed before and after the
    injections?

    8. Did consecutive fever occur in any, and if so, in how many
    of your cases, whether successful or otherwise?

    9. Was the quantity of the evacuations noted before and after
    the injections in any of your cases?

    10. Please to give the details of two or three cases treated by
    saline injections, with age, condition of life, temperament,
    habits, &c., and particulars of such other treatment as may
    have been adopted in addition to the saline injections.

                        ANSWERS BY DR. LEWINS.

    1. None before. One to the amount of twelve ounces immediately
    after the first injection.

    2. The evacuations by purging and vomiting, in most of the
    cases continued. In some of them the purging, the discharge
    from the bowels at least, was increased. Perspiration was
    increased in all.

    3. Yes; no less than ten of the fifteen that have been injected
    up to the present day; but under such circumstances as do not
    detract from the general merits of the practice: this will be
    made evident by the history of the cases that will be sent by
    to-morrow’s post.

    4. Yes; even at the axilla in some of the cases, blueness of
    the surface had taken place to a considerable extent. Five of
    these patients recovered.

    5. Complete suppression, I think, in all except two, and for
    hours. In all the successful, and in some of the unsuccessful
    cases, the effects of the injection in restoring the secretion
    of urine were most evident.

    6. The injections raised the temperature of the body; but in
    all the successful cases, where the veins were injected, the
    patients complained of cold soon after the injection.

    7. Neither the blood nor the evacuations were analysed, but I
    sent some of the blood of a patient that had been injected by
    the veins, to Dr. Reed for analysis to-day.

    8. The consecutive fever in all the patients who were injected,
    has been slight.

    9. No; but they were excessive in most of the cases.

    10. Question ten shall be fully answered by to-morrow’s post.

                                               ROBERT LEWINS, M. D.

    _6 Quality Street, May 26th, 2 o’clock, A. M._


No. 7.

_Latest Communication from Dr. Lewins to the Secretary of the Central
Board of Health._

    Sir,--The urgency of my present private and public duties
    prevents me from communicating more to you to-night than the
    following brief particulars of a case that occurred at the
    Leith Cholera Hospital yesterday:--

    A woman of about forty years of age, was admitted on Sunday
    evening at 7 o’clock. She was _pulseless_, even at the axilla,
    _sightlesss_, _cold_, and _blue_, over almost the whole body.
    _Respiration_ very slow and irregular--in a word, she was
    all but lifeless. It was feared she would be dead before the
    operation of injecting could be commenced. Between 7 at night
    and 2 o’clock next morning, there were thrown in two hundred
    and eighty-four ounces, upwards of twenty-three pounds. The
    report of her situation at 2 on Monday morning, in the hospital
    book, is as follows:--“A change for the better, that appears
    almost miraculous, has taken place. The action of the heart is
    greatly improved; respiration not in the least laborious, but
    quicker than natural; pulse 120, small, but distinct. She can
    articulate distinctly; countenance natural; lips red; tongue
    moist and warm; she perspires freely; heat over the whole body
    natural.”

    A full report of this wonderful case shall be forwarded soon.

                          I remain, Sir, &c.

                                                     ROBERT LEWINS.

    P. S.--In one, the pulse had ceased at the wrist eight
    hours before the injection. Dr. Alison had seen the patient
    eight hours before the operation, and the pulse was then
    imperceptible.

    _Quality Street, Leith, May 29th, 1832, 1 o’clock, A. M._




_Origin of the Cholera at Quebec._


                            _Board of Health, Quebec, June 25th, 1832._

The undersigned, appointed by the Board of Health to investigate and
report upon the introduction and treatment of the cholera, now existing
in this country, have agreed to the following Report, which they
respectfully submit.

The disease, on its first appearance in this city, exhibited all the
characters of that commonly called the Asiatic or Spasmodic Cholera.
It commenced about the 8th instant, in boarding houses and taverns
in the Cul-de-Sac--a low, uncleanly, and ill-ventilated part of the
city--crowded with emigrants of the lowest description, with sailors
and other persons of irregular habits.

About the fourth day of the disease, (the 12th,) it showed itself in
the more elevated parts of the city, among the wealthier classes of
society, and persons of sober and regular habits, who could have had
but little, if any, direct communication with the people among whom the
disease had first appeared.

About the same date, (the 12th,) the disease was observed in various
parts of the city, and in several neighbouring parishes, some few miles
distant, having a constant intercourse with it.

The cases continued to increase in number until about the 16th or 18th,
(being the 8th or 10th day of the disease,) when they began to subside,
both in number and in violence--the disease still prevailing more
extensively in the ill-ventilated parts of the city above mentioned.
About the period of its greatest prevalence, (the 8th or 10th day of
the disease,) the number of cases was estimated to be between 250 and
300, in the course of twenty-four hours.

The undersigned have not as yet been able to discover that any case
of cholera has been landed from any vessel in the harbour, before nor
until several days after its first appearance in the city.

They deem it necessary to add, that some parishes in the neighbourhood
of Quebec have continued free from the disease until lately, and that
no case appears to have yet occurred at Three Rivers, an intermediate
and populous town between Montreal and Quebec, where the steamboats
with emigrants from Quebec, generally arrive.

Since the appearance of this malady, only two soldiers have been
attacked in Quebec, and those while on duty--the rest being closely
confined to their quarters.

The symptoms were the most violent at the commencement, and continued
so until about the 16th or 18th, when they began to mitigate in
severity, as the cases diminished in number.

In the treatment of this disease, recourse has been had to almost every
remedy favourably reported of by European practitioners, and they all
have had, for a time, their advocates--some preferring stimulants,
others opiates, while others satisfied themselves with an intermediate
plan of treatment--the whole of the medical practitioners with one
accord agreeing, however, in the application of external stimulants,
such as oil of turpentine, mustard, warm applications and frictions;
calomel and opium have been much relied on by many. Practitioners speak
with confidence of blood-letting at the onset of the disease, and
before an approach to collapse has been recognised. Sweating has been
much practised, and decidedly with advantage, when it is not allowed
to run into that state of collapse indicated by a pulseless wrist,
dejected countenance, blue extremities, tongue and breath cold, and a
sunken voice, feeling as if it passed through the ears.

Some instances have been noticed, and also observed by our intelligent
clergy, as well as by ourselves, where, in some mild forms of the
disease, nature effected a cure by copious perspiration, encouraged by
warm drinks and extra clothing.

The undersigned, with one accord, have found purgatives injurious, if
used before perspiration or blood-letting had been resorted to, to
allay the irritable state of the stomach and bowels; and then only the
milder purgatives should be employed, such as calomel or blue pills,
guarded with minute doses of opium, and carried off, after a few hours,
with rhubarb, combined with soda and carbonate of ammonia.

Signed, Jos. Morrin, Health Commissioner; W. A. Hall, Resident
Physician; F. X. Tessier, Health Officer; Wm. Lyons, Superintendent of
the Emigrant Hospital.




_Origin of the Cholera at Sunderland._ By T. M. GREENHOW, Esq. of
Newcastle.


The assumed capability of Cholera being conveyed by shipping from one
country to another, on which our system of quarantine is founded, very
naturally gave rise to the suspicion, when it first appeared in the
port of Sunderland, of its having been imported from some place on the
Continent, where it was known to prevail; and several stories were
in circulation descriptive of the manner in which it had thus been
introduced. I shall not here repeat any of these tales, suffice it to
say that none of them have been in any degree authenticated. That the
ships which were blamed for having committed the mischief, were found
to have been from uninfected ports, their bills of health clean, and
their crews healthy; in point of fact they were fairly acquitted of
the charge; and I believe the conviction is now almost universally
entertained by the inhabitants of Sunderland, medical and non-medical,
that the disease did not reach that place from any foreign source
whatever. It may be further stated that the first case of cholera
which took place in this part of the country, was at a considerable
distance from Sunderland, having been at a small village called Team,
about two miles south-west of Newcastle. This case occurred to Dr.
Alexander, of Newcastle, on the 4th of August, 1831. The details are
given in the Appendix, No. I.; other cases occurred at Newcastle
simultaneously, if not before the regular appearance of the disease at
Sunderland; although want of experience of its true characteristics,
and unwillingness to believe in the fact, induced medical gentlemen to
endeavour to prove that these were not cases of the new disease; yet
subsequent observation has sufficiently proved their identity, and, I
believe, it is now generally admitted. Such were the cases of Oswald
Reay, which occurred in October, of William Armstrong in the beginning,
and of Robert Jordan towards the end of November. On the 7th December
the next case occurred, that of Maria Mills, with which commenced the
official reports of the Board of Health of this place. The strictest
inquiries respecting the origin of these cases have failed to obtain
the slightest evidence of their having arisen from any infected source,
and seem to prove, in the most satisfactory manner, that, however the
disease may have since extended itself, its commencement in the country
was spontaneous, upon whatever causes it may have depended.




_On Asiatic Cholera Morbus_. By PAUL M. EVE, M. D. of Augusta,
_Georgia_.


Believing it criminal to withhold from the medical profession anything
on the Cholera Morbus at this moment, and conceiving it a duty to
comply with the request of the editor of the American Journal of the
Medical Sciences, I send the following observations which were made
last summer while I was in Europe. I had felt a reluctance to make a
further communication to the public on this engrossing subject, which
was warranted and justified from my late situation in the Polish
army; my time and attention having been almost exclusively devoted
to surgical cases, and opportunities of investigating this disease
having been comparatively limited. If it is thought, however, that my
observations, imperfect as they are, and that my opinion, humble as it
is, can in any way serve my fellow-labourers in the treatment of this
modern plague, I most willingly and cheerfully present them my views on
the subject.

As I have neither time nor inclination to write a long article, I will
briefly state the principal symptoms of the Asiatic Cholera Morbus, the
appearances on dissection, and then deduce from them the treatment.
An attack is usually preceded by diarrhœa or by uneasiness in the
stomach and bowels for some days, or is suddenly announced by vomiting
and purging, commencing about three o’clock in the morning, when the
temperature is lowest of the twenty-four hours; and is followed and
accompanied by cramps or spasmodic contractions of the abdomen. There
is great prostration of the animal powers; shrinking of the external
parts, particularly of the features, which assume in many places as
well as the fingers and toes, a leaden or purple appearance; a cold
and moist or even a wet skin, conveying when felt, the sensation of
touching a frog; great thirst; the tongue is blue and cold, or moist
and partly covered with a white fur; the pulse is either imperceptible
at the wrist or is quick, frequent, feeble and intermitting;
respiration is slow and very difficult; the voice is much altered,
questions and answers being made in a low whisper; the secretions,
particularly of the kidneys, are diminished, except into the alimentary
canal, where they are altered and augmented, without however any bile;
purging and vomiting, sometimes one only, but generally both; first
the contents of the stomach and intestines are discharged, and then a
peculiar whitish fluid resembling rice-gruel or sero-albuminous matter;
and lastly, cramps of the extremities, most frequently of the legs, and
which may be compared to a bayonet piercing the calf or most muscular
part.

The appearances after death, were almost constantly the same. The
external parts were very much diminished in size; the extremities, the
nose, lips, eyelids, cheeks, &c. were of a bluish or livid colour,
and the skin was wrinkled upon the hands and feet. The vessels of the
brain in some subjects contained black blood, but generally there was
nothing peculiar in the contents of the cranium. There was more blood
in the spine, probably arising from position. The heart, lungs and
large vessels were filled with a fluid resembling tar in colour and
consistency. Two hours after death it was liquid and appeared like
venous blood; but at twenty-four hours it seemed deprived of serosity
and of the property of coagulation, and albuminous concretions were
found in the heart. The stomach and intestines were either empty or
contained matter similar to the vomitings and purgings; their coats
were contracted and paler than in a natural state, or as was most
frequently the case, presented all the varieties from congestion to
sub-inflammation. The liver and vena portæ were distended with black
blood, and the gall-bladder with tenacious, dark yellow, or green bile.
In almost every case the bladder was found empty and contracted.

From the above symptoms and results of post mortem examinations, it
would seem that the pathology of the cholera morbus may be explained
by a want of oxegenation of the blood, which becoming surcharged with
carbon is unfit to stimulate the heart to contraction, and hence the
congestion upon the internal and vital organs at the expense of the
surface and extremities. With this pathological view of the disease,
and from the positive fact of there being a centripetal action of the
blood, is easily deduced the principle of conducting its treatment--the
equilibrium of the circulation must be restored or death will ensue.
Now, mechanically speaking, there are two ways of affecting this
object, either by introducing a power which will give the blood a
centrifugal direction, or calling it back to the surface, by direct
external applications. But the animal economy is governed by other
as well as mechanical laws; the vital properties of the heart are
oppressed, its energy is diminished, and its power of reäction impaired
by an accumulation of blood, and this is peculiarly the case when the
blood is black or not oxegenated; the stimuli or powers introduced
to rouse its action would therefore be worse than useless; besides,
we usually address the heart through the stomach, which is in such
an irritable state as to reject even the mildest article. Upon the
surface, on the contrary, there is a want of action, and stimuli are
called for to excite the skin; to restore its lost or increase its
feeble circulation, and thus draw the blood and heat from the internal
parts of the extremities.

The plan of treatment which I have found most successful, consisted
in varying the following means according to circumstances. Within
the first four hours after an attack, bleeding will generally be
necessary; but when prostration has ensued and when the surface is
covered with cold sweat, leeches to the epigastric region, or cupping
followed by warm fomentations or mustard plaster or blister, together
with frictions and heat to the extremities, will afford the greatest
and most speedy relief. Notwithstanding the various and multiplied
articles of the materia medica which have been recommended, as opium,
calomel, oxide of bismuth, cajuput oil, spirits, &c. to allay vomiting
and purging and calm spasms, I must give my decided preference to
dermoid applications, which invite the blood from the heart, lungs,
liver, stomach, &c. the congestion of which produces these symptoms.
I do not deny that there are cases which can be, and are relieved by
medicines; but, since we possess no remedy which can drive the blood
from the centre to the surface--since all internal medicines are apt
to excite vomiting, one of the most painful, distressing and fatal
symptoms of cholera--and moreover, since we possess means which can
be easily managed and varied to suit circumstances, and whose action
is plain and evident to the senses--I cannot forsake them to launch
upon the sea of experiment and conjecture, in the treatment of this
rapid disease. The language of those who advocate the administration of
internal remedies, is to give so much of a mixture or so many pills,
and if they produce _vomiting_, repeat the dose; but if a cure is to
be effected by relieving the symptoms, why give those medicines which
excite or aggravate them? An infusion of peppermint, or the oil or
essence of this plant, with a few drops of laudanum, in a little warm
brandy and water, is what I have found best adapted for internal use;
and even this should be prohibited when it produces vomiting. This
symptom is often so distressing and so easily excited, that the stomach
will reject whatever is presented to it. In such cases, I rely upon
the horizontal position, perfect rest, and heat and frictions to the
abdomen and extremities, without administering any thing internally.
The warm bath I have known to be of great service, but the time
necessary to prepare it and the exposure of the body to the air, are
serious objections to its general employment. The same will not hold
good in relation to the vapour bath, where the patient can be kept
continually warm. Excessive thirst is best relieved by cold gum water,
or by a piece of ice dissolved in the mouth.

Having enjoyed an opportunity of comparing the practice of the English,
French, German and Poles, while stationed at Warsaw, in the months of
May, June, July, and August, of the past year, and having experienced
personally the disease, I feel some confidence in recommending the
above treatment of the Cholera, to the American practitioner of
medicine: and in support of its correctness and superiority, I will
state that at Wisnia, a town of Gallacia, out of two hundred and forty
persons attacked with it who were subjected to cutaneous frictions, and
to the internal use of only an infusion of chamomile and peppermint
_two alone died_.

To prevent an attack of cholera, cleanliness and sobriety ought to
be most rigidly observed. All sudden or great impressions upon the
system, as changes in the temperature of the air, cold and moisture,
or emotions of the mind, excessive joy, fear, and the depressing
passions, should be carefully avoided. The body to be kept moderately
warm, a belt of flannel is recommended to be worn; and the mind calm,
and confiding in a protecting Providence. The diet should be regular,
and without any material change in the accustomed repasts. Emetics and
purgatives are to be avoided, and certain articles of nourishment which
are known to predispose to colic, or cholera affections; these are bad
beer, sour-crout, cabbage, salad, beans or peas, spinage, cucumbers,
pickles, unripe sour fruit, musk and water melons, cold meats, sour
milk, &c. Good soups, beef, mutton, veal, fowls, eggs, Irish potatoes,
bread, and tea in preference to coffee, should constitute the principal
food of those who inhabit an infected district.

After all that has happened to admonish us, we can still hope that
the cholera may not reach the Southern States. Its general course has
been north-westwardly; from Calcutta it reached the Russian Empire;
from Constantinople it passed to Great Britain. Although it existed in
Hungary and in Vienna, still Lombardy, Switzerland, and Italy, have
escaped; and the same thing is applicable to France and Paris, in
relation to Spain and Portugal. It has not even existed in cities of
the South of France, and Quebec and Montreal are nearly in the latitude
of Paris; besides, these two Canadian cities are remarkable as being
the most filthy and ill-ventilated of America. If it has progressed in
a north-westwardly direction, and if it has avoided a southern latitude
in Europe, why may we not escape its dreadful ravages? Let us, however,
be prepared to meet it, that if it ever does come, we may be ready
to cure the distressed, to relieve the afflicted, and to lessen the
sufferings of the dying victim.

_Augusta, June 30th, 1832._




_Non-Purgative Salts in Cholera._


The following statement, relative to the treatment of cholera in the
prison at Cold Bath Fields, are interesting, and are said by the editor
of the London Medical Gazette, to be entitled to entire confidence as
to its accuracy.

    “The first twelve cases occurred in the vagrant’s ward, and
    the patients were attacked soon after some prisoners had been
    admitted from St. Giles’s, and other infected districts. The
    first case that was reported as cholera, occurred on the 5th of
    April. This man was suddenly attacked, and died after a very
    short illness with all the symptoms of the prevailing epidemic.

    “When the first cases occurred, there were in all about twelve
    hundred persons in the prison; but, up to the beginning of this
    month, they were not afflicted with bowel complaints, nor, in
    fact, with any other epidemic disease, being as healthy as they
    generally are at that season of the year.

    “The first four cases were treated in the common way, with
    brandy and opium, an ammoniated mixture, ginger, sinapisms to
    the region of the stomach, the hot air-bath, &c. &c.; and all
    of them died after a short illness.

    “Since the 4th of April, up to this date, (April 17,) forty
    cases in all have been under treatment. Of this number,
    nineteen were admitted into the Observation ward with the
    premonitory symptoms of cholera. All of these had bowel
    complaints and suspicious ejections; some of them complained
    of severe pain in the abdomen, sickness of the stomach, and
    in several cases these symptoms were attended with cramps,
    chiefly in the lower extremities. The whole of them were
    immediately treated by Mr. Wakefield with non-purgative saline
    remedies, recommended by Dr. Stevens, and in general they were
    convalescent in one, two, or three days, from the commencement
    of this practice. From this we may infer, that where the
    disease is attended to early, and _properly treated_, the state
    of collapse may be prevented in nineteen cases out of twenty.

    “We must state, however, that as the numbers increased, it
    became necessary to dismiss those that appeared to be least
    ill, on purpose to make room for others. Of those that were
    dismissed as convalescent, two were reädmitted soon after in a
    state of collapse, and though every attempt was made to save
    them, yet they both died after a very short illness, with
    the symptoms of cholera in its most virulent form. With the
    exception, however, of the two that died, none of the cases,
    (seventeen in number,) were reported to the Central Board,
    partly, we believe, from a wish to avoid spreading alarm with
    respect to the prison, and partly because the disease was
    checked in the beginning; consequently, the patients had not
    _all_ the symptoms of cholera, such as occur in the worst
    cases, or in the last stage.

    “In addition to the above seventeen which were not reported,
    there were twenty-one cases where the symptoms of cholera were
    very distinctly marked. Of this number, four of the early cases
    were treated in the common way, with diffusible stimuli, &c.
    &c., and all of them died after a short illness. These, with
    the two cases of relapse from the Observation ward, make in all
    six deaths. Mr. Wakefield, however, having lost all faith in
    the common treatment, changed the practice:--at the request of
    Dr. Stevens, the other fifteen cases were put under the saline
    treatment, and all of them recovered.

    “When the patients were first admitted, the following powder
    was immediately given, either in half a tumbler of tepid water,
    or occasionally in a little thin, clear, beef-tea:--

    “Supercarbonate of Soda, ℨss. Muriate of Soda, ℈j. Chlorate of
    Potass, grs. vii.

    “The above was given every hour, and continued until the
    patients were recovering from the state of collapse; after
    which it was diminished in frequency, in proportion as the
    reäction increased.

    “In all these cases, the outline of the practice was nearly
    the same; but in several instances the treatment was varied
    according to circumstances. When the stomach, for example,
    was extremely irritable, it was found that the carbonate of
    soda, given by itself, or the tartrate of soda, in a state of
    effervescence, were the most effective remedies that could be
    used on purpose to allay the irritation, so as to enable the
    stomach to retain the stronger salts.

    “During the progress of the disease, an enema, with a large
    table-spoonful of muriate of soda, dissolved in warm water, was
    administered with or without sugar, starch, &c. every three
    or four hours, at as high a temperature as the patients could
    well bear it. Sinapisms were also applied as early as possible
    to the region of the stomach, betwixt the shoulders, &c.; and
    in the cold stage, frictions were also frequently used with
    warm towels. Of the seventeen cases that were treated in this
    way, two died, (namely, the two patients who were reädmitted
    in a state of complete collapse,) making in seventeen cases,
    two deaths, and fifteen recoveries. But including the whole
    of those that were under the saline treatment, the total
    amount is, in thirty-six cases, two deaths, and thirty-four
    recoveries.

    “The cases in question were under the care of Mr. Wakefield,
    the medical attendant of the establishment, and during his
    absence they were attended to by Mr. J. Wm. Crooke, who kept
    notes of the cases, and saw that the medicines were properly
    administered. We may add, also, that Mr. Wakefield, with a
    degree of fairness which does him great credit, invited Dr.
    Stevens to attend along with him to witness the effect of the
    saline treatment, which has here, we may say, for the first
    time, been fairly tried in this disease.

    “We can also state, that the cholera made its appearance about
    the same period amongst a small colony of Italians, who live
    in a narrow lane within a few hundred yards of the prison. Of
    these, eleven were attacked. The three first cases were treated
    by bleeding, brandy, and opium, all used at the same time,
    and they all died. The other eight cases were attended by Mr.
    Whitmore, a surgeon in the neighbourhood, who, having witnessed
    the effects of the saline treatment in the prison, adopted it.
    All his patients speedily and completely recovered, except
    one, who, on the 13th, was so ill that he was not expected
    to live many hours; even he, however, is now in a state of
    convalescence. _Thus there have been in all fifty-three cases,
    seven of which were treated in the common way, with diffusible
    stimuli; and out of this number seven died; while, of the
    forty-six that were under the saline treatment, there were two
    deaths and forty-four recoveries._”




_Cholera at New York._


The decrease of cholera at New York during the past week has been
exceedingly slow; nevertheless, there can be no doubt that the disease
has passed its zenith in that city.

    August 1st,   No. of cases, 92   deaths[1] 53
           2d,                  81             56
           3d,                  90             38
           4th,                 88             54
           5th,                 96             39
           6th,                101             51
           7th,                 89             28
                               ---            ---
           Totals,             637            319

    [1] These are taken from the city inspector’s reports of
    burials.

Whole number of deaths in New York during the week ending 4th August,
according to the city inspector’s report, 580, of which 383 were from
malignant cholera, 1 cholera morbus, 5 diarrhœa, 8 dysentery, 30
cholera infantum, 2 inflammation of the bowels, and 10 unknown.

The whole number of cases of malignant cholera from the 1st July to
7th August inclusive, reported by the Board of Health, 4497; number of
deaths as reported by the same, 1799. The report of the City Inspector,
which is manifestly the more accurate, gives the number as 2295.




_Health of Philadelphia._


The epidemic whose approach we confidently announced a month since, is
now prevailing among us, and appears as yet scarcely to have attained
its maximum. The public mind having been prepared to expect its
visitation, and quieted, to a considerable extent, by the preparations
made for its reception, there has been little excitement, and certainly
none of that panic which has elsewhere been so favourable to its
ravages.

    Number of cases reported August  2d,          40
                                     3d,          35
                                    4th,          45
                                    5th,         105[2]
                                    6th,         136
                                    7th,         136
                                    8th,         114
                                                 ---
                       Total for the week,       611

    [2] Forty of these cases were in the Arch St. Prison, and not
    being reported until the next day, the number of cases appears
    from the report of the Board of Health to be, August 5th, 65,
    and on the 6th of August, 176.

We hope in our next No. to be able to present a tabular view of the
cases, showing the number each day from the commencement of the
epidemic, the situations in which they have occurred, &c.

The following table exhibits the whole mortality, and also that from
bowel complaints for the 1st week in August for five successive years.

    1828.--1st week, ending August 2d. Whole mortality, 129; of
           which, the deaths from cholera morbus were, adults,
           3; children, 32; Total, 35.--Diarrhœa, adults, 2;
           children, 1; Total, 3.--Dysentery, adults, 0; children,
           5; Total, 5.--Total from bowel complaints, 43.

    1829.--1st week, ending August 8th. Whole mortality, 89; of
           which, the deaths from cholera morbus were, adults, 2;
           children, 18; Total, 20.--Diarrhœa, adults, 2; children,
           2; Total, 4.--Dysentery, adults, 1; children, 2; Total,
           3.--Total from bowel complaints, 27.

    1830.--1st week, ending August 7th. Whole mortality, 80; of
           which, the deaths from cholera morbus were, adults, 0;
           children, 21; Total, 21.--Diarrhœa, adults, 1; children,
           0; Total, 1.--Dysentery, adults, 1; children, 1; Total,
           2.--Total from bowel complaints, 24.

    1831.--1st week, ending August 6th. Whole mortality, 111; of
           which, the deaths from cholera morbus were, adults, 0;
           children, 23; Total, 23.--Diarrhœa, adults, 1; children,
           5; Total, 6.--Dysentery, adults, 1; children, 3; Total,
           4.--Total from bowel complaints, 33.

    1832.--1st week, ending August 4th. Total mortality, 243; of
           which, the deaths from cholera morbus were, adults, 1;
           children, 30; Total, 31.--Malignant cholera, adults, 81;
           children, 3; Total, 84.--Diarrhœa, adults, 5; children,
           4; Total, 9.--Dysentery, adults, 3; children, 2; Total,
           5.--Total from bowel complaints, 129.


PHILADELPHIA--CAREY & LEA--CHESNUT STREET.