IMAGE EVALUATION TEST TARGET (MT-3) 1.0 I.I 1.25 |50 '""— ^ us, M U ill 1.6 Photographic SciGncBS Corporation m «- «(v c\ \ ^ ^\^\ -^v*^ ^J^ ^'1' OFFICF, ... '.''. IKLLiy^' ^0\^«5 OCT 6 1932 PREFATORY NOTE. —- ^«- W.THiNa few days an interesting work, bv the celebrated Dr. W".ri;0. Stevens late of Santa^^^^^ now of Londo... ha/been received by a gentfeman of th.s city, ^om the Co sul ot tl.e ^^ "^t^/ ^J'^^^^^*^ f^"^„ don, entitled " Observations on the Healthy and Diseased Properties of the Blood lUe lollowing extract from the letter accompanying the work. Lo.NDo;^, 14th July, 1832. 1 send you by the ship Hudson a parcel to your address containing Dr^ ^^u u":' ched oreS'aJuX'n ties of th J Bloo^d , with i Treatise on'cholera in the latter F^ o« the ^f^'^^^-^^^V'^^.X' d p^nd d u ,"n a" here; and the success which he relates a. l'**""? ,f "^"''^ ^/"-'f "^"'^'^f „ [f,^^^ ^efing inVerested in such true. I beg your acceptance of the work; and 1 think that if you. "> any soc'm 'cj^""^ "^ . ,dering a matters, were to republish in the United States tlic part which relates to Cboleia, it w ould be renaering a great service to the community in general. ^ ^^^^ ^.^^ ^,^^ ^^^,y y„„^^^ Thomas AsPiNWAtt. Having pyH,,e work i„.. ;|,o h»r,U.««»^^^^^^^^ New-York, September, 1, 1832. i\»\i |«|®ic THE author of the following remarks on Cholera, Dr. Wi.^-M Steve^s-s Sva\?tr±tio"'°thathV. ed a high reputation as a bold and successiul surgeon^ Jiuwhroo^sf dSff the P^^^^^ of the yellow father ^.s eminently dist^ngu^she^^^^ Se'S^'?^ c£n'd!2ts^,^e^U^ giSt attentt Ja.n.n. U. pn^fession ^ ^^Hi^r!^^ ly in London, and, according to the statements herein contained have^^^^^^ Sri reasoning, its value must lera with signal success. Like every mode ^[^'^'^^'Z^li^f.fv.^^^^^^^ »f trial finally be determined solely by careful and exact observaUo of its results. " ^^^^^^ /heartily approve by thLe who have the -n-J-^^^^^^^^^^ Medical Wssion of the republication, in Great Britain . AtKXAXDSR H. Stevkjh, C H () T. E \i A -.^j^- When (liii dinease, which is geiitniUy believed to be of Asiatic origin, bur«it out at a lute purioil li-oni itii uiiial lioiindiiiic's, and exieii'ltil its ravages to- wards ihu WLSt. it was sciurallj- belirvcd (o be less •meiiabii; to trea .incut than it rtaliy is ; consequent- Jy it spread for a time an alarm ali ivtr Kiirupe. Al- most every f!;overniiiciit was in arms a;^ainnt it ; a:id the whole medical talent of the day appeared to be concentrated for the iMirposc oi' investiviatiii!^ its na- ture, and jireventing the mortality iVoin this now but destructive pestilence. It is well linowii, that those pr.ictitioners in this country who had f )rrnerl}- seen the ClKilera in Indi- a, remained, in general, most obstinately pertinaci- ous fifihtir former opinions, both with respect to its nature and treatment ; whilst others, wIm had nr)t yet bound themsdvea to any theory, a'ld were well" aware that noihinj;; hr.d been done in tiie East towaid lessening- the njortality, wore eager in tluir endeavours to find out some mnre firtunate method of tre.ilment than those A^hich had Iiitlu.rlo been us- ed witli so liitie success in other countries It would be, however, but a loss of time to enu- merate the varioas remedies whic'.i were propi)sed, tried, and found to be useless. NA'hcn the C'lioler.i first appeared oa the isolated .sh,)res of tliis islan>l white wine whey with spice, hot brandy and water, cajeput oil, ))ep(ierniinl, laudanum &c , wero otiici- aliy rccommetided to the public b> one Hoard of Health ; w'hilst another piessed into the service all the remedies wliieh had ever been ti'inu;ilit of, and recommended the wliolc to the profossi in in a con- fiscd mass. They approved ofriul hot irons to the wpine, and blei'dini;, together witii the internal U.-.0 of o^)iu;Tj nnd eracti.v, James's p iwdeis, caiomel, <-'a\- enne pepper, chailt and biaraly, ice, quinine, s///.';, acids, fyc , i5'C. Hut noswilhsfanding aU this, tiic mortality continued, as iiii;;ht natur.dly have been ex pecfed ; for such remedies so enipirir-iUy used, cin- ;iot e\rn mitigate the fymploms, inueli less cure the diser.se ;* — and as a general rule, 1 firmly believe that there would have been fewer deaths if the pati- ents had been kept in a warm room. tiJlowed plenty of cold water, and then left t;> the care of a ;^ond nurse. There are however, sonic excejition'* to this rule ; and from wh it I have now seen, my c"'nvio- tion is. that when f'hnlora is taken in time, and pro- perly treated it is, in tlic majority of cases, aiin!"!ft as easily cured as cither the common typhus or the marsh fever. The. tacts wiii;.'U I had prcAii.usly ».!a(ed relative i (he ell'ects of salts on the idood, npi'vared hir a timi to have been alnxist for-otlen ; but. in pn. portion a the danger dreu m :ir, tiiey were ngahi reeurred tr and warmly reeommendci by soim , as at least wnr Ihy of attention in the treatment ofi.'holcra. 'When it had been fairlv p:oved on the Continent that the praclife which had been use.! in India wa» of no value. Sir Astley Cooper, Dr. Prout, Dr. Kl- liotson. Dr dairies Wilsm, Mr. Tra\ers. an 1 some o- Iher (aleiiied individuals, who consider their proies- sion as something imu'e than a mere trade, (ipenly ex- pressed their opiiiion.s in tavour of t!ie saline treat- Tiiciit ; and that, loo, in a manner which renders it impossible forme to fm;". words to express how araleinl I feel to these, and some other scientific in- dividuals, who ha i the ^food sense to perceive that the diseased condition ol the. blood had been too uch overlooked, not merely in Cholera, hut m oth- er diseases. • ji • Previous to the aj)pcaranc(? of Cholera in linn country, the follosvin^ paper appeared in the Mediv.d GazoUe for September 3, 1^)31 : — ' O.t (he Si'itn «f the Blon h nnd EJi'ic' of Salint Mcuiciucs.in M:!i';;naiii iJinccufcs. ' We have been informed, on the anthnrity of Dr. Harder, a physician to the curt of St. I'eter burgh, who aeeonipanicd the Crand Dnlchiss llele;ia to J]n;;'.and, that his countrvman, Dr .lachnichen, of rdir.cow, has demonstraied ' th-.it healthy blood contain.', a notable qeantiiy of free acetic acid, which as w.dl as tlie natniil pi.rtifm of its serous lluid, is in a striking proportion lost in tlio blood of Cholera pr- tients; but that these siibslances are to be regained in nearly their ri>zht propoitimis in the fluids inun- ciatingt'ba priii.x' via;, in Cholera, and voided by the vnmiiiims ami alviiie evaonalions in that disoriler " Wetiiink il due (o our Russian correspondent t. make this announcement, the ratiier as it is intended to correct wliat he regards as an inaccur.icy on our part, though we are free to confess that we are by no means c.'ovinced even now of the err.ir lying with us. We cannot louierstand how a.-etic acid can remain fvec in a solntin-i Mhiidi eoi-.Uiins soda: neither, as th'-: addition cd" acids l)':;c^vens the blood, do- s it seem probabh that the reni.)val cd' such agents should also !i;ive the eiTecf. of rendjring that lluid more dark. It is pot our intenli'oi, b.owever, to enter fiu tlier up- on :: o,ue'>tion, for the satisfactory discussion of which *Thcse observalitns apply onlv to the irmhmid recommended by the Boards of Health ; in some other rcspect.s, the conduct of the present board appear.s to me to have been highly juda-ious ; and it London has hitherto been saved from the awful scenes which h.avc o.n-nrre 1 in P.iris. &c., it has been in no mer^i degree owinr to the active an! nr ;,-"r .oeasu.e.? that wer.- used !o prevent it. I te.,r however, th.-it tnc danger is not vet passed ; ard from wb.U 1 have seen latclv.thcro is rer;soa to dread that tiu? motropchs is at this mo^ msr-t «;uinbcrinr^ on a volcano of oeitilence.' •,i(«''. relative i ;iixh1 lor u liirn n jiriii'iiiiidii u ]n rciuntil tr iis iit least wor .'liouru. tlu' Coiitintiit 111 in India was I'rout, Dr. i:i- •is, ail 1 soino o- liT tliL'ir jirolus- rade, as it is intended acciu'.icy on our liat wr are by no •or l^iiii; with us. icid can remain oda: neither, as Mid, docs it seeiii c:ii.s slioiild also liuid more dark. ■liter Cup tlicr up- ciissiou of which ; in some other id if London has 1 iio mer.n decree lat the danger is :il;s is at this clo- ne ki:k nat^nali: b*a >»e .l.U lake lh« < pi ortmn-' foc, U'. in ^^^^■'^y'>'''-""^''.''\'f'*\*''^^^^^ U .t .lluJd. 01 br.n.ln.:- beforo our reudcr* the .tate- V.y .ka.h. 'A .. c.xr.,uum,. the bk.od .^ « >vf e. d • » .1 .:,.... ...ill. ..... -.i-.i (., ( I tlxi^e who had dit d I I il.i- vtHow levi.r, uu. <.oii.« in tlio wholo Uii-n- > I o.i-.i. i"'"> '» ""• "'l^f';* -'"^ V( ins wa, cou-i-ic;. :\ i ;.i.:i,ii.:" Iroiu Us i.ulural »car- ]et. or Modena led, i .aoi.iti black. I iiavc Iri^nuci.t ' )v tilled on. i'.la-.> •..>:.! ih,! bl icii lluid tAm I'Viu 'he iiearl, and ai.oMu r with liie i'lafk vomit tuK«.. fom Ihehlouiaeh. 'i i.e\ v.. re both so u.diUc 11 • iiloodof healih, r.i.d re.-enibU'd iKch <'thcr so com- pletely, tlial It Wrt.s alnio.t inipn-sibi" to distiiiRUUb tlic oiie frt II! the oilur." ' 'Ibe oxviicn re.slond; and Dr .'^levins lielieves that certain saline ii(;ent«ha\e a specific ( llVct, when a.ln.mi^tered dunuK de, in i."ient« of iJr. i'lcvens whose vicw.s With regard to ihe. .stKtr of die blood ill inaliKoanl di.'ianes appear Uiu> to merit inoic ftttentioii than tliey ha\c re- ceived, and which are. to u certain estent, though itidiiectly, >:rengtheiied by some of the pUeiiouitna whieli tile Cholera lias [ue^eiited in the north ot Ku- '• ill our number l>eforo last wc published a leltir from Dr. ll.nrv. in which he :.ays --Two phyticiaiY, (llermans,) V'senheclt and lirailow, slated publicly and lirmiv vcierdav. in my pUMi.ce. at tho -Medi- cal t'ounVi!, that diirinj,^ the lueceui'.j; eleven day!) thev had tnat>:d, at the Custom lioiise iiosp.ta', thirty C hole a i-atienls, of whom Vn-ii liml not lo.'l viic' 'lheygi^e two t.ilih; sjioonfuls ol coninic. ta- ble salt, inVi'x onnco. of hot water, at once, (die' o;,f ta!'!e sjon^ifiil 'l/'^i ';iiTu7(.'r hii.rline i-old ivtiy hviir ufUrwn7(i.' 'l'iieva;wav.she^-.iii by bleeding." A n- ii.ilartreiitinent has aUi". been tried with »ucce-s at \Var-.aw. by ;Mr- f iarle;--wul loo.-t ot our readers will r, coKeet, tlut Ihis is neither more or less than the practice which !i is been so warmly recomniM d- <■(! by l)r, Mevens, m tonlv in ^ello^v fe^er bi:l a.so (reas.niii-; IVi.m :>.'.al.\L'y) ui iho cure oi all other ma- lii^nant aiMase.-.;' and' iifter reprint in;.; the fir.-l pani- ^iaph from the paper wiiieh liad be. n re.id iit ^ ine Coile-e of I'livsMNans, the editor oli.serv* s :-' ..ow Dr. Ht'. vei.s ho'.d.s the .saline male: iab; of the b.. Oa to be the cans..- of it^ved color, and ccr.ain o-Jscr pro- perties essential to lite. He does not, mJee.l, idui- tilv the saline wilii the colnrini; matter; on the con- Ifiuy hecnnsidcis the latter (/■* a mere nnin.al (^ifC irhirk is ni hlur.':. but i.-hich possa^fC:* lue p- culiar propnlv <')'-ia» never bet-n piilili^iicd, yei <'ur account ot it has made 1)14 dcared upon (he sub ject at all satisfactory, and a^^ainst which powerful objections could not be brou;^lit. *"Dr. Stevens, an emim^nt physician of St. Thomas, has instituted an eKperinienlal inipiiry into this subject, which has led to some iiovt I and interesting results. Froru his e.\pcriiniiit it ap- pears — ' " 1»<. That the blood oihrs its red color m iirely to the presence of the saline matter irliinh is invariably found to i-.vist in it irhile in a healthij alite. ■ •' 'My. Th'it the dark color of cnioua blt- sesses a powerful affinity for carbonic acid, uiltich it takes from the blood t,y attractinti it through the delicate membrane that linen the broncliiat vexsets and air-cells of the lungs. ' " 4thly. That tlie removal of the carbonic acid from the blood by the action of oxygen does not pro- dwe a change in its color, u/i/css there be saline mitter actually present, to impart to it the arterial tint the moment the carbonic acid is ri-moced. ' " 5thly. T'tat acids, alkalies, elenricity, and every thing which deatr^tys the neutrality of s iline inatter, gives to the blood a dark color '• Whatever practical inferences or change in the treatment of diseases these experiments may lead us .to the idea that the red color of the blood i» owing to'the saline matter which if contains, is entirely new: and no one can deny to Dr. Stevens the merit flif having been the first discoverer ol this interesting fact, lie is still prosecuting his inquiries; and Ins researches upon this and other subjects connncted with it, promise much to the profession. 1 hey will soon be laid before the public in detail. 1 have had the pleasure of witnessing a number of Ur. Stevens s experiments, as performed by his own hand, upon the blood; and so far as I have had an opportunity to examine them, they have been performed with great care and accuracy, and were entirely satisfactory. 'We are aware that Dr. Stetens himself is about to publish on this subject ; yet, as there are some parts of Dr. Sewall's letter which 've do not clearly comprehend, and as every thing relating to the blood and the treatment of malignant diseases possesses «-rc:tt interest at this moment we have applied to that gentleman for information on certain noints ; ghoufrf we .succeed in obtaining this, we shall lay it before our readers in another number.' In answer to the above, the following communica- tion wai sunt to the Editor of the Ga/tttc ON TIIK TIIFATMKNT OV JIAI.IO^IA^T D'»»:All.i To the Editorofihe London Medical Oazttte. SiH,- As I have never seen even one case of Indi- an Cholem, of.<.m>e i can only judge of the (reul- mei.t of that disease by reasoning from m.aloify, be- twixt this ** other malignant fevers which 1 nave ao- tually ..een; hut probably I wa. not lar from the truth wheii I stated, that the practice which 1 had found so us.ful in (he malignant lever., ol ilu: Western world, wo.dd be e.iually Miccessful in the tna mento all o- ther forms of malign.mt disease ; & perhaps, also, ut- ter the treatment fias been fairly tried, the ""H""- "» the practice in all malignant diseases will ultima el> be nearly the same. 1 can no;,- add, that the same tieat mrnt'whichl have recommended iii the yellow lever, ii . lias been most extensively used, and with eipial succ.iss, in the treuimont (.1 those malignant forms of the n.ar.h fe>er which were huinerly so fa- tal to the (ienesee country on the soutlieni side of I.uke (J.itario. 'I'liis country is so Hat that the l.rie Canal runs through U for u)maiten so distressing in the last stage, is evidently m these fevers produced in u great measure ''J' "" ^^- cess of acidity in the stomach, 'ih.s may per la s arise from the decomposition of the saline mgie li- entsof the blood by the • irvous 7; electric find which appears to exist to excess in all fevers, but par ticularly lu those of a malignant character. Alter the decomposition, the acids of the salts may be at- tracted into the gastric organs, where t'>t'y^^';\. ' excess, and act as a source of 'ntensc irritation This, however is in part theory ; ^"t there is no •lucstion of the fact, tiiat there is mail the malignant fevers of the new world, particular y in the last .stage of these diseases, an ex. ess ot acids in the ahmei ta- ry canal,which extends from the very tip ol the tongue to the very verge of the anus. When we apply at this period of the disease a piece of litmus paper to the foul or red irritable tongue, the test is red lened almost instantly: & when we apply the same paper to the fluids ejected from the stomach, it is reddened almost as suddenly as if it had been 'I'PPe ^ ' a pure acid. In fact, even the matter of blaclcvom (which is merely an internal eftusion of the black and dissolved blood) receives such an addition of fixed a- cid in the stomach that it etFervesces Ireely with the alkaline carbonates. ^t. • » „„ ... 'The excess of acid which produces the intense 1 - rifatioii in the stomach, is not the acetic, for even flu iimlter of the black vomit lia» no sour imell. I hii ms^-''% IIEAIKl ]aztttt. is« of Inili- fthe trtal- iiialojfy, l»e- li I iiuvc liC- III (he trutli lUll touiiil su ti^'ii world, u'lit of iill ti- ps, ul.iit, at- u^ (ititliiii! uf I ultimately 1' sumc treat ellow li'Vcr, Willi c'i|Uiil ;llilllt I'olllli* crly so fa- i;rii siilc of at the Krie viiUy milesf t it is full of ere are nia- y us sickly, larsh fevers s now very )ther jilaces (onutes, &c. r the mere .TO fiinntrly i> success. so general- those fevers lisoiis. is pro ;h is tliritwii itidii ill the t taitari.'.ed [T, when we vein; when 1 at the sto- tin pusses a- e i;ustric or- mil which is evidently in e hy an cx- lay perhaps ine inj^redi- lectric fluid vers, hut par ter. After may he at- hey exist in sc irritation there is no le malignant he last seis. is the rflett of the poison oii the \ ital fluid; but ilio hlarkurss in the lust stage of these -liseases is produced Itx) Iht lohsuj the sfiliiic iiigipiliinlx,^ wlncUl can prove are be- yond all question the true ciiu.'-e of the red color of healthy blood. The meic tact that tho hlood has a (lark colcir in allthe f^ers which arise from poison has been longknown hut the '.MUses of this dark co- lor have hern but ill understood Anattemp/ to red- den.thr dark color of the bhick Mood in fever has been with some practitioneis. the chief object in the plan of cure ; but ignorance of the real properties of the vital fluid, has led to errors which have been even more fatal than those which now generally cxi;.t a; the consequence of the doctrine of iiiire solidisin. .\cids redden the blue of vegetable colors ; and these agents have been extensively used by a certain class of physicians to redden the blood in various diseases on the supposition that they contain an excess of ox- ygen, which they would give over to the black blood "nnd thus redden its color, The fact is. however, that though acids redden the vegetable colorii.g mat- ter, they com])lct«ly destroy the red color oftlie blood ; yet these arc the very aireiUs that in fever have been thrown so unmercifully into an orgu ), al- ready burning from an excess of acid, on purpose, tts they say, to redden and rcviviiy the color of lUv dark blood, ■i shall afterward have occasion to bring forward some melancholy proofs of the fatiil eftects of.the acid treatment, and to show that, in some places, it has been already used to a fearful extent The calomel, and some other modes of treatment, have done much mischief,* but the acids have been the agents of all olliers, the most destructive in the treatment of the yellow fever, and other diseases that really possess a malignant character. *We are indebted to Dr. Proiit for the discovery that the muriatic is the acid that is chiefly generated in the morbid conditions of this organ tThe above paper was written previous to the appearance of Cholera in thi< country. The blood in this disease has since been analyzed by Dr. O'Shaghnessy, Dr. Turner, Dr. Thomson, of Glasgow, &c. They all agree in the fact, that there is a material diminution of the saline matter. Dr. Thomson however, makes the diminution to be less than any of the others; but the cause of this has been ably pointed oirt by Dr. O'- Shaughnessy, in one of the late numbers of the Lancet. ^'i'hc calomel practice, in Cholera, hud been tried at Warsaw, and found to be of no use. even before the arrival of Mr. Searle in that city, Notwithstanding this, he conin>enced with his favorite remedy ; but, ac- cording- to the latest accounts, he had been trying the saline treatment with the most marked success . The calomel practice appears to have completely failed, even in the hands of Mr. Searle, who is known to have been one of its warmest advocates. In one of the lafo numbers of the Journal Unirnsnl ct Hebdomadaire we find it stated in a letter from M, Londe, the President of the French Omraission, now in Polaiid, that * The principal means used here against the Cholera, are 1. Calomel in .strong doses, (from 8 to 20 S"- ^f^ hour, or even half hour.) It is administered here in the Hospital do Bagatelle by Mr, S ?n English Phi tycian. In this Hospital the mortality is frightful.', I H hitok from thi Iom (if iln taline in-n dicuts, oxygen ]% not ultrartcii into the ciifiiliilii''i I'l Ihu Iuii^k aitfir fheieiiKiv.il of ihc cirlj .nic aciJ ; it liivst, if it l)C at- tracted lit Hint pcrioJ. "W-i 'lin ,lnuiKC»t oxy.u'i lum no niiTc ellccl m ir l('.niii- llie lIuiU bliuicl lluiii it hail in reJdciiinn Hie l''""-''^ '1"' t''''* '''^^ '"'''' "*'"'" line trirtttiT, un.l nf ccursi' ii> rrd cumr h'oin uunici'- ^lllnindi^tillta wutcr. V.t. tlimmli tliis pvactii'.! b\n b.'L'Uttlrcaily \vi'i;;lte.l in the I ul.uicc ami (nun, I wanting, wr arc nnndyid alii>i)''t iluily l»y tlic rec.ita- iiicrulntiimufnieati.* fur o\^-','fii;»tin'^ t!u- l.laclcblr.o. . r>xyKcnalin|j;thc liliinl Imwov.'r. in n no n>c m »uih ra^ci, for the blood can only bo rrddi-ix d l.y saliiio rrmtdiffl. C'alomil fiiul antinimy nay Irct tlu; sto- mach, and add tot'.io .iill'crin'. il the jiatiunts. A- f idi and opium rnnv and do diirktMi and dcslniy tlii' md color of the biood; liuL whin tlic i.-d cohu' is lo-t an in bad frvcr, it (.an ' nly ho rcMori d l.y th- isc (" thone reiutdics whicli .uo. inrculay, in its Ucalliiy itr»ti-, the true cause ol 'Hh ivdiioss. •It may b.-. casilv asccilainod, hy th.- litmus paper, wlicthrr' there be "or he net, in Chohia. :\n (•\c(!.«ts(f acid either in the blood (-r in th.; fluid cjoit.-d lr.;m ihc Knstric orpans. If thorn bean oxctss ol ai-id. then the alkaline carbon ito-s arc th(> rr medics, oi :dl other*, the moiit likelv to be useful ; i» then- he no excess of acid, thci the luiNiuic of muri;ite ot sod.i «nd nitrate of potass uiav pi"h;iblv !;c preferred; nnd «9 all parties ai;rec in adiiiiitin-; (hat. durin2;lb(dirsf utacc of Cholera, the b'.o.d is not only di-euHcd. hut blitck in color and thick in it i coris^tonce, I am, therefore, inclined lo believo that, ii)i./r>- fill cin'tnii- stances, thenon-puri::('tirr sili;ie vinhrnifH are he remedirs, of all oth,'r», Ihu m"-t lilcdn to bo nHfJnl; for they not merely redden llio color of tho blood, but,by"iiicreasini; thclliiidity ofils solid inar^-diOMts, nndaddins t.i its stinuil.iiinaf pr^M-er. they will ren- der the blood iTioiv fluid, and. of course, better btlod to serve the impt!io quantity or the rirulcnce of the poison that hus been taken into the system; but in all such cases, reaction is the road ov which the anim.d oconomv marches to health, and the first duty r-f the. p'.ivsicim is dccideaiy to brinK on reaction, or fever as speodilv as he can. When this is efTected. shonld thi reaction run hiih, he excitement maybe rodncod bv tn > hsc ofthe lancet, and the typhoid symptoms, which sometimes nlUrnard occur, may probsblj bciucienlcd by the Hill) tcfpiciit use otth« carbonate ofiodii, and other iu» line nadicinifl, which wo know do peiixess the pow- er iif preventing; that black and dis.-olved state of thebloicl. which is, in reality, in I'l v( r, the true cause of the nervous as well an the other bad symi- lUUJS. 'The difui.ihle stimuli proihur their i fleet in some cases, bvn dirtctatid transitory impression im the nervous" svsum; but. .is ali'Ludy slated, the saline ai'enl* enti-rtlie circulation, mis; 'Viih, and bz-conic ■par, of the binod. The Mood is lb" natural stimu- lus if the heart, and the i.etivo non-purt-ative saline ni'dicine.s decidedly add lo its stiiiiuiatin;^; ^1(>wer: till St', when •.•,i\c!i (iirly in Chidera, and i;i active do- ses, \\ ill by incveasin',' tin; stimiilatini; power of the > il.il fluid, enable it to act with more force on the vastii!urorp;ans and in this way rou'-c the p.iticnts from (hilt cidil lit.orstane of torpor^ in wlueh it ap- p. ;irs they t;eiierally die. „. ^ . ., „„ ' Krmi/what I hav;r seen oft'ieir enects in other dieases. 1 have Utile dimlU that, if the saliiu niedi- cliies be f.iirly tried, the n:(iitai;ty from <,'ho,era will be con-idtrably le.^s than it has liiiberto licen; but to s:iv thetruih, 'I do not anticipate mueh advantage frem eithrr the saline or any I'i'aer remedies, or iie- lieve (hat ihev -.vill he fairly tried, rr -enerally !nc- cossfiil. so (oiij; as thev are i.^edby pructitioner.s •.vbo believe that fever is a ncrvmis impression, and who believe also that all our retnedies in that disease act merely by sympathy, or some my-terious a^'cncy. on tb just as Wl day, than oil. • There history of formidabh the yellow proijuceb of heat to when the below a c;; poison of I mornin^io yellow fei appears tl can prodti the roiddl plains oft the contao plying tl m every t if it once main her* bnt to fut mortality poses a 1 * Nami is««tii il«M^ left hy Ihi mil iithur if tsa the V)OW veil sliite of (I-, the true r bad «jrm- nVct in some • ssidii on the il, ilir- saline. unci liccoriic tnnil Htirmi- ;^;itivc saline idn;:; ^)l>wt'r; ill ;i;;tivf! do- liuuci" ofthc (nrof; on the the )-t''»^»<'< I which it iip- Vects in other siiliiij nicUi- <,'ho!t ra will ) bcin; hut to I'h n:lviint»gc >c(Jiij;:,or he- :;;tiii'nv!ly sno- liriu'iitionLTH jirt'ssii'n. and II thut lUseaRe 'lidus ii^cncy. itioiKMS have mc moilicines, iiirnt of fever; !y lor lhi> vc- (f tlicoi nscl'nl, .: roiiiodicH are the treatment >een Ronerally lines arc ofti'n r iiilvrr'.i' and ioletely riirtd in three week* To thuie, however, who are dt!i|)o>^ed tokee the conlratt betwixt the ellcctii of the neutral lalti and the citric acid, in the treatment of tcurvy, 1 would rccouimenil the |ieruital of Mr. Cameron * ni<.|ier, on this
  • eai>e which they will find in the MedicoCbiru.gical Review, in one ofthc uuu»bcr< for 182!). ' It ha» long been, and I am snrry to ob»er\ c still i* t common source of error, jaiMi ularly in fever, to cnnlnuiu' a similarity in certain syniiitonis with « •anicness inUiiid. The sixuadic cholera, whieli is OCcaiiionally nut with dnrinj; the hotnionths. Imtli in thin ami in other countries, in evidently as tut.dly different fiiMii the InJian Chokra as east is from wcot. The one IK a syiiipiu' . tic alliction, followed by a mere iiionii'iitary e a aemciit, arising in pari fin in a severe loeul init.ilion in (he i;itslric oi(;ans; iho other, however, in a most malignant disease, priilnc- ed by the existence of asiieeifie. ;>nd viinknt iioJM.n in tlie syoleni, which contaminates every drop of the blood, and excites diseustd uc'".. in c.eiy solid of the body, t-iich beini! «»• ^".JlVrcent 1 have merely given . f'«.™' ;«;;»^,*; but the bame subject Will be con.idrred »'*;«»« n» re n, detail. Ihe above ha» been « r.tten n ha.t. nul may probably contain more error. «»'•»""•• should t^he' treatment, however, vvhtch has been^o u.elul in the malipnau disease* r,l «h«; m- ^ Worl^^ bef.nnd, even in the shuhtesi ^^K^"' '''J""?, jh! sulTeriugs ordimini.h f^« ""'L'-'f If .jl^T.V" 'aid other divisions of the ghbe. I shall then " "r*"' forthedisid^c which I now fee '" »PP^"'.^"S ^^^^ fore the profession ns the advocate "f.^*^,*^'"";* !, muchinoppo.ilion to the com.i.rn "P'"'""*.?; '" present day. That this may be put down to .U pw Dcr ttcccuut, isthe wiihot, Sir. youv obedient servant, .Stplemhcr '- '831. \ n.nv :, .. unserve, that «hcn the paper was rtfttl at ft', I'oiicKeofl'hvsicians, abi ni fifty copie* ol I were hastily piinled, and m« non-pnrgatiT« nc titral limits * Namely, the (wo that are referrtd to in the letter of Dr. Btrry . ) B«« the Suppl«m«ntarf numb«r of the Medical Gaactte for .Tawu .Tawubry lik. 18 ciUior 41)e one <ho believed that tliolera was produced cither by a nervous im- pression, or a local inilanunation. would not try the saline practice, because they could not see on what principle it could possibly do !>;ood. Sonic would not try it because it was too cold for the stomach: and one philosopher of tlic right old breed, who ap- pears to be ignorant of eveiy imjjrovement that has been made in the profe»ivnicn ; it -■meraliy was,) a large sinapism was immediately applied to the epigastric region, and where the pa- , tienti were cramped in the extremities, frictions were used with hot flannel. The pain produced by the spasms in the muscles were not only reli; veel by the frictions, but by this and the app ication oi si- napisms to various parts of the body, the quantity ol animal heat was increased, and this, 1 need scarcely ay, is an object of great importance in the treaiineiit ofCholera. Thirdly. A pow(?cr containing j Carbonate of soda, half a drachm, j Muriate of soda, one scruple, \ Chlorate of potass, grs.vij. ! was dissohed in half a tumbler of water, and given i soon after the Seidlitz. In severe cases, the above powder was administered every halt hour. In those that were less severe, it was used every hour, and lu some malignant cases it was given every fiKecn mi- nutes. In shoit, it was : iven more or less frequently according to the circumstances of the cio, and con- tinued until the circuhdion was fairly rcstore:el; it was then given at longer intervals, and when the re- action was completely established, it was left oil by de;'-rees. . • ■. 1 1 ji Fourthly. Whrre the stomach was irritable, tlie use of the above powder was occasionally suspended and common etiervcscing mixtures, or small doses ot the common soda pov.d.-rs, wi'h an excess ol the carbonates, were frequcitly used, until the irritation was lessened, and then the carbonate of soda wi li larger doses of the chlorate of potass were generally given without the addition of the muriate ot soela, and frequently iu such cases the chlorate of potass was glv.Mi by Itself, in doses containing ten grams each. Fifthly. A solution of muriate of soda was also thrown up into tne intestines, at as high a tempe- rature as the patients could well bear this saline "sixthly. In two very severe cases, which occurred out of the prison, the p.atients were put into a hot sa- line bath with evident advantage. It is well k""^". that a hot saline (laid is a better conductor of heat than fresh water at tho same temperature; but, inele- i.eudent of this, apart of the saline ingredients n'ay Lo absorbed from the skin, and the patients may a so be benefitted by res|.iring the hot saline vapor. It is but fair to state, however, that this means, which was evidently hcneficiid in the cases m which it was tried was proposed by Mr. Marsden, one of the sur- „c ;ns to the Free Hospital in Greville-strect. Seventhly. Seltzer wafer Avas allowed ad libitum, wl'un the patients expressed a desire for something to drink A strong infusion of green tea was also occasit saline vapor. It is t this means, which asesin which it was Kdoii, OIK. of the sur- revillc-strcct. allowed ad libUum, iesire for something green tea was also ases, apparently wit' oner gives to his son, qui me plait en lui, ct •lens, et que jamais il trc licclc, touchant la 11 Eighthly. It was considered essentially necessary to keej) a large ftre, both night and day, in every room where there was a patient with Cholera. It is i.i-w well liiiown that in by far the majority of cases, the collapse commences beiwixt two o'clock in the iimr- ning and .six A. M., or, in oMicr words, at Uie period of the Iwentv-four iiours when *he atmosphere is coldest : froio which it appears that external cold acts as an exciting cause to the state d asphyxia. l>ut independent of this, we have seen that the degree of force, with which oxygen can remove carbonic acid through the medium of a membrane, depends, ma great de^jrec, on the tempc .iturcof the t\v<> fluids. — Now, when the teniperature of the blood is so very Fow, as it is during '.he state of collapse, and if the air which tlie patients then breathe be also cold, the small quantity of carbonic acid wiiich exists in the black venous bhiod, will not be attracted by-tlie cold air, and consecpiently this of itself may be one cause of the sudden death. Ninthly. It is necessary to be very careful not to dismiss tlie patients as cured until they have been, at least, several days completely out of danger. Two of the cases which proved fatal in the prison, at Cold-Bath Fields, were lost from our not haviiu^ been at that time sulli( ; ntly aware of the importance of this. , ,, , Tenthly. The patients ought not to be allowed to use one jlarticle of solid or indigestible food, for at least Jivt days after they have recovered from the state of colkipse. We nearly lost more cases than on-;, ii.;e fcr life, by i:'j(.ctii;ar a <:.]'an' f]-ii-l iivId the veins. Tiie ejections, and every other souicc Oi impurity ought to be immediately removed from the room where the patients arc ; and the intected ward. 1 ou'd be fumigated at least twice a day ^v• J gun- powder, and every panicle ot suspicious clolh.ns. beddii!"-, &c., should' be boil- a. for at least half au hour. 10 a strong solution o( common soda. 'lb. so v\ ho are recovering from tl>e disease are 1 - able to a relapse, and such cases are general^ fata! but from what I have seen, my belief .>, 'I'f «n'^^ who luivecempletelv r.eovered, alter having had the Ciu lera once, Uave an ui.munity from any lutuie at- *1l,:';il:;: 'is':i";-Une of the treatment and mea,,s which were used: lii- following is. 1 I cLeve, a l.ui f Uitcment of the outliOL- oi the result ;— ■ The three first cases which occurred In the prison vere treated by Mr. ^^ "'^V'^' '^"V ' f C- Z tbev - u ith oi)ium, brandv, the hot-air bath, c^ c. , but t .cv uliaie.:it.eravery li.ort lUnoss. Almost^ .inmed.- ate'v alter this, anoth: unwell at the time. 1 his gen- tleman was not then aw.'.re that any "^^ l";;,'i"" .^i"' been n, a'"' [''.•^''^ ' '"J- t!,c result was, tl-.at thi. patH;;:t vu.s past ='•' » !'=;YJ, recovery befoieeilhevMr. \> akefield or n^ >elt saw Hm in tlie m.uning;-con.eque:,t!y. m t^hctmir cases thatw.ne treated in the prison in that waj tlicrc vere four deaths and not one recovery unc.er fbe common ])r.actice. . , . li may be proper to state that previous to the be- -rinr.ino-of A.nil there were no bowel complain s m The i.riM.n, an'd the vn h.^le of the pri.soners were theii as healthy as they generally are at that sefuon of he vear. The first ease that was r. ported to the Loa,d of Health ocenrred on t!:e 5th H {>V"'?,7/''« ^'J'"^ fv..tment was commenced on the 8th There were ill a" a» that i'eri< d about one thousand t'.irce bundled souls in the prison; a.d from the 8th of npnl to the cessation of the lir^t epidemic, there -.vere at lei.st one bundled ie.,li\ idual.s who were evidently more or less, under the intlmnee of the poison. In about fifty of the above cases, the patients weie atf;icked with'a bowel cmiplaint and most of them bad, m-..eor less, irritation at the :loioach. 1 he fluids that we;e ejected, were gencraHy deficient m bile; and the bowel ccmiplaint was attended with the fo!lov,ii):i i»eculiaritic.^;:— ■ , . i • „ .„<. First.' The iue lii.ation to go to the night-chair Came on more suddenly than it generally does ni cases ot common diarrhcea. Pec-ndlv. The ejections wore less bilious than in common dianlKoa': and opium, chalh, astringents, i\ /■ _ 1 :.. *.., ,. r. r^t ^Lnivi infill •Vc. whicli are genorally u ]i!iwel comi)!:iints, v.ere (ul in ca^^s of common no use in checking the o((^\t•i t '.'inpijini:', ,.*.*'.' - ^- , dianho^a. which occurs when the patients are under the influence of the Cholera poisr.n. 1 hc-^e remedies were ehieflv u.srd in c.^'s vJueh occurred onto the pn.en; but" fh.'V evidenfiy had no eftect in checking the sp diavrha i wbieli ocrurred in the fittv eases in the prison to which I refer, "l he whole of these were im.nediatelv put under the saline Ireetmert, ar( this .ii.nnarf.i to rive :in inr.-icdiata cLctk to tne di-tase, ■>-.d I 1 el'cve it «-a-! owing t'l iiu- saIhm- renK-dies. m vv'll -- to 'he eireuvnsr:'tice of their being cnnstantJy ^ . :^ ., „..„.„, ro,,;,,,- ,.t wMl i;.kencareof.fiu-.t n«>t ... ,i ;-,. i-.--:-..-^ .v}r: \<- v< ■■:■[■'■ ■ coa^^niiCiuiV, though they were constantly breathing in an atraos- 12 (inert ««Ripl«t«ly ii-nprcgiiatad with the |/i'^s»a, yot uot oB« ot thctn Vas Ui»t. There were also about thirty-one similar cases, iu which the above symptoms were sti'.l more distiiicUy walked, and in muny ot thi:no the bowel complaint was more or less accompanied with cramps. I'hesc were all treated in the same way with the non-purga- tive salts, and in three, four, or five diiys, every one of them were sent from the observation ward, as we believe! at the tune, completely out of danger, lam lorry, however, to be obliged to add, that t\\ oof these ca«e» which had been unfortunately dismissed too •ooD, and sent back as cured to the cold wards of the prison, were attacl..ed with collapse during the nisht; and before they could ap;nin be put under the sanne treatment, their stomachs were >o irritable that they fiould scarcely retain evcnateaspoonfnlof water; and both these cases proved fata! in a very short period from the comuiencement of the collapse In Rddition to the eighty-one individuals already referred to, we bad about nineteen cases iu tlie pri- son, where the patients were either attacked with the disease, and got into a state of asphyxia in the cold wards of the prison during the night, or where the stomach was so irrit-ihle in the first s age that it could not retain the stronger salts. In a' most every one of those cases the disease assumci.1 a most ma- lignant character. These were all treated with ilie energetic non-purgative saline remedies; and in the nineteen maiignai.t cases to which I now relVr, we had eighteen recoveries, and only one death; cinsa quentiy, the total n-iraber of patients, who were all evidently under the influence of the Cholera p;»ison, was about one hundred, yet in those cases where we trusted almost entirely to the saline praeticc, wc had Only three deaths, and iiii)ety-se\ en rfccoveiies. Jn corroboration of the above slatement, I will iu- Bcrt here the following letter from Mr. Wakefield, which was published m the Medical Gazette for April 28, 1832. ['In further illustration of the treatment which has teen adopted in the cases of Cholera which have oc- fcarred at Cold-Bath Fields, we insert the following coramnnicRtion from Mr. Wakefield, the intelligent •nd highly respectable practitioner who has the medical charge of the prisoners.'] -Editor of the haviriK uccn similar oasftJ in the e«mm^ricam«ii-. transtormod rapidly into a state of collapse, ray con- vicLi n is that every one of those ;»atienti were more o- less in serious danger; and I bijiieve als.) that, had they either been Ictt to tnomsalves or improperly troated, the mijority of thesa cise^i would have rutt into a state of c:);'ai)5e, Perhaps iu a taw hours; in- deed 1 h ivo little &.>XJ\. th.it th ', onL'-ii.ill ot tUata wou'd h ive been l;ist under the i)raciico which is ge- nc'-.iily ad'«pted in the treatm;nt of this disease. 'in iependently of the numerous cases where the inJividu.ils were laboring under thj premonitory sviaptoms I have now had twenty-five cases ot deci- de 1 Ch^ilera. where the patients were in a state ot collapse; and in justice to Dr. Stevens, who suggest- ed the uie of the saline remedies, as well as Irom a sense of what I owe to the pu!)lic, I conceive it my duly to ^tato.that after havin.; seen both the old and "-"new treatment fairly put to the test, 1 am lully CMivinCv;J. ♦hit the saline practice is mit only the most scientific, but decidedly the most successful that has vet been .; '.opted fiir the cure ot Cholera; and fr.im what 1 have se in, my conviction is, that it this trea'..iont be fairly ani ex:ensively tried, the mnrta- litv from Cholera will b.> greatly dimmished. './hen used It an early period, ic either prevents or arrests the provr-ss oi the fatal symptoms; and even whcri Ihi-* tivatmiitU is not used until a later peri.,ci ci the d'is-asf, its ellocts are distinctly marked: and I may saf'lv su- that 1 have seen several most malignant casx's recover Irorn the state of v..llapse under the s.i- line tr. \traent. where the patients, 1 doubt not, would have di.;.l uailer any other practice. ' We have n.iw upward ot twelve hundred persons in this prison; and IV(mi the commencement of the disease up to this date, there have been nearly one hundred cases where individuals have been more or less evidently laboring under the influence of the Cholera poison. Tweuty-five ot these assumed the n^ali-nant character of the disease, bavin- the majo- rity of the symptoms described m the printed docii- ment issued by Dr. Macann. Four of the first cases, as before .•bserved, were treated in the cimimon way, and every one of them died. All the others, howe- ver wer > immediately put under the use of the sa in© practice as recommended by Dr. »•«:;«"''; ^"l"."^"* the whole nuirtber who have been thus treated, we ' Lansdowti-Plaee. Brnnswick -Square, April -Jo, 1932. • 8iR,~^So much has already been written on the tubject of Cholera, that I should not now appear be- fore tne public, but from a conviction thai the facts which 1 am about to state, if generally known and properly authenticated, (which they can ensilybe,) must be usf l^ul to those of the profession who in fu- ture may »■■ cal cd upon to treat this new, but most malignant disease. 'The first case which I saw, occurred on the olh of this month, in the prison at Cold-Hath Fields. Three other* quickly followed, and were immediately put under the common treatment: these four patients di- ed, aftc a short illness, with all the symptoms ot Cholera distinctly marked. ' Soon after the commencement of the disease, a nnraber of the prisoners were attacked with marked symptoms of derangement in the L'l'stiic org.iMt; and tss ail of these cases occurred in the infect...! part of the prison, it is more than probable from this, as well Ri the genera! appearance of the patients, that the dinrrhcea with which they were attacked, was the e(- fwt of the poison which' produces Cholera From hrve'oniTha'^'three deaths from Cholera, and two ot "k sc were rases of relapse. I may state also, that within the last lew daj s I have had one most raahg^ naut case in the New Prison at Clerkenwell, where the patient was in a state of complete eollaj.se before I .aw him. flis extremities were cold ; h.s pulse at the wrist was entirely gone; he ''^^ the h,h"fr» voice, and his tongue was icy cold 1 h s man, like those in the other prison, was immediately put under the 'ialine treatment with the happiest clfects, and I consider him now in a state of convalescence. ' 1 am. Sir, ' Your obedient Servant, ' H. \V\KBriier,D ' It has been observed, late !y, by individuals who are .nill anxious to cling i- 'heir tormer opimons. that the above cases occur: -^ at a pc«'"^'» .when the d s-iso was on the decline in this metropolis, fhese .r.'^ntl^mcn for-et, however, that London is not a vil- hn-, and that though the disease was then decreas- " in Southwark, Tlotherhithe, ^c. ing e, eri.se before cold; his pulse at had the Cholera I This man, like lediatcly put under )iest cflfects, and I palesceace- t Servant, I. \V\KErrBt,r> ' Y individuals who r former opinions, X period when the iietropolis. These London is not a vil- I was then decreas- .^c, where it first was onlj' bei^inning ?here the prison is r.«t important £»ot ■srluch the stiid individuals forget to notice, namely, that almost every one of those patients, either in or out of the prison' died, who were treated in the sune quarter and at the same time with the remedies re- commended by the Central Hoard of Hoai'h; whilst the fact is equally certain, that almost every one of those casBj rec()verec<, which was treated , either by myself or others, with the non- purgative alkalins salts. There were other individuals, even lately, yfaohid to little respect for thiiir own reputation as to d^ny that Choler* ever existed in LonJiin; and those arj equally in error who beiieve, at prjsent, that this disease has ceased to exist merely beciusj the BotrJ of Health may not think proper to puJlislia:! acc.iu.it of the cass-'s: but the truth is, that in ni.uiy parts of London, the cases, at this mmnent, ;iie as numjiom, a!id jus.t as viiu'.ent, or perU.ips even more so, tliaa those thai occurred at an ea.liir pc: ioJ In the first irruption of Cholera which occurred In the prison of Cold-Bath Fields, the disease was con- fined entirely to the males. It cnu^nMC^di in the be'^innin-'-of" April, and thj last case was dismissed cuTed on"the SJlli of th.} same month. From this pe- riod lip to the 3J of .lune, there were no new cases; hut on that day it broke out a second tiins. In this instance it commenced amon'zst tlie feni,;!es, and soon spread almost a. I overthe whole ostablishnent, and is now at this moment much more virulent, and I am sorry to add. raoro f.ital, th.m it has ever been at any former period. In the first cnse that ocsurreJ, the woman was attacked on the night o: thuSJ.anJ died on the 5th. Her sister, who attenJed her, was next taken ill, but recovered under the saline treat- ment. feoon after the commencement of this secomd ir- ruption, I called at the prison, and there were then foiivcaies. These were under th;! saline treatment, and as they were all doing well, I fUd not return.— On the 21st of June, however, I rec ived ft note from Mr. Wakefield, requesting me to meet him at the pri'^on as soon as possible When 1 went there, I ff ■ about twenty p.fients with Cholera, and out of thi ; ..umber five were, actually dyinnp. There was one obvious canse for this, which 1 do not feel myself at liberty to point out, — suffice it to say, that it ori- ginated from either a mistake or neglect on the i)art of the nurses who administered the medicines. A saline fluid, similar to that which had been used at Leith, wa? injected in two case^, into the veins; but ihe one died i-lm.ost immrdiately, and the oth^r, though h p. rallied for a time, yet he also ultimately died.* From the commencement of this second irruption there have been, in all, abnm ei,!i;hty-onc cases: many of these have be ■ oi'the most malignant description f Out of this nnni ,t there have been thiiteen df'th.-. and the other sixty-eight have cither recovered or are now apparently nearly out of danger; but new ca- ses are liraiight into the infirmary almost everj' hour. They are all of them, howov.;r, now under the most energetic trentinent, and I sincerely trust (hat the mortality of the disease will be arrested in its pro- gress. \Vhen the Cholera was first rasrin'r in the prison at Cold-Bath Fields, the disease broke out about the same time amongst a •olooy o/ilmetfUit H&Tub*, wW resided in the neighborhood. The first cases war* put under the care of a physician, who had charge of a Cholera hospital in that part of London . 'I hesa- patieiits were first bled, and then most scientificalljr treated with opium and brandy: but the result was such, that the other Italians who were taken ill about the same lime, refused to be treated by the Cholera, physician; and fortunately for themteivos sent for islr. \Vhitinortf, an intelligent practitioner, who live* in that neig.ibnrhood. This gentleman had seen th» elficts of tne saline treatment in the prison, and af- terward trusted eutirely to this, m every decided case of Cholera which he attended. Since then he h.is had in his own private practice about thirty Cho- lera patients, chiefly amo.ngst the Italians, and out of this number he has lost only two cases, end tared a- bout twentv-oight; and this surely is no common oc- currence, particularly amongst the poorer clastes, v.hL'ie we uo not always see them early, and where we are not certain either that the medicines which we proscribe are properly administered, or that they are not occasionally used at the same time with other improper agents which counteract the beneficial ef- fects of the alkaline salts. The first case which Mr Whitmore lost, was that of a v.-oraan whose husband had just died from Cho- lera and this patient had not used the saline powders which he had ordered. The second unsuccessful caeiy was the almost immcdiUe result. ♦You will observe, Sir. I was very tardy in put- ting these patients un.ler the saline treatment; but I must beg to observe, that this did not arise from a eonvictiononmy part that they were not cases of Cholcra,'for, perhaps, a better marked case than the lir.s-t was never witnessed ; but 1 was anxious to try whether, while bile continued to |)a.s into the duo- denum, the dianha-a and vomiting could not be ar- rested l)v '.inv other nu%insthan the saline medicines, as recoiiimended by Dr. Stevens which 1 had seen used with so mnvh success m ihi; prison at CoUt- Uith I'iekls. 1 think, however, you will a-ree with m'e, that I gave chalk and opinni (the usual reme- di.V; a M-iv fiir trial in the above cases. 1 am he more partiJnhu- m pointing out this, as my belief noroisthul the non.purgative a kaline salts are, as Dr S. asserts, mmo useful in ivlievms the sickness at the stom:ich, and ebet'kin- the diiirha-a than common astrin'rcnt or ahsorhont me.licires. 1 may also obsei-A e, that these ca>cs .show that tr.e rice-wa- ter evaetiiti'.'iis are not invarid.ly present in the ear- h sta-o oil'ie Indian <;hn|era; andlrom whatl have Jeen of this malif^nimt disnase lli.M.gh 1 b.hcveUuit no treatment will be suooes^lul m every rase of co - lapse, vet mvth..ron-l. conMCt.on is, that a much (-realer nnmbiT of patie.nts Will he saved by the sa- line treatment th.r: by any other practice that has vet be n tried. , _ . , " '1 have been thp more induced to cnmmnnicate the above facts, as I observed that .,thers (even the Central Board of Hoalth) are stdl rocommending the use of medicines which have been lox;'; "xeil, ,fnirly tru:iL mul found to be not onlu w.it/t.-.s but actually i)ijurious. « I am, Sir, ' Your obedient Servant, 'HkNUV WHITMORE. Cold-Bath Square, May 21, lii32. '1 mav add, that on last Sunday night, just before n>idni"lit, I was called on to att.nd another female, who resides in the same parish, and .at no great ins- tance from the above patients 'Ihis woman had been sufVering for two or three davs (n,m vec llo.MU'al in Greville street; she b is sin.s" been dismissed cured, and is now in hetter health than she had been previous to 'Sooii'aft'er this case occurred, seven other patients wereadmi:ted int. th. same hospital, s.k of them were fr.nn Hine-cnrt, SailVon-hill, and ojk- from IlollLi-n; two of the nn-ses who attended these pa- tients were also attacked. These patients wore at- ..iuled l.v Mr. Whitmore, Mr Marsd.ii. and my- seli-onsman, who was hronaht t.. the ho.,- t:.. m the last stage of collapse, died soon after admission. VO case th:\n the \nxiniis to try into the duo- ild not be ar- iie mciliciiies, eh 1 had seen ison lit Cold- rill ai^ree with e usual renie- es. I am the as my belief e suits are, as >i the sickness iirrha-a, than ciiu'ti. 1 may at t!ie rice-wa- sont in llii; ear- ni what I have . 1 b.'lievethut rj' rase of col- !, that a much vcd by the sa- ictice that has n communicate licrs (even the ommendintnthe n;^ iiHf.il, fitirly hS but actually rvant, Wmr.MonE. gbt, just before another female, n no ^"jreat dis- bis woman had fr(/m vomiting ir the first time, vas also exceed- iviu!?. Hlie was .tmcnt; reaction mint in all the inlinued to im- iind I have now 3C0Vcr. She is, uerely from the [Mil previoU'f ill j;reat mental an- ^ne of wimm had Sunday, the same 1 did not see ei- hem were repor- Cholera. rVhitmore's cora" i the saline treat' >pi!;\l in Grevillc ed cured, and is been previous to vcn other patients lital, si\- of them II, and OIK' from ttended those pa- patients were at- Tarsdeii, and inv- .,( the hosj;'tL.'. in n after admission. We also lost one of the nurses, a very siuut woman, who was attacked most violently, on tlie Ulst o Mav She was put under the saline treatment, and oniMondai', the -Uh of June, was f;o far recovered from the state of collapse as f be coii,.ideied()Ut )t durer. The same evcnint;, about >even o clocic, shc'was attacked with a violent cr.uni) in the s.i- mach, which was probably followed by mflanimut. m and organic disease in that organ. Alio- this ;he ir- ritation was so ;;reat, that even cold water could not be retained, and she died on the evenini; ot the ()th. After her death it was ascertained, that almo:,l iin- medialely before she had been attacked with the cramp in the stomach, she had eaten a ivliole lobster (probably a bad one,) which had been bn>u^ht iti to herclandestinelv bv one (d' her companions. 'I his woman, however, and the man, to whom I have re- ferred, were the only two patients tiiat were hist in the above hospital, ii-oi.i the i)criod they commenced with the saline remedies. And 1 regret tluil in the lir.'it case which we lost we did not inject the saline fluid into the veins, nor try the clfect ot a veiy lar-e ... *• • ^ il.-. I.. . tU ^. I dose of a saline solution j^ivm iniernally ; for tli.s I believe may be used, not only with impunity, but with great advai.tajie in such cases, The above case., occuired in a hospital into which the patients are generally brought very late, and of- ten in the very worst foiiiis of the disease; yet had it not been i\,v the imprudent conduct of one ot the nurses, out of ten maliL'iuint cases of Cholera wc should have saved nine: but, even as it was, out of the.-e ten, eight patients were saved ;and ihis is very different from the result whichattended the common treatment in the same hospilal, lor under that, I bc- lieve, more than (nie-half died. 1 may here ..'serve that the saline treatment was adopted in thin hospital in direct oppositu.n lo tbe opinion of the medical gentlemen (.f that establish- ment. The remedi^^s j.reviously used had not l)een so successful as exj-ectcd, conseipieiitiy the saline treatment was adoj)ted. Mr. Whitmore, who lives in the neighl)orh;,(.d, was called in for the express purpose of seeing tliat the plan was propeily pursu- ed. This gentleinan reijuested me to attend the ca- ses along- M-ilh him. which Idid. Mr. Mai>den, the surgeon to the establishment, also ai tended the cases with us. 'this gentleman was evidently opposed, at first, to the saline practice, and, perhaps, the more so, as the treatment had been in some measure forced upon bin. by some of the governors oi the hos|)ital, I bad, liowever, the satisfaction of hearing Mr. Mars- den make tbe follovving manly declaration m the presence of fi.ur other medical gentlemen. lie sta- ted firmly, " that no pcrs.ni coidd have tbonght less of the saline treatment than he did, until he had seen it tried; but after what he had witnessed in that es- tablishment within the last fifteen days, that a man must be more than a skeptic wh.> would ,.iuse to admit the evidence of his own senses; and from what he had now witnessed, he was willing to admit that the saline practice was doi'idedly the most success- ful that he had seen died." The saline treatmeiit has now been used, in that part of L(nulon, in abnut two hundred r.nd twenty- six cases of Cholera. Out of this number there have been alxjut twenty deaths, and u[)\vard ot two hun- dred recoveries, "it is true, however, that many of these were not cases of collapse; l>.r this, where wo saw them early, was generally prevented, by the im- mediate use of the saline treatment; lot from what 1 have seen, my conviction is that, if these cases had been treated with the common remedies, the ouc- halfof them would have been lost. Or, when wo compare the result even in the most malignant *^"'^'* with the average mortality not only in London, Dui in other places, ii will be found that the balance is greatly in favor oi'lhe saline treatment I m'ight bring forward many additional facts on this sui'iect, hut I trust that 1 have already said quite enough to induce any impartial j)ractitioner to give the saline tn atnient a fair trial in Cholera; but as 1 have said before, my belief is, that there must he a very material change, both in the theory and the practice of medicine, before either this, or any other treatment, will be generally successful. I should feel myself wantii g in a proper scmjc cf jrratitiidc were I to omit this opnortunity of expres- sing the deep obligatitn which 1 leel to Mr. Wake- field, whose crmduct has been beyond all praise; and were it not (or this gentleman, it is very proba- ble that I should not have had an opportunity of try- ing the etlcet of this practice in the treatment of Cholera. I bad previously made several attempts toward giving it a trial, but in some of them I met with such discouragement, that I was compelled to give it Jip almost in'despair. I must also take this (>pjiortunity of returning my sincere thanks to the magistrates of Middlesex, for the liberal and kind manner in which they have been jileased juiblicly to express their approbation of the success of the treatment that was used in the prison which is under their care. 1 have also to thank them f(u- their kindness to Mr Crooke, who having seen the saline treatment extensively used in the West India fevers, was anxious to see it get a fair trial in Cholera. When the first opportunity occur- red he relinquished, for a time, his studies as a stu- dent; and though he had a firm belief that the dis- ease was contagious, yet he cheerfully volunteered his services, and remained almost constantly in the prison, both day and night; and to his unwearied at- tenti(ui to the sick, but above all to the exeniplar;r conduct of :Mr. Chesterton, the governor of the pri- son, I believe we were indebted, in no small degree, for the success of our practice. I have also to express my thanks to Mr. Whit- more, as well as to Mr Maisden, Mr. Spencer, and other gentlemen, not only for their having given this practice a trial, but also tor the manner in which they have expressed their conviction of its superio- rity to the methods of treatment in general use. I mav add, that the candid and manly conduct of Mr. Wrikefiel I, Mr. Marsden, and the whole of the gen- tlemen whom I have met in that quarter, is to me some consolation for the illiberal and unfounded at- tacks to which every individual must expose him- self who ventures to appear bet, ue the public, even when be is actuated by the purest motives, or when that which he states i"s most strictly correct. But as I have formerly said, truth, whatever may as- sail it, will ultimately maintain iis course, and those who attempt to impede its progress, though they may succeed for a time, yet they will at last find it as hopeless a task as it would be to prevent the inount:iin torrent from finding its way to the sea, in- to which it is ultimately to be received. ON THE INJECTION OF SALINE SOLUTIONS IN CHOLERA. The injecting of medicated substances into a vein is neither a new nor a difficult experiment, and when we once find out the proper remedies to use for cu- ring a disease, the mere act of throwing it into the ves'ieU is exceedingly simple. '-JJBfc^-.' ^■-IW^' 16 Th« op«rMi«u oi iDjeciln2 m ta)in« tolution into the veins in Cholera «-a«, 1 believe, fir»t proposed by Mr. Smart, in a letter which is dated Cranborne, November 11th, and published in the Medical Ga- aetteliir the 2(ith of November. ISai. Mr. Smart appears to have had but little faith in the cnmruon remedies J for he asks, * What are ^encbection and calomel expected to eifectl means, the best adapted, in my opinion, to linally cxiinKuish the stili dicker- ing Hame of life!'— and after alluding to the action of the salts on the blood, as stated m the pajier which was read at the Collct;e of Physicians, he then adds, • I would therefore propose, not only to try the in- jection of the above (namely, the saline) remedieo into the veins, but also the transfusion of pure blood.' Mr. smort also announces his inltntioii ot tryinj; the saline injection, should circumslances reiulir it ne- cessary. 1 must observe, however, that in his hands >t would not have been sncces...ful, forhe appesus to have but very confused idea- vinthis subject, and be- int; misled, as it would appear, by tiu; ojtinioiis of Dr. tClanny, he actually proposes to inject carbonic acid at the same time, into the fiins. He also .recoia- mends the use of brandy and opium, so that what he would have gained by the saline injecliims in the treatment of Cholera, he would have lost by the car- bonic acid, the opium, and the other improper reme- dies which he proposes to use. On the 3d ot December, that is a week after the above letter had been published, a similar prop.nsal was made by the Editor of the Medical Gazette, tinly this better informed individual did not recom- mend the injection of carbonic acid into she veins, for the purpose of giving an arterial coltir to the black blood, which is so invariably met with in cases of Cholera. REMEDIES TRIED AT SUNDERL.\ND IN CHOLERA— OTHERS SUGGESTED * We mentioned last week, that a hog;shead of brandy, already mixed with laudanum in due pro- portion, had been furnished by government for the use of the Cholera patients at Sunderland We re- gret to sav, that little benefit has been derived as yet from this, the volatile oils, or any other method of treatment which has been tried; nor has any thing occurred to throw any additional li}:ht, cither on the nature or treatment of the disease. The inhalation of oxygen has been tried in several cases without any apparent advantage; the pnlse, indeed, rosea little during the inhalation of the gas, but immediatc- iy on leaving it oft, ;rie sinking of the pulse was mmd to be greater than before its use. Some ni- trous oxide was in preparation a few days ago, and ere this, we doubt not, has been tried. We must confess, however, that we entertain little hope from this class of remedies, because the lungs do not act upon that portion of oxygen which the air naturally contains, it having been long ago ascertained, by Dr. John Davy, in India, that only from one-fourth to one-third of (he proper quantity of carbonic acid wat found in the air expired by thrrse I 'oriug under Cholera. A galvanic battery has been rdered to be lent to Sunderland, and the effects of this mn.st pow- erful agent are to be ascertained. The experiments ef the late Mr. Finlayson, at Ceylon, thcugh too limi- ted to warrant anv general inference, were certainly nth a» to justify further trial: in one of his patients, wfco was "Moribund," a galvanic cnrreht from a •0^1 battery wm passed through the ehtst, the man iaim«dlat«I-v re'jri'td, and uKimately recovered Tbt same gentleman also states, that in (tvn out of three cases, the functions of the lungs appeared to be res- tored by stimulating them with ammonia, volati- lized so as to impregnate the atmoophere with itt fumes. ' ll'e eai-nrxtly recommend a trial nf injecting me- dicated sola, ion.i into the veins, particidurlij some of the neutral sulti, «s muriate of soda. No one who ever saw a leech disgorge its black blood upon salt, can fail to have obsiTved its instant conversion into 1 bril iant scarlet. That the clange of color carries with it a correspondina- change of character, we do not venture to assert: uut it is at least worth ascer- taining; and wc think that the views of Dr. Stevens, ns to ilu- oflrct of salts on the blood, to which we have ropcilcdly culled attentiiin, ou^ht to be put to the te^t as spci'dily :is possible. It affords no mean claim to the iiivcstif^^'tif.n of these doctrines, that a man of Di- Front's hich character shou'd have declared the essay containing them, and which was published in this journal, to be one which, spite of some imperfec- tions, seems to contain the germs of discoveries of the last importance to mankind' In the paper which was read at the College of Phy- sicians, 1 had stated that the iiMuia! .salts of iho hood woie not merely the c?Hse of its red or arterial color, but iinc; chief 'ciiH«e of its stimulating po\yer. 'I'hfcie were some v.ho deniel«rii bin alinnKt una- voidably led praclitior.crg to inquire, wlietlu-r tlieic to-yet any untried expedient wiiicl'i tni^lit by possi- bility b« u.itful. About a m-^'Uh u;o. baviu; piMcu 17 dra\''u bioiicl, j mix- obtaininp; Ihu ii:nv red Kucressive supplie* ol'ncwlv tditwilh different i^nhstancts, ^vtll-known general result of reiulcrinjj; llie fl.iid dark ftad thick by means of »tio:>K «ciJs. mil of a bni^lxt »Ciu-'ct !t/ means ilf the neutral «.il(s. The tiiiusiiioii fi'om thuMiuIenahueofvoiMius to a vi-nniii- n tv.icwi- C»?»ng tliiit of arterial blood, is ceitainly a li'miirlculilc pTieiiomcnon; and those pri'sent agreed, th.i' if any tbing ««ai to be hoped for fi-nni elFcctiiig a siinilar chaii>;e in ur;;ent cascft of ClioltTa, it was most ra- tionally to lie attempted by direct iiiji'Ction into the Tcin«— a process which Mr. Arnoit und^'rlcoU t • perform, photild circumstances occur to render the j^PncecdinR fvasiibie,' &c. &c The above letter was written by Dr. Macleod ; ftnd it i» to be regretted tint tbi.'* proposal was not *ooner put into practice , for if it had, tlicre is little rfoubt tlial many individuals would have been saved who have since fillen victims to the dmease. I'ut, unfortunately, the benefit which has since been deri- ved from the saline treatment was prevented for ft tiraej partly by acircum^itance alioaoy r ferred to ; for the EdUor ofthc iMi'dico-Cbir. Review not only denied tnv statements in the public journals, but he candidly "confesses th.at previously to their publica- tion he had senia copy of the Trinidad documents to l3r O'S .for the express purpose, .is he says, of pre- rcntinc; this gentleman from leaning to my side. 'J'he propo.tal for iiijectiiia; a saline fluid into the rein* was first put in pn'.ctice by Dr. Latta, of J^eitb. We are not informed at what date it was fir«t tried; but the letter commnnicatinq: the first in- formation on this subject to the Central IJoaid of Health is dated T.eitb.' May I5lh. 18.32. The result of Dr. L::tfa's experiments is well known. It has a'sri !)cen since (lied by others. In these also there lias been some recoveries*, and several deaths; but J sincerely trust th.m the fiilnres in fulure will be less frequent. The -Mbiimen which has been used is Jiltocethor unnecessary, for the blood in Cholera has mnr;' (rinsisfence than the blood in health. The «har"i-p'^inted si'vei" instrument whieh is generally uttached to Read's nppiratus is too sharp at the piint to be introdnred with sa'ety into a vein; and my coiniction is. also, th.it the sa'ine fluid which has been used is too Hrn'e ii ninntity and not snfficient- Irsfrons;; andthis, in all probabili'v, has been one chief cause of the many failures We know it to be a fact, that when animals are killed in a state of ex- bsuation. or immediately after they have been taking very hard exereiset, a very lar^e "portion of salt is then required, on purpose to preserve them from the putrefactive process, and when the blood, as i n Cholera, i« not merely deficient in saline matter, but is also in a diseased condition from other cause. It is then essentially necessary not onlv to supply the blood witk the natural saline ingredients which it has lost, but to tbrfiw into the torrent k lar^«r yv^ portion than usual, for the purj>osc of enabling it ff. resist the destructive effects of the morbid poison' 1 hnihjectioii, however, of ssline fluids dircetlj- iiito tl'.o blo[\i is a* yet only in its infancy. I Ivav* n I daubt that i: will be the means of »aving many livi's ; but it wilt seldom be required where the pa* tients are seen early iti the disease, and proprrlv trcatLd ; consequently, where one individual will be preserved fioin Cholera by this operation, a llion- sand will be s.iveJ by the internal use of the ener- getic nonpurgative salts. Tbcr.* is one point of view, however, in which I consider Dr l.atta's ex* p.rimfnts as possessina; an intense value — and that 18, inasmuch as they ailord the most unequivocal ev- iJunce in favor of the o|)inions with resji- ct to the cllL-efi nf salts on the blood, which were first pulw lie'}' communicated to the profession in the paper which was read at the college of Physicians. When the Cholera is left to i t»ell, or even where it is treated in the beginning with improper remedies if is almost incredible, to those who have not seen it, how rapid!) it runs its course to a fatal termina- tion ; but it is cqiiallv incredible, when the diieasa is propel !y treated. Iiow very soon it may f ften be nrrested in its rapi I progress. I have f*en, in some of the very worst eases, where, when a few doses of the saline mixture could be retained in the svitera for a sufficient time to enter the circulation, the fa- tal symptoms were almost immediatelj' arrested ; and even when the collapse has cnmmeneed, after a short period, the pulse can be felt beginning to creep animal heat begins to be evolved, and thotigb tlie patients continue weak for a time, yet they gradu.;.!- jy recover from the state of collapse. In two of the most malignant cases which I liavfl seen, there was no premonitory diarrhoea : and in one of them the bowels had not been open for three days previous to the attack ; consequently. Cholera is not merely an excessive diarrhoea, for neither the bowel complaint, the rice-water ejections, vomiting, nor cramps, are essential to this disease ; and wher« these svmptoms do eiist, they are merely the e^ fects of the poison — for they are merely accidental ; but a »u(I(fen coldness ofttie blood, and of count of the whole bo-y. without nry obvious cause, if, pn^ haps, the best characteristic symptom of this ptstir leulial disease. In the first sfaffe of Cholera, the ejectiong are, l« general, passed with great force ; but as the dite Sf advances, the intestines become cold, and freotent* '7 so torpid, th.at even hot saline enemata can oe re- tained with great, ease : consequently in such e»' SOS, there is no necessity for plugging the rectanDi as recommended by Dr. "Clanny, The rice-water ejections, which are (generally pan* sed ST copiously in the first stage of Cholera, are, likp every other secretion in the body, derived en* tirely from the circu'ating current : and as the e«« lorins: matter of the blood is. perhaps, the only in- gredient which is not drained off in this way. it nat* urillv follows that a given qn.-.utity of black Cholert blood most be more dense, and contain more eolor* ing matter, and less aeruna, than is met with in th« t The following is one of the many facts which may be bron>xht forward to proye that the stronjer eaKe are essentially necessary in the treatment of Cholera. I saw one most interesting case of a fine little gtrt, about nine years of age. where the physicians who attended her had trusted the cure merely tothe ea»lH»" Bate of soda combined with landannm. Under this treatment, the stage of collapse came on »n enddenlf, «nd tn such a degree, that it waa judged oeeeiMry to inject • ealin* floid into tbo veiiw< Tbi* irat doaoi and the child roeovered. * 8m WiUoB on tb» BIaoA -nfi; ■■mr\ ^^dlt. «■*»., Sat the arterial bloodf P*^"/""* ]"* *':i;c£*on a. grlaKcfnot oplv Id C h.-Iera*: but al.o .n the mal r ^V?^ have .ee„ tbat.i„ tjeearly .^v^of^^;;^ '"^fJiJ^^S^r^A^t^^lS^- ^1^^^ teK:;.5^s.^r^-H- Stride l^s^x;^'Vi;«^a^i:^n:S^f^ »„d forcible .%.ntract.on .. Fp»;'f''»y, «^»;»*1 Xids. fute collap.e Jnearly twenty four hour.. Wh.« poisoned or acrid quality '5/frL the bodv Thi he r.-«ction commenced, th« tfr.t ••« «hat he mad. which are in thi* way re nored from »''«, """J^ *,"5 l^^^u speed was to be(c for some .all mackarel. At urine which is seceted at this period is » •" «l'«"e1 This could not be obtained at the moment, ht wa* -J- ;irUh considerable force ''^^^'ir^yifhe bUdder by owed a part of a .alt herring, which h. ate w.tt» - ;;«n on the last drops "f the acrid flmd v^;«J^^^ eri which go far f.ward confirming the oi/'"">n« "I pelled, is probably the chief cau e why this organ ^ .;;\,hich I have already advanced in this work • ;o firm and contracted after death. '^^^^ j^e present volume has already «"««'*• We have seen that animal heat is genemeciana e uui, « » y or ginally intended, the ob* Toivcd in the extreme texture all over th^^^^^^^ ervaTon.wSl intend to^.ake on thi. .ub,e«l ^A^:^:^:^^^^^^^^ ^rZJ wiU prota^y be published .a a ...araf fonu. ierom 55 Cnuiaiacntuai ••*'* 100 Cholem Blood. t«ram "msm tb« body, of in the loalig* all other di«- lequa'-tity of I potviule. I had gentrtl* imarkably th« state of com* louM. When that hr road* nnaekarcl. A« mt, he wa« •%!• t ate witb ft* tionRon ChoU e opinion! on in thi« work* dy attained a tended, the ob« a thie tubjetl leforro. Or. I