*, mi Microfiche . ■^W', ■ «: ICMH Cbllection de microfiches (monographies) J ^ M -i, 'V Canadian Institufa for Historieil Microraproductiona/ Inttitut Canadian da microraproductiona historiqua* TtdHikal and BibHotripliie NotM / Mottt tadmiquM at MbUofraphUliMi ^, Tli* Inititutt hM atMrn^tlMhto obtainllM batt eriiinal copy availabia f or f ilmini. ^aataras of this cony «vhidi may ba biMiefraphlcally nniqwa. wrhkh niay altar any of tha imaiM in ttia raprodifction. or wivifch may . liffiif kantly chanaa tha inual matNod of f ibnint/aria chackad balow. - \'- OCotowrad co«art/ Cowvartvrt 6$ eovltur □ Covart da iwapd/ Couvartura andoMimafAa L'liwtitut a mkrof ilm* la maillaar aMampMira qu'il l«i a M poMlMa da ta procurtr . Lat d4tails da cat anamplaira <|iil spnt pautltra iiniquat dii point da viit, MbUoarapiiiquai 4ui^aii«ant modif iar Hna imata raproduit*. ou q«ii panvant anifar una modif ieation dam la mMHida normala da f iknafa Mmt indi^juit : ' -ci-dataoM. ' '■■■■ ^ ''-:'.:■■■ . \- "-;:■.■:■; ^-^ □ Colourad paipM/ . PUfat .da coulaiir ; Pagat damapd/ ' □ Covir* rattorad and/or laminatad/ CouvaMura rattaiiria at/bu pallicuM* * r~n H§M rattorad and/of laminatad/ L_J Pagat rastiMrAai at/oM paNicultot U -fe □ Covar titia minint/ La titra da couvartura martqua □ Colourad mapi/ ' ' .diktat gAographiqua* an ooulaur ■ . - f ■ ' ' ■■ ■ i ...■: ■'.'■■'". Colourad ink (i.a. othar than blua orMaek)/ £na« da coulaiir (i^. antra qua Maua ou noira) Colourad plitas and/or illinf rations/ Planchas at/ou illuttratiohs an coulaur Bound with othar. matariai/ RaM avac d'autrat documants /I F»ga« diioolourad. ttainajl or foxad/ ^ ' Paga* dicolorAa*, tacNtj^ ou piquiat □ Paga* datachad/ PigatditacMM HShowrthroufh/. Traniparanca •.) , r~y\ Quality of print varia«/ d ■*. Qtialit4 iniyrf* da I'imprastion Continuous pagination/ Pagination eontinua V .' ?'-A' IquM □ 'Tjght binding may causa shadows or distortion along infarior margin/ La raliura sarrte paut eausar da I'ombra ou da la < distorsion la long da la marga intiriaura Blank laavat addad during rastoration may appoar within tha taxt. Whanavar possiblf , thasa hatra ' baan omittad f rom f iliming/ 11 sa paut qua cartainas pagas Manchas afoutAM tors d'una rastauratibh apparmsant dans la taxti,' , ' mais. Iprsqua cala itait possiMa. cas pagas n'ont ; ^pasatifilmAas. '' ■:■ .'^'■- ■ J' .^''- \ :.■-',.: -' □ Inchidas indax(as)/ Comprand un (das) indax '~X^ TitIa on haadar ukan from:/ L* titra da I'an-tfta proviant: □ TitIa paga of issua/ i Paga da titra da la livraison □ Captionof issua/ Titra da depart da la livraison Masthaad/ Ganiriqua (pAriodiquas) dt la livraison Q Additional commants:/ Wrinkled pages may Cbmmantairas supplimantairas: ' filni slightly out of focus. This itam is f ilmad at tha raduction ratio chackad balow/ Ca document ast fi^mi au taux da riduction indiqui ci-dassous. ^«x- D "l*Xr -ttxr ^223r ^mr 12X 16X n 30X V 20X 24X 28X n 32X Th« ttopy fHm«4 Iwrt hat bMn r«produo«d thanks totht gMMrotityof: M«trop6tlt«n Toronto Ref«r«nc« LIbriry Baldwin Koom Tha Imagit appaaring Kara ara tha bast quality poaalb'la eonaidarlne tha condition and iaolblllty of tha original eopy and In kaaplna with tha fllminfl eontract apaolfloatlona. - Orlfflrtal copiaa In prlntad papar eovart ara fllmad baglnnlno wlth^tha front oovar and anding on tha laat paga with a prlntad or ilhittratad imprat- aion. or tha j^ok oovar whan appropriata. All othar origliial eoplaa ara |llmad baglnning on tha firat paga with a prlntad or ilhittratad Imprai- • aion, and anding on tha laat paga with a prlntad or llluatratad lmpra«alon. Thf laat raeordad frania on aaoh mioroficha ahalt contain tha aymbol— «»• (maaning "CON' TINMBD"), or tha aymbol V (maaning "INO'O.' whichavar appilaa. Mapa. plataa, charta. ate., may ba fllmad at diffaraht raductlon Ratios. Thoaa too larga to ba antirahf includad In onaaxpoaura ara fllmad baglnning In tha uppar laft hand eornar. left to right and top to bottom, aa many f ramas ai raquirad. Tho following diagrams illuttrata tha mathod: -■/■ L'a»amplalra fllmil fut raprodult grica * Ja g«n4roalt4 da: >< HatropoMtan Toronto Raf a ranca Library Baldwin Room ;,_: ■..-..^-..v- ■-■■;. Laa Imagaa aulvantaa oHt 4ti raproduitai avac la plus grand toln. eompta tanu da ia condition at da la nattatida I'axamplaira fiim4. at •n conformity avac laa conditiona du contrat da . fiimoga. ;. Lot axamplalraa originaux dont ia couvartura %ri papiar aat Imprimia sont fl|m«s an comrnan^ant par la pramlar plat at mn tarnmiant toit par la . darnlAra paga qui comporta una amprainta d'Impraialon ou d'illuatration. aolt par la sacond plat, salon Id caa. Tous laa autras axampiairas originaUx sont f limds an coihmanpant par la pramiirj paga qui comporta una ampralntd^ d'impraaaion ou d'illuatration at an tarmlnant par la darnl*ra paga qui oomporta una talla ainprtinfa. ...... ^ ' : Vn das synibolas sulvanta apparltird aur la ■'' ■ ■ ■' darni*ra imaga da chaqua microfidha, salon la cas: la symbols -^ signifia "A 8UIVRE". la syhfiboia ▼ signlfia "FIN'\ Las cartas, planchaa. tablaibi, ate. pauvant Btra fiinflBs A das taux da rOduction diffBrants. Lorsqua la dooumantast trap grand pour Btra° raproduit an urt saul clichB. 11 ast fiimB B partir da I'fngta supBriaur gaucha, da gauehf B droita. at da hfut aiybas. an pranant la nomlira -* d'ima0as,nBcassaira. Laa diagrammas sulvants lllustrant ia mBthoda. , 1 2 '1 3 • 7-- 6 -#r ■■/ Mioocorv nsoamOH ntr cnait (ANSI ond ISO TEST CHART N9- 2) 'i ■7: ,-4 A /IPPLIgD JM/K3E Jnc SS-m 1BS3 East Moin StrMi / S'JS RochMtw. N«w Yorli 14609 USA / (M6) 482 - 0360 - Phoo. / (716) 288 -MM -Fox : | < ■ ..»..< - i : :-. .f 'M ■■\ \ r :■ i # K 'J \ \ , _ ■ ' . ' "'•■Vi.'"- -^ : ', ;'. -• ■ v ■ ^ ,. .' _■"•*', ., / ' ->'■ ■ , , ■ . ■ ■ >• ■ ■ '■ : ' ■.^\ ' ■ ■ 1 ■' 1 ' ' _ .' ■ " ■ • ^ ■ Us ^ ■■.-■. \ '** ^' , ■ _ . _^ . _ ■ _ _ '_ ' i_- _ ._ .- _ ' \' ' '. * :■■; ■ ■ \' . ■ ■. • ■ A ■■■■.- ■ • . ( •>, ■ ;■ ' ' •"■.■■'. -\ '■ '■■^■■.■^ -'■■■; '■■^^ ■ :^- ■■:■-':•' >■ ... . -.• . . , ^ANx ■ " *" ' ^■■- : ■■• ^ ■■ ' , 1 ■ ■•-.-. ■ ■ ■■-. ' • '.'_■' /^ ^■"::^t \; ■\ niEDICAL INAUGURAL DISSERTATION •>.:.,. ON ASIATIC CHOIiERAt WHICH, IN ACCORDANCE WITH THE STATUTES, RULES & ORDINANCES , . •■ orrH* ■:'■■] UNIVERSITY OF M'OII^L COLLEGE, ^^ F0« THH ATTAIMIIHlfT or THi DEGREE OP DOCTOR III MEDICINE AND SURGBRV, ■;r. -^ WAM ommnmo vt nMMwmom w THE MEDICAL FACULTY" OP THE SAID UNIVERSITY, ". 1- ■ ■■ ■■■■'. .• . .' ■■■:,:.. ■ ■»■;■',.. : *. OPMONTHSAL. " Ectie aubit rin» taciturn carpilque medullM ' ** Ignis edax, calidlqoeincendit viacera tabcb ' " Ebibit humoram, dream vitalia flisun, " Pcstia^ etin nceo linguam tomn paliito " Cospit ; defiwaoi int qui •udor in artu% " Noqfiiit, atfiueoctdoBlacrymanim vena nfiigit.' LCCAH. astk May, 1835. ^ MONTREAL: XMDCCCXXXV. ^W' ,»i ' ' 1 '> p ] i -Vi ti • 4 V ^ i • \ i-.Vi t TO • -■ •,■--.. 0, JOHN STEPIIENSOnr, M.D. S.C.L. ;_...': I Ac. Ac. Ac PBOrESBOB or ANATOnit AND 1)1 IDW IFE B Y, " ■ * ■ ■ ,• ■ ■ IHTMS UNIVERSITY OP M'ailll. COLLKOE. Il^srBC^KD.SlRt f* The following F^tay h d«dicMed to you, m ttn bumbU ^ Mknowlidgmcnt of the deep obligBtioDi under which your kindiieii, through a long coiine of (tudiei, hat kid me. M'hateter knowledge I m»y have attained of the profeuioo to which I have aipired» I shall ever consider you a« lUy guide, amidst the various intricacies with which the study of medicine abounds. Your promptitude in imparting, could be equalled only by your facility of communicating, and J||co|»de»«fension which you hate always manifested in accommodating y|^Wstructions to tb« eapacitiee of your pupils. ' ^ ^ An intimate acquaintance with the virtues of yoUr private life, has afibrdcd me an opportunity of contemplating a charaeter, which I shall ever consider it my highest ambition to imitate ; and though the period has now come, when I am about to enter on the great theatre of life, 1 tnut that, in icting my part, I shall never lose sight of the worthy exnmple which you havJ afforded me, both in your public and private life. Permit me^ to auure you that I shall never look back on the years I have pasted under your insUuctions but with the most sinoere feelings of 'gcatitud(|. , , ■.l.L:._- ■..--.•,. -;L^.,^-, ^ !■•■»■■ ■ Sib, .-■•,■• 'With respect, ' ■ ;" ■,'"^' Tour much obliged Pupil, JOSEPH WORKMAN. ■/• /. \. •f 4i ■mr\ ' ■■■ '.-' '. ^''i •■i^' K ■■ ' ' ' ■■■■.-■ ■.••.-■-., . \ • > . ■ - ■ - ■/ ; ■ _.■ ■■■;•:■.■. . ■ -■ » r r ■....■;■ '■' I '-' • . ■ ' ■ .."."',' » '■"■ ■" . V 1 u MRDICAL INAUGURAL DISSERTATION ON ■■ ^ . ASIATIC CHOUQRA. ■% 4 ^ .\ IlffTBODVCTIOlt. Ttta subject of the following essay is one which has attracted the attention of the medical world, during the last serenteeD yiears. Jt is a disease, with which, i» this country, we ttare been wofully familiar. Whe- ther we consider it in relation to the dreadful ravages it has committed, the terrific aspect which it wears, or the interesting phenomena which it displays, it cannot fail to exciteui us the most intefise feelings of awe and admiration. ■'• • ■ ■: .:'|-- /■.■■.•■■'::■.,;■/ In its desolating career it has spared neither age, nor sex, nor rank. Its path has been that of Deatl) ; and its ravages have exceeded those of famine and the sword. In selecting it as the subject of my Inaugural Disser- tation, I cannot be actuated by the hope of throwing light upon a disease that has enkbarrassed the roost eminent, and the most saoacious nkembers of the pro- fession. The difficulties in which its consideration is involved, are jiot perhaps the lea^t powerful induce- ments to the Undertaking of the task ; yet I cannot flatter myself with the hope pf being able to ofler any- ■■4 ^ ASlAtlC CHOLEKA. those who *»»5^ observation. . . ^jj,ie to enter The arrangement ^ . cholera. ^M^-^u .'V^itlineof theHistoryotAsi^Uci. V A brief outline oi^^^ .i3' The Causes of the ^^^^ ' iS^, The Diagnosis. ^ -^^^^ _ St The Ptognpsi^ 6 J The Pathology^ 7^ The Treatment. __-^_-.. ./ nI ^ J Cholera, ana '^""r Sydenham »»"■;; u is said Hippocrates, Ar^"\',^l?ed of t^^^ that^m 1669 ana ^^^, ^n 1 i« ^d^tan ; anS m 1730 and l^°"»*"^:«« extent, m *V"**"!-RC88ine the vaUed, to a«.«J*^^2on, an emde«nic 1^^5„ore ftach successive ^^^^Tl-iatic Cholera, prevau«u, M less efder^f L extensive or ej^e^c P^^|„,e , •have no lecoid ot w e j^ j^e, «J™^S nesti- before «>? y?"'®JL,ieTe that *e tiem^»»^ „ been inclU«djto b*ev hi^onan^toW n»»«yg JJ, lences, wh'* *)*, extenaTe dev»9tatmM^» ^ having ««riV^ariS» peno^'V^*™. cSd" the »!*'*5r^'in qwSion; yet ;"'"g,^«hirboth his- ^^^^ Si^ientific »f»>^ " \ . ;\ ^ , ASIATIC CHOLERA. 7 tnricftl and medical writers have been accjistomed to toricalana meai ^^ ^^^^ numerous and ^^'«;i^.^ra4rthatte?rf^^ ^me to time, sprung JnTthrro^toHf the w^^^^ whicK would almost "P fn^ tie irrand hot-bed in which nature has !!°i*il^^ircres of the human race, we feel mchned of fliose mentioned by C;"rj !J"i?"[i,h. i™, ign .. Asiatic Ciholera manifested itself jgfhe ye"' )'»"** iB^re a tanre and populous tow»)out sixty milM nT^V CalSSta, in'Zt part of the «•"""■»» «' ^f"" Ml ciUed the Sunderljunds, or Lowlands,-* hich com- SU {he extensive district lying hetwien thonumerous "uu'statS'to tave*^??^ «m«Uaneously at.se, ve" ortre^pri^inthi»part..ndto ha«radi.te^^^ SJL .urK>undi»g districts. I-Lj-'y .{' "S" ^^ j*«£»if nf Patna. on the Ganges, 300 miles «. w. oi SS^. ttJmiddle of iugustitbegantoattrac ?he trrps Of the Marquis of Hastings oa the banks of ihpsSdeand in the month of November, itedevas- SSc^^^tlStlnpwero neriod of five days, 6000 human bemgshadfallen its ?fctims During the following^mont^ the disease had abated in every par* of India ; but m February 1818, it sS up with wnewed virulence, and assumed t^ dreadful character which it has ever since retemod. StrSing towards the south, with deadly strides, it attaS the most southern ^criht of Hmdostan, and nassed over to the adjacent island of Ceylon, in the Sh of December, "in November of the following 4Lar (18V9) it was introduced into MauriUus; and^n ISmir? 1820, it appeared in the isle of ^ TV» X^ eastward we trace it advancing with untmiig pace, and devastating the rich and PPP"»f"« ^«"°*"f^^»S«S the great Alteian mountains o» th« "orth, tp ^New Holland on the south ; appearing m Arracan in 1818, in Java in 1819, in Canton in 1820, in Pekm m 1821,^ and inthotelandofTimorin 1823. To the westward, we '^y .■ V--: : ;■ • / ' I ;: ■-■.■■■ ^. ■; I ft 8 ASIATIC CHOtEHA. It did ndt advance j. "J^^A^T iFrom the north of its operations »» ^?» ?*'^^^^ Persia it passed to the WderBoft^^^^^ in September » 8«8 it w«^^ ^^^^^ feto every part mouth of the Wolgaji^preadiog ^ g^pended, hv a of Europe, that now seemed to^na^^r^ ^^^^ fcer _ single hair, the ar[fi>| ^^^^ northern winter proved, head. But the ngours ,*^* ?i-"° -d^tence, for it gradu- at this time, uncon^waVU)^^^^^ iations^to the ally subsided, and relieved the trem^^j^^ ^ west, from the jRP^^f^^ u^w Httle Of its P^^ From this time tiUj829jW^^^ gress ; but it never had eef»JJ^*^ ** ^e^ Tiolence. In f^iaaedannuallT,^^^ >the8ummer of 18«9itraged witn ^^ ^^^^^^^^ eastern province of P^««v^^^^^^ the KirghM Jihon, and acro«^ the gwal^^w.pi^j ^^^o^^^ <^ Kassaki, it '*f^*?X^^^^ inontb of Au^^^^ It thefrpnUejs ^^Tartajr m fhe^w. ^^^^^ ^^^ ^ continued here until the^f^^^^ graduallysubsided. Inthe 8^^^ and skirting the Sut of Persia ijj"^^^:.?^* we find it once more western coast of the Caspwn ^^^^^ ^ ^„ Astracban in Astracban on^the ^»th/{,^!iVmiddleof Septenir Spassed^up tl^ Wolga^^B^^^^^^ ,„ ^pHI 138V ber it had reached the city ^^j^^^j^g^ whose devoted it had reached Warsaw, a «ty again v _^ ^^^^ head the powers of heaven and ear^^^^ ^-^^ ttea^^ burgh< f .^. „^ f«iiAw it into Berlin in August, 1 Awards the 80«^ wefcttow '^^^^^^^r it shewed and into Viemia in Seotem^^^ England was in a state itself in Hamburg ; and while aii isnns 1 ■^m^^^^Ai '-'T',^ T ,7." , ASIATIC CHOLERA. » of trepidation, and wasting uscrul time in dkcuAiing measures, to prevent its entrance, the disease unex- , pectedly showed itself in Sunderland. Prom this place It spread in various directions, and before the dose of the winter, it had shewn itselfin all the principal towns of Great Britain, in the spring of 1832 it was preva- lent in Dublin. In the beginning of April a vessel, n^pied " the Carricks," sailed from Dublin, with 167 emigrantH. Ten days after sailing one death took place, and during the succeeding fifteen days, thirty* nine more were added to this one. From this time up to the arrival of the vessel at Grosse isle, the quarantine station below Quebec, only five deaths more occurred. The captaiii reported to the boarding officer .** forty- four deaths, by some unknown disease.** Whatever, at that time, may have been the general opinion, as to> the real nature of this ** unknown disease,*' no one jaow thinks of questioning its identity with Asiatic Cholera. '• We have had, since that time, but too many instances, perfectly similar to this, of the appearance of Cholera amongst emigrants on board of vessels bound to Que- bec ; and the itwful havoc committed by it, in several of them, has been such as to excite the sympathjr of the most heartless. The Carricks arrived at Grosse Isle on* the 3d of June, and while the vessel was Ij^iog thiere, a female passenger died, after three hours illness.. On the 7th of June a sailor died of Cholera ill a boariding- house in Quebec; and on that evening the steamboat Yoyageur left Quebec for Af ontreal ; butyin consequence of being overloaded witlk emigrants^ the captaib was obligedto put back, and disembark a number of them. Several of tile disembarked emigrants were, venr toon after, seiJEed with Cholera The boat .proceeded on her way to Montreal'; but before arriving at Three Rivers, an emigrant named K^rr was taken ill, and died before the vessel came into the port of Montreal. Another emigrant named M*Kee bad been seized on the afternoon of the same day (Juno 9th) ; he was caiK ried from the boat into a tavern near the wharf. The dead body of Kerr was exposed to the public, gaze, during tiie next day, (Sunday lOth;) ana was V ' ? /./ \3. '^♦' ■. ■; ■■I . tv ■ . 1 ^ r- n t, ■'•>■ -i ^^, /ISlATie CHpI-ERA. visited by great numl^vfro^-^ S'tf ^^K^ pewoM also w«n\ *"*Vn^ the B^rro^^^ kmong others a soWier fj^^the ^J^j ? ;o|die^was place Wlera appeared ttot^ighMnav J ^ Longst its first yictims. ^"J-J^ "Ss of the town. , several cases <>ccurredjn var ous p^^ ^^^ ^ ^^^ ^^^^ In several of them communieat^^^^^^ connexion could be traced, but Jf^X'lUh several other cases could be discovered. . ^,^. *^-e«^e bf ^^^ took place occurred, and Hcontinue^^^ it, acme. until the 19th, ^nth^<^^^^ alonff the_„ From M« ^^Sl^wa^^ the disease, in this *'**"™».„ " ^„_ m the St. l*w- „ rapid as we hare seen it •"P^SPwe.y feoiUly for wn«, in wb «h *«S^d ttKSrie oi the Itik of to transmission— we find itiB»«v ^ in seTeral i 9' " -X. ' LSIATiC CHOtERA. li ted by some to hfiv< second case did not strongest girbunds fot 6th; fork would be Mrs of its appesrance along the grand southern tho- rouKhfare, were df so confused and contradlctorjr a na- ture, that it IS absolutely impossible to follow it in this course with any degree of saHsfactiun. ^We find the disease reported iii New York, July 4th; but sow cases are Mid to h^vebeen observed previous to this date. The first case of Cholera in Philadelphia, is sta- occurred on July 6lh ; but as a jccur until the I4th, we have the rejecting the reftlity of that on the oiu- lur It ^w«.- -- kn anomaly which, I believe, has nevir been observed in this disease, that a period T)f nine days should elap^ after its arrival, without the appearance of a seconf case, especially in so populous a city as Philadelphia, \and at a season of the year so favorable to its develop^ment as the first weeks of July. From New York and Philadelphia, th^ disease passed into the various surrouyiding States r^ and before the close of the year, it had^ traversed artmost the whole fece of the northern continent. ; , v^ , In Montreal it contimied to rage with terrific vio- lence, till the end of Jun^ >« **»* beginning of July it remitted in its violence ; Wnd many an earnest prayer was offered that it might be removed from amongst us. The whole city was one scene of mourning and of mi- sery. In the short space of three weeks hundreds had been left without parents, Without a morsel to eat,^aiid without a shelter wherein \to lay their heads--all the ties of nature were torn asutader— death was in every dwelling^ and the wailing of ihe widow and the orphan was to be heard, no matter vWiither we should direct our stepS; No wonder theii that a gleam of hope should beam across our faces, Vhen we flattered our- selres that the disease bad spent its fury, and wais pas- sing away like the spent thundeVcloud from over our heads. But our fojad hopes werfe soon (o be blasted ; for before the middle of July* theV disease, like a giant refreshed from slumber, awaked With renewed vigour.. Hitherto its victims had principallyNbeen from anAong^ the poor, and thc^pper ranks wej^ flattering them- selves on a happy exemption from it^ravages : the di- /' ^..-i^. I(* ;.:^;. IS ASIATIC CHOLERy ^''rh^Sial nomber of deaths in Montreal, from to ine »<>*"V"''J"r^*^i-gaae until ite termination, was breaking ««^^i*^" /X^^aCu 200O were reported ****** H?^ kluXrtTf the real number; formany SSKr/l^^ C^2le/a^^^^^ from ^a^ous oh, ^^^ Sra Te^lJardonaWe^nature, were ^P^^^**? *S3?embS- middte of winter, to l*™"^' *%^°;*™y S«ed dtae.» had *»15?f^Ai^\t*^tg;S' Many that decree of credit to wnicn a wa» cumro ^^ met with ; and it *«L«^'?*'S'^' SJ^X AbUUc theee were attempted ^ ,^."?"H„'fS,e disease Cholera. Froj»fteftMofimnocas^ "Tiir 'l^ '^SSftes^tottSt hid had Cholera Whv should the gentleman have found »t necessary .wj ^*2sfanxpr4tonofso^^q^^^^ «i!^^«J»^^^^^^J^X^''^l^^i would ever dream that the causp of an effect was tne effect itselt ■■" ■-' ■ '■ ■' Ptimarr* or Specifle Caiwe. Few Bt the DfMent lime, wffl be f8un« «>"»"»».™?"S CMera " whu« endemic m this tjountry ;» but it u TOT wrtaWe, that if much that has been wntten™ ■mntmn'^mtimmM.,,: ASIATIC CHOLERA. t$ we mutt, for the pretent; be content with a cnmlid acknowledgement of our total ignorance. The agents which act aa the eaaential causes of most of the dis- eases to which the animal economy is liable, are of a nature far too subtile to be detected by any means with which science has yet made us acquainted. Indeed, when we consider how lar the most refined and com- plicated processes of inorganic chemistry, fall short of those which are performed in the animnl economy, and which are properly termed vital chemical actions, or more commonly, vital actions, we will cease t<» be sur- prised that our knowledge of the nature of morbific agents is so imperfect as it is. With all our boasted powers of art, we cannot imitate any one of the sim- plest actions of an animal structure. Chymifaction, chylification and fecation of the food ; oxygenation and depuration of the blood ; secretion of bile, urine, serum, mucus, or saliva, are processes, of the intimate nature of which, we are as totally ignorant, as we are of the mysterious union subsisting between mind and organi- zation. If our ideas of the actions of our bodies, in the healthy condition, with which wo are of course most familiar, be so very imperfect, they must be still more so, when We come to consider these actions in the dis- eased state. Were we able to detjpct the material prin- ciple, through the immediate agency of whichj a muscle is rendered subservient to the dictates of the will ; or those, by which the proper nerves of the different senses are rendered susceptible of the various impressions made upon them bv their respective stimulants, we might be warrantable in our expectations of detecting the subtile agents by which such diseases as Small Pox, Scarlet Fever, Plague wad Cholera are produced. The numerous reports that have been propagated, lelative to the stateof the atmosphere, in places where Cholera has prevailed ; the detection oi animalculn . floating in myriads in it ; the extraordi||||»r rapidity with which putrefoction has taken place;, Up unusual m „ tality amongst horses, o(»ws, dogs, and even ducks, have been all totally void of truth, or merely coinciden- tal with the exiateoce of the malady. It wasostated in J*. ."y^- I : ' I fli ■',•1 if A 1 41 V^ S ■ ASIATIC cholera!: tl.e American papen., in 1839, that f««»r«»5 J*)*. P^J^f" ence «f Uio CholSra in Montreal, a piece of fleah meat* .uTpended fru.n the top of one of our spire.. ^"J^"^ completely putrefied in a very short tJoie. ^ Now^^taj in the first place, is nothing very atrangj in the montha of June or July, aa every unfortunate butcher can but ?o« frequen^^^^^^^ witne«i ; but, in the -econd olace, we are not to suppose that, because a piece of d^ad ZZtZlilr pu& ^»;« »-Jfn™lf"p«Tl' must bear it company, or that *^« PJ?f*^^ - faction and diseased action are «»^»>«; '^^ffflK ' lar • in the third place, we must not fore^ T^**^*"; ^ habitmits of ourgoodW »1»^ "»^'*f^^*u**^.i°ff 1 our Iteeples, and therefor1e,if putrW^^^ much more rapid at thia altitude than ^^ ^^at of the bulcheS' stalte, still we «>uld not> ^'^"^^ aflected by Tuch^ Cholera, it is not 8U%ri«^^ obiect shoull atlrnct our attention. If a dead cat be ^t L 1 1?rstreets or a'doglje ob V rcMotve tf'fmirL^^^ is immediately noted as^^ most extraordinarylhenomenon, and to be accounted; SronWby he "mysterious epidemic constitution of theatmosphere;" and certainly no condition of the at- m«8Dhe^ can hi better entitled to the term epidemic, or^ne aUhan that ohaerved where -^cooccurrence, takeplacd; for cats and dog«s and men, too, dieioaU P'^StSl J^^ Asiatic Cholera mav TisVp^rf^cUy independent k<«»w° ^*^*.Ifi«r«f the ail- iTS^revailed amongst the Tcrlnt^?. of thflhd^^^^^ and on the IrifsSl^A^bii ;' n the frigid region, of Rusaui, and ^undeTthV«^^^^ o^a W*?** f""'^'?. 5! ^SJe^i^Ud the fecial climate x^ swampaofthe sotfthern state, of America. Iheai.- O*^ . tX&Hljj ASIATIC CIIOLEUA. 17 :^ unsti has ccrtninly not manifcMitrd nn cqiinl dogrco of virulonco in nil those diflbront phicos ; but this is a cir-. cumstnnco to Wnttrihutcd to tho iiillucnco of socon* diirv causes, nnd not tonny diflerunco in the charaot^r ol tfio primary Snocitic cnust*. That the Specific cause of Cholera is not an epidemic principle, depending unon a peculiar con^ititution of the atmosphere, appears from the following considerations to Im) n legitimate cnnclusion. Disenscs which ordina- rily receive the name of epidemirs, are ohsorvod to be of short duration. They either coiiiiiienco in one par-- liculnr locality, and radiate into numerous others, shovir-| ing a predilection for those which are most siniilar tO that in which they commenced, or they originate simul* tnno tusly in n number of places, without any intercom- munication by travelling, commerce, or other modes of conveyance ; and alllor having prevailed with greater' or less intensity for a period of time, generally limited, they^re observed to cease entirely, sometimes sud- denly, or to lose that identity of character^ which di- scoRCs/^ept up by contagion, are found never .to part witli. Epidemics can be transmitted beyond/tbe dis- tricts in which they are produced by means di persons travelling, who have contracted them in the aiseased districts; but in such instanceSj it invariably happens that no other cased follow those, in the residents or tho 1 dace to which the epidemic has been carried. It is lighiy improbable that tho same epidemic constitution of the atmosphere, which may liavo given origin to Cholera in the Province of Bengal, in 1817, or at any more remote period, should not only have continued to exist ever since, but also travel gradually over the face of the whole habitable world, unchanged by every mo- difying ngentj whose influence over diseases truly ep.i-> demic has been long well known ; as extremes of heat and cold, of dryness apd humidity, altitude, soil, difier- ence of habits of life in the inhabitants, with many others that need not here bQ mentioned. If the pri- mary cause of Cholera be an epidemic constitution of the atmosphere, it is strange that it should trayerse ex- tensive . tracts of land and sea, in opposition to the _^ . Zl e ^ . ^ ■ '.^1^,"' \ • * - ■*,; .-* ■ li jjl ASIATIC CHOLERA, tend in Ihe IndUn l»eninj.ila, ana t Atlantic Ocean, and threaded i\» ;^?;;*P„^|^ted the countriee of the St. »-«^^T*'li:^!ri^„Sril^pre^ on i)oth sides, and never •"•n»\«'»'"« '^ < J^^ coincldenl\ Ttarrlred in Quebec and th^^^^^^^^^ ^ ,,.,el^ with the landing «f/""£"JVhe naawKe. It ia ttrange on which it had '"KtidS^ "•^•' -H*^" that a disease, realWdemic,«^^^^ Amerfca, Ijmg itwif in the lower P'J/^'CIrrinSe and ma^f^bundrea iouth of the flulf of St. ^[;*^;*"^J " at eiifc disease. Slues nearer to ?««»?«>« PJ^^raKc having until the arrival 'f * •V^'^jr^rltill tfat thtti diseaw^^ cases of it on hoard; ;j^"*;*£fttth«t time prevented If really '^^«H;"i*^;r!*^ b^^^^ from entering the«) placet, by me « goroua q««'*n*'J?- ^ ^uKout fear of refutation, in no In few, I m$ht aay, ^"""*''T^i„ -«▼ olace which Jtancea' H^Tcholej^^a^^^^^ J^^Xrect, with has had no^tnmim^n^wc^^^ places in ^hich "'f^ *"*^i_P- f^ee Interco^rM with in- Uom that »"LP»"^*^X^toease. M'm itrange fected .|»lacea. has escaped ine^^ anlpideinic di- that Cholera should ^"^^^"^^ ^ i. aUoget»><*' un- Use,whiW.in.t*15ene^«»^^^ to di- „Ue di-eases^^^thj^t^ti'^^^^^ ^i^wTf?- - place to place should be ar- - «er have existed, or which, ■beeii Sounteracted^by op^ Fv-™» 'izi tt.;ffi Jl!missllS^ ChXa should J^nt%dea«atelHfc5^'fen^^ unquestionable be sought for elsewhere, whenineu j^ ^j„ gome i^fsWebeenarnirdedof^beiDg^ j^j^ fiSances, a disease <^«"y»'^f„2^CfcXra should Slrraniethat«jecontag|o^^^^^ ^ be denied } for Plafue, »maH rox, jv ^te. It WUna have all, in ^^e ^^^^^^ ^f i;;i;n^^ l al ogyubsisUng be. \./, teases ackn( that its transi tributedtoagei., Ifthey did exist posing attd adi^ agent adeauate r4 a~ ^ / "^ ■'% \^ "/. _ ^liF , ,/ lA TIC CHOLERA. It *♦ Ilk: Cholera, In their trantroilMoa .„„^_lh«y hung nround ihe camp, and .larch of armiet ; thoy were carried be- the ae*s nml bocHmo>njcrftfttMl in new mmU ; and day Ihey have rotaiiiv^ Iho very anmo charactert^ which lh«»f ahewe.1 at their ctimmonccment. Iroi* the time that Cholera became an itinerant to thij day. It hai in ita movonunUH aeloctcd the highways of men for its path. Wholher wc contemplate it in the east isolating tlwrranks of tli« vlctonous Drilish, "r'nthj west stalking amid»t the hordes of the Russians ; with the cararan traversing Iho groat ntcppos on the borders of the Caspian Sea, or the frail bark on the bosom of the ocean, bearing from their fathers' home the squalid •migrants, seeking »' other limds and other 8kies"-we see It uniform in its grand and general laws of move- ment, and we trace, in iu general aspect, all the linea- ments of the family, to which, in spile of predetermina- tion, we are obliged to admit its conHanguinity. * The Inefficiency of quarantines and sanitacy cordoni, t6 arrest the progress of Cholera, has been adduced as a proof of ita noncontagious nature ; but before advan- cingthia circumstance as an argument in support of any oRinlon, it would b* necessary to show, that such «sWbli8h«yjnt8 have been carried into full operation; ^HW^oiSd bo necessary to prove that quarantine regi^la- tions and sanitary cordons, when strictly enforced, have foiled to effect the desired object. Now, the instancet of the spreading of the disease being prevented, by the enforcement of a strict quarantine at Niagara and Mlra- michi, and the celebrated fact of theJirrestingof Cbo- -lera in the Isle of Boutboii, by a vigilant ^rdon, are facts which stond In dirict opposition to the assertion above alluded to. Will coy one pretend to say that tmr mockery of a quarantine at Grosae Isle li calcula- ted to effect the exclusion of a contagious disease? Let a strict system of quarantine be earned into ftill ope- ration, and then let us see if Cholera will continue to visit this countiT annually, as it wdl do, so long as ^ things are managed as they haire been teretofore. In no country in the world » there a foirer field for testing \ • I .^' "^: r% , ^ ^puiyipplijill^ii^ ^ Jc .■« |i \' ■•IB 1 ill 2(J * ASIATIC cilOLEttA, its efficacy— WO have only one route by which the di- sease can cflcct a^ entrance— the tide of emigration flows up the St. Lawrence, " et nulla vestigia retroi-su" —let a quarantine station be fixed 160 or 200 miles be Idw Quebec, and not nearer^et every vessel entering > the river be brought to, at this Station, and every one that has had disease on board during the passage, be detained long enough to ascertain that it is not likely to reappear. Such vessels as have diseascf^oh board should be kept, until the state of health of all on board is sucli as to warrant their dismission. Every vessel that may have, or may have had Cbolera on board, should be kept at least a fortnight after her arrival, in the former case, and in the latter, a fortnight after the occurrence of the last case among her passengers* l4astly, every vei^l should undergo a thorough cleaning. A second quarantine station should be fixed near Quebec— that at G rosse Isle would perhaps be the most eligible. At this station every vessel should be a second time exa- mined, and should cases of cholera have occurred since the last examination, she should be sent back to the .first station, to be there dealt with as other vessels ar- riving with Cholera on board. It is true, such a system of quarantine would be attended with considerable ex- pense ; but this would be a matter of trifling consider- tion, when compared with thei loss which this country must sustain by the annual ravages of Cholera ; and should wej by a fair trial of Isiich a system, succeed in keeping out the disease, our neighbours of the United States, ever celebrated for their liberality and public . spirit, could not refuse to contribute largely to defray the expenses of an establishment, from which they would derive no less advantage than ourselves— for they may rest assured, every season that we have^ Cho- lera, we will send them a sample df it. The trial of such a system as-that, of wbichan outline hat here been ^giveCt, would surely be worth making; and should it fail, we would have the consolation of having done whiat we could to avert one of the greatest calamities - that can afflict us. ■ - - T^he contagious nature of Cholera has again been ■y III M ' J ASIATIC CHOLERA St ■ ■■ . ' ; (lonietl, on the aaMimcrf ground that the proportion of persons aflfectod by it, out of a given' number exposed, is too small to warrant our admitting its communication b^ this means. But we do not observe that all conta- gious diseases are equally energetic, reluUvo to the number of persons that will be affected by them, upon coming witnin their spheres of action. A predisposi- tion, of a certain decree, 19 Tequired for tliem all, in or- der to ensure their production. .Some of them ap* pear to require this predisposition in a very trifling degree, while others will not act unless it be present to a considerable extent; and theve are some persona^ who will resist particular diseases, even of the most in' tense virulchce. Thus some have ueyer taken Smalt- pox, though repeatedly exposed toW, others have ne- ver had Measles; and in the eldest Vnd most eminent practitioners oftihis^ity, w^e h/ive a remarkable instaneo of resistance to me actioiil6f!the contagion of Scarla- tina ; even Flague itself has failed in aflfe^ing some who have been exposed to it. We should, however, judge very erroneously of the proportion of persons a^cted by Cholera, were ^e to look upon the mere, number of reputed, or full^ developed cases of the disetuse, as the criterion by which >ve are to form our opinion-^-out of the whole population of thiscity, both in 1832jancl 1834, it is no exaggeration to say, that seven-eightns labour- ed under th9 influence of the primary cause m Cholera, at one time or other, from the commencement till the ternlination of the malady. The same obseivation has been made^ in every place where Cholera has appear- ed, not hy the advocates of contagion, any more than by hs opponents./ How then can it be sail 'that the sphere Of action of theprimary eause of Choi )ra u more limited in extent, than thai of many other iiseases of an unquestionably contagious nature ? The relation subsisting between the printary cause, and the predisposing and exciting causes cf Cholera, and the dependence of the former upon the latter, for the full develppcmcnt of its action, have not received that degree of attention which they demand Irom those who would fi>rni just conclusions upon this nart of the I PH i ^^■ I tl V ASIATIC CHOLBRA. mubiect. DuVing the preTslence of the diseaie, com. dSW M- Mcape its influence-wUp there chancet "(oCXv^lsork^^ffecied a «trong;degree of pre- dbpSsUon, ^ shall probably observe the speedy devCK rpementof the disease, without the aid of any other agencies • but, in nineteen cases out of twenty, thodi*. eaSiC hi fully developed, before the applicatK>n rfwrniof le weuinowri iU^ ^ '^".^S Sir" Z^ It is fromlbi. circumstance tWwe^fin^^^^^^^^^ irv ohvsicians, liiedical students, and hospital atten- dLs w KCuerally esc^ From the ptecautionan^ 2:eJ^i:s,^lch ffieir «fKJ»T ^rS! onSSSu^^^ serve, they seldom! afford the disease an opportunity oi iSSjMnKitselftl They are nc^,howev«y,exeinpted froi the inffuence of the priinary aiuse ; fo^^amon^t them, during some iart of the period of the disease, we shaU find tKat theVoportion ^»»« ^^j^^' "^^^^ J?!} rangementof the digestive organs, *«d ^he other pre- moStory symptoms of the disease, is ^f ^jrerf^er «hftn ARionifflt the lEeneral population. Let them only app"ywSg?park to the train, and we shal have Jo^^Ki^more^f^quent explosions than we might "^^^^S^^^ of this city, in^ short publica- tion onOhole?a in 18S2, stated that the clergy enjoy- Ta complete immunity' from the di^ ; but a mc^e Stensive^nowledge of facts would have prevented his falling into so palpable an error ; for the medic^ aUendant upon the genUemen of (he seminary, had no J^^^KnfZ^ofth^^ all labouring under violent premomtory symptoms , Id KforLd me, that lK>tlSng but Ae ^^^^^^ tic measures, and close aUentioh on his part, conj9med J^iththe 1^ strict adherence to h« inj«^^^» theirs, prevented the full developement ot the disease , 8» much for /randonii statements. ■ . I ^. . ,^ Upon thi whole then, it would appear A^t ?hole^ thoukfa mn^b less extensive in its sphere^of action,^ and JSTiridoletit in the immedgte effects reso^^mg fiSmihe afctionofitsprtmary caU than somojothw^ contagiousdiseases, a&rds, upon a mature consider*. ■J- k »". I M ASIATIC CHOLERA. tion of all the facts connectied with i^,8ufiicient evidciince of its being a disease, communicatod and kept up; by contagion. #^ y^\ ■:■■• , X '.--■.■■■■■-■■ ' } ■•■ ■■ ■ ' y ■ . i The causes predispositifrthe system to Cholera, are/ _UU those which have a tendency to disturb that equilM Hibriuiri of the functions, in which consists thatconditmn I of Ihe body, properly called good health ; excessive fa-- tigue, from long continued exertion, or want of slef/p ;^i the depressing passions, as j^rief from the loss of friends* fright, extreme apprehension of danger Irom the dis- ease; a debilitated condition of the system, respiting from previous disease (particularly of the di^esitive organs),or from habits of intemperance ; that pecu- liarity of constitution usually termed nervous mobility ; all powerfully predispose to this disease. There is reii- 8on to believe that in somo families, a very great ten- dency to Cholert exists ;* for in 1834 it was observed that many families which, had suffered in t?32, were again visited by the diseaise ; whilst others, whoescar ped in 1832, were also exempt in 1 834. The male sex appeared to be more liable to Cholera than the female; but this difference must result from the more strict i»d- herence to temperate habits Of life in the latter. I re- marked, that amongst femalea attacked, a great num- ber were in the catamenial period. The general con- stitutional disturbance which, in many females, accom- panies this important process, cannot fail to render them, during that time, more obnoxious to the influ- ence of morbific agents. No age can be said to be ex- empt from Cholera ; but the advanced stages of life are those on which it falls with most violence ; very few recover from the disease, who have passed the sixtieth year ; and from forty-five to sixty, is the period of life, which furnishes the greatest proportional num- ber of cases. It has not been observed that those who' have had Cholera once, 'are exempt from a second aC- • tack. ';:■■■■.:: ■ ..:. •■,>■...;:•■/-■ n ASIATIC CHOLERA. i,-: '■ Exciting caines.' ' ■/ The most prominent agents amoiigst this class of cmise^, are undoubtedly, such as have a tendency to disturb,either directly or indirectly, thefunct>ns of the digestive apparatus— all articles of food, of drink, that tend to product indigestioil, either froih their quality or quantity, must be avoided during the prevalence of Cho- lera; Hut it is impossiblerto specify the various sub- stamjcs whmh shoufd be proscribed— nothing that is di- gestecl with difficulty during a season of health, can be indulf^cd in ^urin^ Cholera, without great hazard ; and whatey«?rrs re^^dily digested by the sfoninch, in health, m^y he mdulged in, to a moderate extent, with perfect Gaiety. Substances which agree perfectly well with the digestive organs in one individual, may prove very detrimental to those of others. Many cases ofCholera, Ola very violent form, have been observed to follow an ilUdvised administration of emetic, or purgative medicines. The disturbance of the alimentary canal produced by these agents, is all that, in such cases, is required to givethe most complete develOpement to the lurking disease; therefore, during the prevalence of Cholera, every derantrement of the alimentary canal should be treated with the utmost circumspection. By the exhibition of strong medicines We may ^re a mirtfe, the existence of which we may not suspect. , A very hurtful in^pression was generally prevalent, that water was a daiigerous fluid to drink during Oho- lera. Cold water, »»i«cce«»irc^ttan«ttM, isindeed dan- gerous; and what drink is not, if we transgress the li- mits of paoderation?; But of all the beverages which we can indulge in, th<^re is none so safe, when used with caution, as pure watej-. The temperature of the wa- ter which we drink should be aboiit ihat of our river waterat theseasoo. A few mouihfulls, taken slowly, will, atany time, be mbre powerful in allaying our thirst, than a large quantity, U|ped doWn with voracity. If «he oljservance of the htws of ten^pcrance be more in- ^imbent upon us at o^e time tha^ at any Other, it is ■7 » I 4i *\ •KMff*' ASIATIC CHOLERA. U during the existence of Cholera. But we are not to suppose that mere abstinence from stinmlating liquors, constitutes temperance; our nuideration must be ex> tended i6 ^yety thing that can influence the functions of the body ; Mrhether it be in food, drink, exercise, sleep, clothing, or the indulgence of any of our appetites. ^: The phenomena manifested b^ Cholera in various CMes, or in the different stages ofthe same case, render it necessary, in order to consider them with advantage, to divide the disease into different periods. The divi- sion which appears to me the most accurate/ is that which has been adopted by Professor Jackson of Phila- delphia, in the 22d Number of *< The American Journal of the Medical Sciences." The arrangement which that gentleman has made, ili^the following :— > . First period—incipient irritation, or the pronaonitorT stage. Second period-— confiitned irritation,or forming stage. Third period— Incipient concentration— collapse com- mencing. Fourth period— Ksonfirmedconcentration-^complete collapse. « Fifth period— reaction— febrile state. The number of cases which the disease presentisi, in different periods, diflfers widely in private practice,from the number observed in hospitals. In the former, not lessrthan five cases are met with in the second, for one in the third stage; whilst in the latter, four cases are met in the third, or in the close of the second, for one in the early part ofthe second period. The number of cases whicn come under medical treatment in the early parts of the first period, in priviite practice, exceeds the sum of all the others ; yet it falls far short of the actual numbcir of persons that labour under the premonitory -. -X-^-Htfifci;. , TT^iWjIf HUPSW' ■ •Kv \ .\ "^ l*'^- ... ,:-^^ i|| ASIATIC CHOLEft 4. • jBjniptoms ; for many nev6r have recourse to any medi- cal advice, but by a well regulated regimen, are restor- ed to their usual condition of health. In private prac- ' tice, the disease is comparatively seldom seen in the fifth stage ; whilst in hospital9/as a great majority of the cases must inevitably run into collapse, because of the advanced period of the disease in which the patients are generally brought in, it must' either terminate by deatb,in the collapsed state, or pass into the stage of febrile reaction. A knowledge of the tyihptoihs of the first, or pre- monitory stage of Cholera, is of the utmost importance, not only to tn6 practitioner of medicine, but also to the community at large j for no disease can be more insidir OU8 in its approaches, nor is there, perhaps, in the whole range of medical nosology, a disease, which, if duly at- tended to in the premonitory stage, is so much under the control of medicine. .But if this period be suffered to pass, unattended to, the patient may have perhaps squandered away " golden minutes," which he may de- plore, but c^nnptrecal. In Cholera it has been but too truly said, "that prevention is every thing, and cure too often impracticable" ■ ■ Th//premonitory symptoms may generally be con- sidered aA the direct result of the action of the specific 9ause. The digestive apparatus seems to be their seat ; they usually first obtrude themselves Upon the notice of the Dfktieat after taking some article of diet which he finds ti^dis&gree with his stomach ; this disagreement is therxonsequence of the abnormal cooditipn of the ali- htery mucous membrane, in relation with the inges- , which is produced either directljr or^directly, by the impression of the primary morbific agfent. In this cbnditiqn of the digestive organs, the otdinary articles offood act upon them as foreign bodies, and necessarily give rise to feelings of uneasiness, referred to the epi- gastric centre. If the person so affected pays attention to these kindly admonitions of instinct, and allows na- ture the state of qiiiescenciB which is indispensable to the full exertion of her salutary powers, the lapse of a v^ry short time"^ will, in general, suffice to enable her to i . '*..•' *W»'R1'?r' re- t^ ' ■ -' ce, the idir niA i.« ^ ASIATIC CHOLERA. «7 > >^" gain the ascendancy over her deadly antagonist. But should her voice not be hearkened to, should the time- ly notice she has given^ of the mortal struggle that has commeuced within her realm, be unheeded, or her po- tent arm be shackled by the indiscretion of the patient, she soon tbiU make herself be heard, but it will be with the voice of the growling volcano, which is about to burst forth in irresistible fury, and pour out from its writhing entrails the headlong torrent, to blast, in its desolating path, the fair face of nature's loveliest works. If the premonitory symptoms, either from the apra- vating influence of exciting causey, or the predommant power of the primary morbific agent, should be found to assume a formidable shape, they will vary considera- ably in different constitutions and temperaments— they will differ according to the differente of exciting causes. In the sanguine and plethoric, tpe most proaiinent de- rangements will manifest themselves in the vascular system. The action f a bilious temperament, the stools will be 6urcliarged with bile^j^n such cases there will be a i;^mbiling^ uneasy sensation of the bowels, ra- tlier than kctu^l pain ; and \each dejection will be suc- ceeded by \ smifirtlng sensation of heat at the anus, and in the lower extremity of the rectum. In the nervous temperament^ tlie phenomena are of a different charac- ter. The action\of the heaityand arteries is little, if at all excited ; oftei^ it is diminished ; the thirst is not so very urgent; biit the energies of the nervous system are • evidently exalted \ spasfmodictwitchingsin the muscles, particularly in thecal jes of the legs; colicky pains in the boweli, and a gene|ral agitation of the mind, as well as of the body, w ill\bei)l^erved.V In the great majority : of cases, the pren omtcjry symptoms are unaccompanied by any painful sensations ; and in this circumstance con- sists the dangerous aijid deaJly character of Cholera. J-Jljy*jp^, ■^afrF?|8ppfs^^' »■* .' ■ i" ll! H . ASIATIC CHOLERA. The patient, indeed, ubserves that his calls to stool are unusually frequent,and the discharges very free and co^ pious ; but /MiM) that faithrul sentinel of nature, here sounds no alarm ; the insidious enemy advances, and is sapping away the foundations of the fortress, while his devuted victim ia reposing in undisturbed tranquility. Nothing is more commtin amongst the lower classes of society, during the prevalence of Cholera, than to meet with cases advanced to the third or fourth stage, after the existence of a copious diarrhea, fur perhaps a whole _ week. When questioned as to the existence of previ<»us indisposition, the fuitients almost invariably declare that they have beenVerfectly well till- within the last few hours But we never should brieve them ; for if we follow up our inquiries, we will find they have had '* a lax" for several davs, but they have bad no pain; and there could be no harm, they tell us, in a looseness of the bowel8,.^ unattended by pajn,«ince they have al- ways consideJ-ed the violence or a disease, to be in the direct ratio of the pa|n attending it. Again, in persons of intemperate habits, the presence of abdominaluneas- iness, and even of a considerable degrae of pain, with derangement of the bowels, excites no alarm; for they are accustomed to these occurrences; their habits al- most invariably lead to thes^j^sequences. The disease being thus alflKl to progress, we find, after the lapse of a longer oflborter time, the aeconi ttagH ushered in. Perhaps the majoiity of cases, usu* allf recognised as decided Cholera, in private practice, are^met with at this period. It is only now that the patient begins to bo alive to a sense of his real danger, the diarrhoea becomes troubl^ome, and b^ins to ex- haust the powers x>f the system; vomitine, if it have not before oeen present, soon appears ; at first the niiTt- ter thrown up is that which chances to be inthesto* mach, but afterwards' it* is often a tbin greenish fluid, and ultimately, it frequently is as clear as spring water, the thirst becomes insufierable; every feeling of the patient seems to be absorbed in the one insatiable de- sire for cold fluid ; his Unceasing entreaties, and some- times, imperative demands for "cold water," are al- ii- •«F=lF»-3''/ ASIATIC CHOLERA. 9!) V " 1 J -/ « ' , ;/■ • ■» . ■ i< ■■ yi-i most irresiftable. This staKe of Cholera is, most Are- auently, suddenly develope<^ by the action of some of le exciting causes, as a copious draught of cold water, or of an^ other fluid ; some quack medicine taken by the advice of intermeddling gossips ; a forced meal, either of ordinary food or of some dainty preparations, taken to flatter the rebellious stomach ; or a hearty glass of the grand panacea, grog ; to these might be added manjr others, too well Known to require enume- ration. It is not long before that most distressing of all the symptoms, eramp^ presents itself; and it iff now that consternation seizes the bjiystanders. It usually commences in the toes and fingers, and iEidvances tO" wards the trunk, the patient's cries are often paraly-. zing ; yet,in some cases, the most excrutiating suffering can hardly extort even a groan ; so unyielding is the ^mental firmness evinced by those who are too proud to be thought of an unmanly frame. These cases of se« ▼ere cramps, though alarming to the attendants, are far/ from being invariably the most unfavourable ; for re-f covery has taken place where the degree of agony suf^ fered, might, of itself, have been thought adequate to the extinction of life, and in some ol the very worst cases that are met with, cramp has never appeared, or has terminated very Speedily. As this stage advances, all the symptoms assume a more deadly aspect, but above all the changes that take place, there is none which should so much excite our apprehension as the appearance of the ** rtce-toa/er- «rdob"->now it is that the vital powers are beginning to give way. The vital moleculah" affinities, by which the various animal compounds are held in combination, are beginning to be overpowered ; the constituent ele- ments of the blood, that fluid which is essential to the existence of life, cease to be held together by that vital attraction which heretofore existed between them ; the serous portion, which, in the whole system, exceeds four-fifths of the whole mass, escapes by every pore, not only of the alimentary canal, but also of the skin. This state of things if not mitigated, cannot long con^ tinue without the appearance of other more lethal 'M* < *i / J> ,-!•■ fl SO ASIATIC CHOLERA. :!*•' symptoms ; the third period^ or that of incipient collApte is ushered in ; the whole appearance of the patient now undergoes a change which indicates the tottering con* dition of the powers of lild^- , ,' / M.Eflo* lublt faoin lcth& di*crM lliitati." , Deatb^ which had, till now, in concealment, been des- troying the internal parts, shews his grim visage on the surface. The paleness of the tomb is difllUsed over the face ; the coral lips have lost their hue ; tbe eye, thajt but a few hours gone, seemed only *' formed to threa- ten and command," has lost its lustre ; the tears refuse to iiow, even at the excitement of the most distres- Hing severing of all the ties of sympathy and affection; the voice becomes hollow, sunken, and almost inaudi- ble, coming as it were from the bottom of the throat/ and resembling a loud whisper ; the tongue feels cold, and when the finger is placed upon it, it gives a sensa- titm like that produced by touching a frog ; a deln^inif sweat covers the whole surface, and in the depressions about the clavicles it forms into small ponds ; the skin feels ad if coated oyer with maple juice, and the hand adheres to it, when nibbed along it ; the respiration be- comes frequent, alid labored, and the breath is cold ; the patient sighs frequently ; in some cases, the coun- tenance at this time, is truly horrifying ; there is a wildness, intermingled with despair and agony, which gives the patient an aspect that makes us at once shrink and shudder ; in fact the " facies cholerica" cannot be described in one halfits horrors. The first time that any person sees it, b^ professes that he never before saw any thing to be compiared with it ; and he never could have formed an adequate idea of it, from the most vi- vid description. . The symptoms of the fourth stage are [ynncinaUy those observed in the third, but in a more marked and aggravated form. External congestion shews itself ; the nails, the fingers and toes become blue ; this livi- -dity advanfits towards the triink ; the fingers shrivel, and are perfectly similar to those qf a washerwoman.. The patient feels a Bensation ol a h eavy weight in the •^ -f, t'-r-.. ASIATIC CHOLEAA. 91 n ^ 1 ■■;•'■., lower and posterior part of the thorax, m if some Inrgu •olid masa wore squoozinff his ioMide : so UistrotiHing is this symptom, that I have lieard some implnre to hnvo their "inside laid open," and the substance removed. Another very distressing symptom often complained if, is a violent pain in the side ; this has been supposed to ro« suit from spasm of the dianhragm, but it may be mere- ly a modification Of the otiier symptoms last spoken of, which seems tobothecon8e<^uenceofnulnioinicconges- tion, giring rise to an impossibility of dilating the lunj;s,— and causing a sensation of sutTocation, which is rt'lkict- "^ ed u|K>n the respiratory muscles. It is not likely that cramp of the diaphragm could occur, without causing instant death ; for the motion of the thorax must 1)0 completely suspended, so long as this violent ctmtrac- tion of the diapnragm continues ; but this suspension is not observed. The pulse in the extremities, which had for some time been flagging, now becomes almost im- eerceptible, and very soon ceases to be felt, if the lip e turned down, the blood, in the vessels of the lining membrane, is seen to be completely stagnated, and if it be forced out of them they, do not nil again ; the same will be olMserved with the vessels on the surface of the extremities. The e^es are sunk in their sockets; the bones of the feice project, and seem to have no covering/ but the cold livid skin. The temperature of the bodv is at least fifteen degrees below the ordinary standard. The mouth stands agape ; the alae of the nostrils are V dilated ; the superior muscles of respiration are seen to labour much, and the patient looks like a man hanging. For some time preceding death all the phenomena of , animal life seem to have completelv ceased ; the patient lies on the l^ck, in a state of perfect insensibility, with the eyes fixedly turned upwards, and the upper eye-lid half closed ; he is in a comatose condition. Death, that till now seemed to have prolonged the existence of his victim, rnerely to enjoy tne spectacle of bis tortures, in - sullen triumph bears away his spoil. Such is a faint outline of the ordinary symptoms of this fearful disease ; but it is not to be expected, that the small space allotted to this subject in an inau< jftj igiiraL I'. '. ■/■. ft > -n '. .'W ' . < ,1 ASIATIC CHOLERA. vNsay, a full deiKHption can be given of the varied phe- nomena ofa diaease whoie depiction moeki the powers of human language. Many aymptoms, not mentioned hero, are to be met with in an extensive practice; enough however, baa been given, to cOnvej a general idea of itn nature. DIAOlWOtlt/ In the fully formed state of Cholera, difficulty of Diatfnosis can hardly arise; the disease is but too easily recognised; yet cases of disease of the alimen- tary canal are met with, which so closely simpato nearly all the features of Cholera, that they are some- times mistaken for it. The similarity between the symptoms attendant upon a case of poisoning by arsenic, and this disease, is soinetimes so close that it is not possible, from a mere ej^amination of them alone, to dis- tinguish the one aflliotion from the other. Cases are on record where persons who had swallowed a large quantity of this substance, have been carried to the Cholera hospital, and received as patients labouring under fully-lonkied Cholera ; nor has the nature of the affection been ascertairied, before the accidental disco- very of the fiict that poison had been taken. In many {>laces too, where Cfholera has appeared, we are in- brmed, so much has this disease appeared to resemble the action of poison, that unfortunate religious sectis have been almost exterminated, from suBpiciQn having fallen upon them of attempts to destroy their fellow- citizens bv poisoning the wells. Last summe^-, during the prevalence of Cholera, I saw a case of poisoning, by excess iii eating, after long continued hunger; and the symptoms were so very similar to those or Cholera, that, without having discovered the fact otherwise, I could not possibly have ascertained, by the appearance of the patient, the real nature of the case. I saw a pa- 1 ■ » I ■» ■■•» ■iW^i' \%. AflUTfCCHOT.EnA. 9$ tioiit o( Dr. ^lopV'"'*""'" '^'^"^ **i*^ NiinieliiiHs Tor whom (lintKoiitluniiiii WtjANHont, with iill<ctin a moru stronKly/ markud caio — almost uvory nigiclv of the upper ana lowvr uxtremitioH wan thrown iiito the moiit v!oloir|. -contractions, and knotM wore ftilt in them like knohs on the branchoti of an oak ; the inuNclos ol'tho back and of the nock wore so yio- h>iitly afTccted, that (ho patient actually ro§(od at times' ou (he heels and occiput, in the form of a bow. This eaKe was no oilier than a violent fit of hysteria, brought on diirin(( (he.catamenial discharge. Thoro Is little doubt (hat many such cases have been recorded as ge*- nuhie Asiatic Cholera; and manv infallible remedies have been proclaimed to the world by ignorant practi- tioneqi, or designing emnirics, wlio perhaps liavo never in their lives seen a real case of Cholera. There is . good reason to believe too, tliat most, or rather all of (he cases that have been recorded as instances of Asia* tic Cholera, apnearing sporadically, Ixefore the intro- duction of the disease from other places, have been no other than cases of intense muco-intestinal irritation, resulting from very violent excitation of the digestive mucous surface Indeed, the important part which this tissue plays in the animal economv, the infinitely varied svmpathetic derangements to which irritation of this tissue gives birth, have never yet received from the great body of the medical faculty, that attention which ought to be bestowed upon them, before it is possible lor us (o obtain correct ideas of the nhenomema of the greater nunlber of the diseases incident to the human .body. -^<^"': ■ : r-^'- ' ■ \i- :..' '^- .-. ■'■' :■.■ : ^ ]- I ■ •I PROOIfOSIfi. i M' i Our prognosis will generally bo determined by the stage to which the disease has advanced when we are E - > , y »' - - _^ - :". ';.- -\ N 4' - - ■ • ; ,'■.-■. . % ■ ■•■• ■ - * y.A f; 4 ,il^^^^ ' • 9i 1 ASIATIC CHOLERA. Allied ill. In the first stage, it ma^ be saiil to be, with few exc^options, fa vqurable— cases, indeeil, will be met _ With, in which, fniriii the advanced age of the patient, strong predisposition, the violence of exciting causes, the intensity of theimpfession of the primary cquse, the incontroulablo terrorof the patient, or his utter reckless- ness, all the eflfbrts of the practitioner must prove un- availing. So long as watery stools have not yet ap' peared, we have gbod grounds to hope for a favourable issue ; but when this symptom has shewn itself, we can- not be too guarded in the opfnion we venture to give- still. While there is a ray <»f hope, we should take taro hot to extinguish it, for once the practitioner has " given up" the case, he cannot rely a moment on the co-opera- tion of the relatives and attendants, ia seconding his efr forts; so soon iis his back is turh%d, each of them will be for administering some infallible cure, of the efficacy of which he will quote a hundred 'indisputable proofs. From an unguarded frankness en the pArt of the medi- cal attendants, the worst consequences have sometimes resulted. I jiave seen cases ttiat niight have ended fa- vourably, put beyond all hopes of recovery, iii one hour, by the interference of intermeddling boobii^s, who should have been rewarded for their labour by half a day in the stocks or tjie pillory. f f the vi^l^ice o: the urgent symptoms, as vomiting, purging and ctanip, is found to abate, and a. general warmth to be diflTused ovdr the surface, the piitse beo conning fuller and freer, the countenance ;more lively, the secretion of urine recommencing, and a chabge^in the intestinal secretions take place, indicating the pre- sence of bile and healthy fecal matter, Or even colored mucus, a free wa^iii perspiration on the skirt, with an abatement of the thirst and gastric irritability, we have good reason to expect a favourable termination. The symptoms which lead us to an iinfavdurable proiSrnosis, are most of thcoi^ Of a Very unequivocal character— -an obstinate C'Ontinuance of watery or co- lourless stools, and the Tomiting of a fluid similar to that discharged by stool; a profuse, cold, clammy sweat ; shrivelling of the fingers, and blueness of the fi ii . -*-*- - ^\ 4 ^-i ■■'■■ rr ASIATIC CHOLERA. $$ extremities ; flngging of the pulse ; frequent deep sigh- ing, with «n appearance of distress and anxiety in the, countenance ; suppression of urine ; severe pain in the side; early cessation of Toniiting, unaccompanied hy an improvement in the other symptoms ; the voice be- coming ftlmost extinct ; the breath perceptibly cold, abd the respiration laborious; great restlessness, and tossing about in the bed ; are all indicative of a tatal issue, to these jnight be added a great many others, but more would be quite unnecessary. / - A temporary amelioration of the symptiiims is fre- . quently observed^ even in the worst cases ; but it % only a delusive improvement, for nature seeing unable^ to rally sufficient force to: keep it up, and wes<»metimes observe the patient unexpectedly to expire in a very short time, after fond hopes of his recovery had sprung up in the hearts of bis friends. Even after having suc- ceeded in anaying the violent syoiptQins, we may be unable to leadf the patient back to health ; the powers of nature may have been already too far exhausted, to be adequate to his restoration ; and though we may have conducted the shattered vessel off the quicksands of death, she may sink at the very entrance ol the port. m -*^ PATHOI4M»y* The researches of the pathological anatomist, which have thrown so much light onlhe doctrines of disease in general, have hitherto ejected but little that can tend to give us correct ideas of the morbid condition of the organs during the first stages of Cholera, or that can lead us to form indications of treatment suited to the disease^ action existing. Most of the morbid ap- pearances presented to us on post mortem inspection^ are the result of changes that have taken place a short time previous to the cessation of life, after the termina- tion of those important actions which constitute the *i S6 ASIATIC CHOLERA. esisential phenoinenii of (he disease, so far at least as the treatment is concerned. It is not to he expected that the Usual morbid alterations of structure, (which weftare accustomed to tind after diseases of an ordinary nature,) as softening, hardening, thickening, enlarge- ment, diminution, ulceration, gangrene, &c. will be met with in a very extensive degree, after so short a period aS that usually required lor the extinction of life, by a disease of such intensity as Cholera. These are changes depending upon an ahnormHl state of the process of nu • tritioni and therefore are not the production of a day. _Tirae is required for their completion ; and, above all, ^ a certain degree of energy in the nutritive action of the part is required. Are we then to look for etfects,i to produce which there are no causes existing.^ The ecchymosed appearance of the mucous surface of the intestines, usually observed in Cholera subjects, has by. many been mistaken for gangrene, but it differs widely from, this condition. This eccbymosed state may he . considered analogous to that state of the cutaneous . surface Which is also met with in Cholera. Both of them result from the Vitiated . eondition of the blood, and the morbid condition of the extreme vessels in these parts, the vitality of which being completely destroy- ed, their contents must become stagnated, and tlie structy^e of these parts being the most lax in the whole system, we fidd, as a consequence^ the dark, viscid blood deposited here in considerabl#layers. Iti the in- ferior portion of the small intestines, and the coecal ex- trenoiity of the colon, these dark patches are always . seen in greatest ii>unclance. In phthisis pulmonalis, accompanied by ulceratioa of the intestines, we find * this portion 6f them most extensively ulcerated ; there is reason, therefere> to believe that the vitality ofthisn part of the alimentary caiial, is weaker, and its struc- ture less firm, than those of any of the rest of that or- gain. From these circumstances we may readily con" ceive that this is the place in wbkh ecchymosis should be most extensively met with, ^he degree of vital energy of this part of the intestines, we infer, a priori^ is not required to be so exalted, as in the portion in T f •? M -i . ♦ ^ ^M ASIATIC CHOLERA. 37 which the process dfalimentatioi), more Appiopruitely, is eOected. On almost the entire aHiiientary surface (hero in found, after Cholera, a coating of a whitish (enarioiis fluid^ resembling* the matter of (he riccwater »((>ols,; its presence gives us no information relative to the tru<; natiire of the disease. We know that a morhid action has been required for its production, but what that nc tion was, the fluid alone cannot shew to us. All ilio abdominal vessels; but particularly the extreme rami- fications of the mesenteric arteries and veins, arc found congested ; and the r olour ofthe intestines, upon tfieir peritoneal side, is of a dark or rusty red, resemblit^g (lecaying leaves in Octobef. The large arterial trunks are found contracted, and contain very little bkHui, w*hilst the corresponding veins are proportionably dis- tended, and overloaded with dark, grumous, uncoagu- lated blood. The bladder is gedtrally found without a drop of urine, and contracted almost to obliteration. 'The large intestines, particularly the descending colon and the sigmoid flexure, are found contracted, some- times to one-fburth their usual size. Many other mor- bid appearances might be mentioned, but their enume- ^ration would be more a matter of curiosity than of uti- lity. The post mortem phe'homena of Cholera, then, itierely prove to us that there ha? existed ao extraor- dinary disturbance in the .Vascular apparatus ofthe ali- mentary organs ; but it is impossible ibc us to separate the morbid appearances that have been caused by the esseqtial deranged actions, constituting the real disease, from those whi^iih are merely secondary, and have been necessarily produced by the more important ones that have precedfed. We must* therefore liave . recourse to ^ot^ier data, upon which to found our indications, rela- tiVb to the true nature of this disease; and these data aje ihe symptoms., If we examine closely the pfieno- nena^liresented to us by acase of incipient Cholera, we md that the firstcognizable deviations from the healthy slquilibrium manifest themselyes in the functions of the lUmentary canal. -Thei extraordinary prevalencQ of castro-intestinal, derangement dtifriitg the ' presence of ASIATIC CHOLERA. .n] 88 this diseasii in any vicinity/ leads w to conclude that the specific cause, whateyer may be rts natur^ or on whatever part of the Hyetem it may make it» first im- oression, haij a direct relation with the mucous sur- fhce of this organ. The appearanpe of the ton«ie and fauces, the epigastric sensations, the mental 4le- pression, and tlie fastidious condition of the appetite, all indicate a morbid degree of action existing in the castro-int^tinal apparatus. From a comparative vww ?.J these symptoms with those, which accompany other aflection/of these organs, we are induced^ to Ijelieve that there exists an abnormal exaltation of their vitaj ener^es, or that peculiar condition of th^irnervous^and vascular systems, now usually designated irritation. With this term we have generally been accustomed to associate theldeaof pain as its necessary concomitant ; but we muslnot forget that the gastro-intestinal mu- cous tissue.doSs not stand in the same intimate rflation with thecentrexjf perception, as roost of the other parts of the system. Through 4he intervention of theg«n- glionio system, from which this tissue is almost solely supplied with nervous energy, impressions made upon it are not tiansroitted to the seat of consciousness ; hence a very high degree cflf excitement may ©wjt in jU actions wittout the «»»»fe8t»«w ofpam^ mach, from its immediate connexion with theiirain, by the gislric branch of the eighth l^^ofj^^^^* m^ intimations of sufiering much more readily than tbeoUier parts of the canal, ye^ we know thatjrntaUon of this xir- ^n frequently exists to a considerabte degree without livingmore than indistincfsensations of pain The sto: mach, however, declares Us sufferings by a.no less une- quivocal intimation, through the agency <)f its rouscular apparatus; hence we observe the Jritonoroenat of n^ retehing «nd vomiting. '^ Througbont the whole sys- teni,wSfind1the various mucous membwnw w 'e»^t';;5 with muscular^ structuWs, to whose motiqn they ^nd intherehition of indices. Tt»«r **>« """i!;!!!^ i^ perineum are associated .wiOi thb sensibiWy of ll»e Urinary prgans; those of the mouth,^ pharynx, ^d cSDpliL4r>fith the^roucqw lining of these^p^ssages; J*. , . " "<. ,,:; ,..■;■• ■ ■;.•!- 0-'-'-"v-v^-.:'";-;.- .■■;■■■,.;■■:.■,•' ■ 1 • r- . ■- ■ ■■■■■-. ' ■ -^.-f ■■ ' .'•- '.,■■■''■.■.■■■• ■-.-■,. . . , ■ .- ■ t ^ - ■ ^^ ASIATIC CHOLERA 39 / the muscles of resfjirationf with tlie mucous membrane of the air-passages, and with that of the stomach ; and the muscular coat of ihe whole alimentary canal, wfith its mucous coat. The appropriate incitements to ac- tioo, in thes^ various muscular apparatus, are propa- g^teid fifoih, their respective mucous membranes : pur^ gatives incite the muscular coat of the intestines to motion, solely by the stimulation transmitted to it from the mucous coat; accelerated peristelic motion is ' necessarily preceiled by increased nervous energy annlinaiy cases of irritation, when only a ^smajl portion of (he canal is affected, we have often to observe the nioductionofmost alarmin|5 phenomena. ; Everyday i-o see tremendous convulsions produced m^ children, by worms. From the sartie cause result palpitations, syncope, tetanus, and a wliole host of other affections. ■ drude, ilidecestible substances, that do not correspond with the assimilating powers of this organ, are observed (o produce the most astonishing effects-as violent > cramps, spasms, and in some instances, even rupture ofthe,stomach, congestion, collapse, toma and death. , The excited acUon of the mucous membrane; in Cholera, cannot be expected to be succeeded by tlie ordinary corisequencesofirritationinother organsof a different structure, and of less extent.. Thelendencjr to pWo- gosis,'or a completion of the process called mflamma- tipn, is in Cholera altogether suppressed, by two of k ^tlte strongest agencies in the reduction of ov.eraction, \ tdwit, vliscular depletion, and cofisequent nervous M^stratioh. The degree of excitement seems to be Insufficient to keep up* an inordinate flow upon the |)arts%ut not toeffectthe dimination of the more v^^^^^ talised fluids, which form the deposits effused by inflam- mtitory. action. Besides, in the alimentary mucous tis- sue, ttie sanguineous fluids have^two very differed channel^ ihrSugh which, when flowing in^mcreased- . quantities, they may take th^ir couree. . • Orte, of th^se is fhat by the proper nutritive vessel^ of the tissue, an4 the other is that by the exceming or secerning mucous w ■ \- X ' ■*■ ■y" / ■ t ■ \- X . I ■i ASIATIC C seroui Collides 6n|h^ surface ing aa tife fluids are 'determim these/channelf ,. we shall hav of phfoffosis, or an eflTusion ai^o in the diarrhcea of Cholera, and ERA. 41 if the cana^. Accord- into one^or other of Uing the bhenomena ;ous to tliat obflierred ff other affectioDs in oft the ho ove jmin which the nutritive action undergoes no inci^ase in its. energy. It is very probable, that,\Were the \ extent of surfii^eiafiected in Asiatic Cholera,\iiinite4i toW portion canal, instead of reaching from one extremity to ther, we should see a very difierentlserieit of phe- »na resulting. The fluids, insteW of jfoeinj^diflused a |iurface of fifteen square feel, w0uld tie deter- _..... jd to one particular locality ; tlie ^nergyl of the nervous apparatus would be concenttoted on this part, and there would be observable as gr^t ^ diS^r^nce in the effects resulting, as there is betweeii the un^odifi ed force of the sun's rays, and that whiob tiiey abquire when concentrated by a convex lens. Tj \ ' The morbid phenomena obsierved in the latter stages of Cholera, are referrable to the efilbcts Produced bv the action of the primary fause, in Conjunction with those vi\ ich have Resulted from these ^ects. , The complete dritininggfthesystem by the colliquative' serous effu- sion,, from the vessels opening oq the intestinal surface,' noi: only deprives everv part of the systeim of themutri- tiv^ fluids, b^ which tne energies of all the organs are kej )t up, bu| it alto produces a vitiated condition of ^he reitiamtng portion, rendering it completely unfit for t^e Curposes which it is ititended to effect. The viscid , lalck blood in the organs acts upon them as^ del9terioik8 ^supstance, and roust soon cause a complete destructia of their vitality. Hence we see every organ in the be dy completely paralyzed, and death is the speedy an inevitable result. \ '* \ In cases, in which the action pf the prinoaiy c^use is, ▼ery intense, the ordinary series of phenomena is pot \. observed to take place. So much is effected by the 1 first agent, that little is.left to be doiie in order to effect \ the coinplete.extinction of all vitality in the system; \ hence, «4ses arenaet witVin which the patient is at \ once prostrated and life extinguished almost as rtqpiid- . •■/'■ .: 'V M: : / ASIATIC CriOLEHA. ' It orul»e liaU be^n struck by lightning; in «>tlier iii- •tai^es one or two fnint efforts at vomiting are made, tKe patient lias a copious alvine dejection, coUapse in- •tantly gucceeds, and death results in a very lew hours. Here the intervention of the exhausting serous diarr- boea 19 not required to destroy life ; and the complete destruction of the vital energies prevents the occnrrence of that exalted action in the mtestinal muc4>us membrane which is its efficient cause. For the same reason, in very violent* casesi we observe that cramps are eitner i altogthpr absent, or terminate very speedily; the tome remark has been made with resrard to vomitmg, Both these symptoms indicate an undue degree of sUmulation in the muscular fibre ; but this undue stimulation, r^ . suiting from exalted nervous energy, must cease to be produced as soon as Uiis energy becomes extinct, l o- wards the termination of the fourth stage, or that oi ftilly formed collapse, we geiierally find the paUent, un- less of a very robust haWt of body, fall mto a state of complete quiescence, vomiting and cramps are gonej the fluid discharge runs uninterniittingly from him, and he is totally unconscious of the passage of it per anum. * TBEATinElfT* Nothing can more fully Illustrate the yague and in- consistent opinions of medical men, relative to the pa- thology of Cfholera, than the endless variety of reme- dies tnat haire been recommended in its treatment. In- deed a very cursory exartiination of the various modes of treatment which have been trumpeted forth, as tri- umphantly successful in this ^isease, will suffice to con- vince us that the great majoriljr of practitipners have been guided by no clear or decided views of its real nature. Were we, for instance, to ask with Mrhtit in- tention tartrate of antimony has been injected into the veins, would not the practitioner be ratlier puzzled, in ■ 'r —-/"■ i %N ^3 ■ •■ / — ■- -4, . imost ^^ ASIATIC CHOLKI^A. ' ^» ihapiiig ii3^%lnd of a plausable r^? TUiu remark appliee with equal force- to liundreijjl Qfother remedies Which Kfevfe been had recour§e to. .4^ . ^, -- ^ The treatment of Cholera must be deternHned, Almost exclusively, by the period of the Klisean^ at whith the practitioner happens to be called in. Sh^^ild ^tho pa- tient be so fortunate as to have recourse to medical aU^ vice, during the premonitory Btage, there in little doubt of the physician being able, by a judicious cni^oymeiit of appropriate remedies, ahd a strict syslenr u1 i^giinon, seconded by the prudence and attention ol the piitient, to control the threatening malady. As the diseftjp, in nineteen cases out of twenty, commences by a diarr^ hoea, varying in duration from a few hours to several days, or even, in some cases, to one or two weeks, it must be our principal object to bec^mie well acquainted with the remedies by which this affection h most cer- tainly and safely controlled j and a preference s^iould always be given to^uch as we may find, generallyy«ost efficacious, ^nd with whose mode of action we are,'i sequently, best acquainted. . , In many cases of inclpieiit choleric diarrhcBa, all is requisite, is merely to enfoice the observance of ab^ solute quiescence. Every organ in t^e system should be allowed a perfect state of rest For this purpose the patient should be ordered to bed ; the room should be kfipt agreeably cool, and freely ventihited by throwing open the windows, if the weather be hot, or by keepmg open those of the^djoining apartments ifjt should be cool or windy. :/-\ ' "^i., • Very linSted quantities of mild dduents, at a codl temperature, as sago-water, rice-water, flourgniel* may be given. But unless strict reliance can be placed in the prudence of the patient and his attend- ^ ants, it will be safer to prescribe cpmplete^abstir nence from every article both of food and drink. This may appear to be unnecessary seventy ; butjhere are few practitioners that have had extensive experience in the treatment of Cholera, who cannot bear witnws to its general propriety. There is always amongst the community a belief, that the directions of medical men \ * ■'•'*.' J ♦♦ ASIATIC CHOLERA. are graduated froiii a calculation, that their liniits ninv be trapsgressod without risk, and we cannot in all cases, predict to what extt^nt this transgression nia^ reach; now, the state of the stomach, in this stage, is. often such, that the slightest impression upon it will give full developeinent to the symptons of the second, whereas, if it were allowed to bo at perfect rest, nature would be quite able to re-establish the equilibrium of the functions, without any assistance from medicine. If possible, we ought always to place the patient under thd immediate controul ofamo/0 attendant, who should watch every movement both of the nurse and of the relatives. If the person whom we select be nd< a re- lative, it will be so much the betterj^and he should always be a man of good sense and firm nerve. In tho management of Cholera, at this period, and still more particularly in the subsequent 4me, we cannot bo too punctilious ; our commands should be absolute, decisive and clear— we should never suffbr the slightest devia- tion from them ; for the life of our patient may be the forfeit of the most trifling remission which we concede. Women are not to be tnisted with the management of the patient, unless w« cannot procure a good male*^at- tendant Tbis is a "nile that should be more attlmded to, than may b^inaQ3[ bo supposed — th^ have not|.suf- ficienjtfirmnesf, or rather they are possessed of too much tendenieii^ to fesist the almost irresistible entrea- ties which the iwtient often makes, for something to satiate his unquenchable thirst— so far as cpurage is concerned^ to encounter the greatest personiil danger, 9Dd aflfoction, to undergo the most trying privations, oiir confidence in them ibay be unlimited— they never desert their potC^ Men are cowards by the bedside of pestilence, mit wiNineii seem there to acquire energ^e* beyond the powers of our conception. Perhaps one of the greatest difficulties which tne practitioner has to encounter, is that df convincing the patient of t]ie ex« tent of his dai^ef'— ^if we represent his case to lum in an exaggerated form, we may excite a degree of ^arm that wUr prove faigUy prejudicial; if we atteiUpt to describe his situation in its real nfitiirtti jf Will j^ner- - -. * gSJ*. Jei^••.^'S^^'i^. ^ k. * ASIATIC CHOLEK a: r^S ally fail lb making ourselves sufliGiently iiiiclerHlupJ.; and If we depreciate thoDeril in which lie stands, he may disregard all precaution. In many cases wo find a degree qf apathy existing, which cannot be recnrdiMl m any other li^ht than that of absolute fatuity. Palitiils are met with, in>. whom a dinrrhoja has run on for many days, and yet they have never bestowed a Ihouirht upon It, until they have been startled by the accession ol cramps, Tomiting, and watery limpid stools ; when we interrogate them, they confess that tliey " have liad "lI"^ :/**! "^r""' ^¥* 5 *»"' **»«y " thought nothing about It, lor there wA no pain ;" tliey have been uwu finally thirsty, and have jni^ulged freely in the use of fluids-indeed we generaMy find that the violent symn. toms first appear after ah unusually copious dran«lil, to allay the tliirst, which alone attracts their attenUon. . Bed pu/Ut cue tiUin." ^ *^ It will often be fouhd, that if the patient be merely eu- joined to remain tranquil, and to abstain from every ^me, something m the shape of medicine, he wUi fake just as much of our advice as he judges iie :■ 4 * .■,-' A- •' ■ ■' ■ :" ^^iF 40 ASIATIC CHOLERA. th«r frtMJ, ami biliou* Ueranpsment be *»»<»^J«*»^*^ ^J^i doM of calomel, followed, after a few »f «J»' ^•f " do dose of^hubarb, will tumclently »^lJ^^^.^^, ory orjrana, and P«>cure a «»fe eracuatjin of Ae bow^ «|H ; aafine purgative, and draatica -^ "^^ ^^ JT^?^ Jed on, lt«t%e,theemploymentofjan^^^ would, in many cawHi, leem to be most appMcaWe .mil Jropa able miJchiefh;-i«H»etlaie.b«inc*«medb^ "LdnSnbtralion ; and It Will, cot^^^^Ji^J "J^f gj^ dent to omit their xm^ as we c^ manage the cast duite well without them* ., . ^.u «k« •« ^Stimulating subrtaw?ea, which merely exalt the ac- tinn of the dweative orjrMiti without exertmg any al- r«tl ^rXent%0^ l^u^iou.*" It ia trueJpU- Of l^^^^^^^^^ lSl?thw? tftU fiia in eAeting the deaired purpo^. h»/e doiM SDod, IliiT ba¥« m a hundred »ggja^"V5 i^l^SSdit^^nU awl from an unfounded awar thote inraUMAle hours, during «'»»«n^ ?^i, " propLr^TttOtHied t«N would hare h^en quM; irjctabU^ *^Whei the Iwwehi have bwme «»«»«»»/ J?^'J^ aoo^rth^are attended to the better ; and though* in fS .u^tance aa aoon as we have ^^^^^''^^^^ '7 j»s'^ « ASIATIC CHOLBIA. ¥t ■J:. " / / ■ ' / ■ . • / ■ A. will b« Mceiiary for us to anticipate th« diarrlioen, i •, tliough it may not yet have commenced, still fnim (he proaence of other unequivocal aymptoma, we may have reaiOD to expect it in a aliorterur hinger time. Dr. Stephenson bad some case* last year, in which the first symptom was a suppression of urine ; on close exaii»i- nation, be discovered the existence of other derange- ; ments, which put bis diagnosis beyond question ; and bj a timely recount to proper remedies, he succeeded ^ preventing the Airther progress of the disease. When Tomiting has already commenced, the sooner we arrest it the better, for the prostrating effects of this operation are too well known to require anything to Iw said on its baneful tendency at this critical period. In getteral.adrachmofetberyWith thirty drops oflaudanuni, will arrest thi* aclioii al th«cmted con^ , dition. We should not hope that the in<^Bse of quan- tity in this medicine will be a substitute for the want of action in the mucous membrane, when its vitality has ' been already overpowered ; if it acts at all it will act best in small doses, and if the membrane be becoming insusceptible of stimulation, too large a dose will onl^ extinguish the little of life that is remaining. In this ■tate of declining vitality the tissues are in a condition ^ t / /•-" • 4. ■^^w^ p,'- :r-- 48 ASIATIC CHOLERA. very nnalogoiin to that in which they are placed b^ long cniitinuod cttid (ir hunger, and'we know that in this case a very moderate degree of stimulation is all that can be safely had recourse to ; and if we stiqaulate too freely we hasten the complete death of the party. , It is from this circumstance thai the application of general warmth is so intolenible"^ to the patients, and so Imneful in its re- sults. Some patients in Chpleia hi^ve been actually roasted to death. A most valuable accesiftion to the treatment of Cholera, and one that Is fortunateljr nost grateful to the patient, and very i^asily procuied in this country, is ice. The safest mode of administMing it, is by giving it in pieces about the size of an almond, and itistrncting the patient to allow it ib dissolve in the mouth, and swallow it as it melts. The effect it pro- ; duces is astonishing, and tends strongly to corroborate ■ ^- the views that hare here been taken 9t the pathology ofCholera. ^ A great deal more might be said on this subject, but this Essay has already been extended bejrond its pre- scribed limits ; besides the aulbor is not vain enough to supposethatso important a subject would be much .be- nefitted by anything which be mi^ht be able to suggest. 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