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" No one can deny the talent displayed in Notre Danie,— the rich and poetic tone 'if the description, the graphic reality of the more active foenes, and the actual presence given by the imagination to the cathedral: ijt>i sculpture is a living thing in Hugo's hands, and the dim purple of the (lofty aisles becomes instinct with spiritual existence." — Ifindon Literary Gazette. ■ ^<>#>rfs^s'»^^Wi^^A-^V MONEYPENNY. A ROMANCE OF NEW YORK AT THE PRESENT HOUR. Price 25 cents. " We a.ssure our readers that in these pages they will have a fund of pleasant reading, where pathos and humor are delightfully commingled, like the clouds and the sunshine of a morning spring." — True Sun. THE INDIANlSrHIS^WIGWAM. OR, CIIARACTERI.STICS OF THE RED RACE OF AMERICA. BY HENHY B.. 9CHOOT,r-- > irs. |th« CHOLERA: I TS CAUSES, SYMPTOMS. AND . ) TREATMENT, (K)NSIDERED AND EXPLAINED, ■ BY J. P. BATCH1'.LDER, M.D., OF li ..V/ YOEK CITY. ! i| NEW YORK: DEWITT & DAVENPORT, TRIBUNE BUILDINGS. 1849. f^ * '? . /,. .SH jVmio TT I i/_o \"i i&''( ^ .^v^^.H -^ -t' > ; 1 i. ) '/.. # . 1' v. a. If: T i^ ^- H T I /.a L' •! '• f) — ' ■ ■ r , . ~ / if ',i '•■ B. Craighead, Printer, ; j^ „: '■ i ii kl ., lia Pulton Street. ■*■ ' ■ ^-"i !'..-T <'. . : * <•> , _ ;. ,.; .. .. . .. , .. ., > n i ; ■' I CHOLERA, &c. (• t 4 Thc fact that through certain phenomena presented with tolera- ble uniformity by epidemics, there runs an analogy which, taken in connexion with circumstances attending their movements, progress, and termination, has led to the thought that their causes, although involved in irapenttrable obscurity, may be few— similar — perhaps identical ; while the effects they produced were modified by acci- '4'dents, incident to their evolution, by circumstances pertaining to the subjects acted on; or by contingencies connected with season, climate. Sec. This view, it must be admitted, accords well with the simplicity of Nature, who produces the greatest number and variety of effects from the feweat possible causes, in which her wis- dom is apparent, and manifestly difleri}nt from that of man, who is prone to overlook the simple means by which her vast machinery is put and kept in motion for the attainment of results the most grand and sublimo. Ignorant of causes, we may, however, by watching the phenomena they originate, deduce the laws by which they are governed : and furthermore, by reasoning from effects, we are sometimes led to a knowledge of their causes. By pursuing this method in respect to chemical affinity, gravita- tion, etc., philosophers have been able to deduce and settle their laws so firmly that we implicitly and unconsciously act on them in our daily pursuits; and by patient observance, careful analogy, and study of the phenomena of diseases, we have likewisa become acquainted with the laws by vvhich they are governed without knowing their causss. Tn respect to Cholera this method has been unfortunately too much neglected, and the attention has been diverted from its legitimate objects; hence the failure to ascertain and settle in a satisfactory manner, the laws by which its propagation from in- dividual to iadividual is regulated and determined, and also its pre- cise nature. Q J / 4 CHOLERA, CONSIDERED AND EXPLAINED. Having considered this part of the subject so far as it relates to conta^i'^n and infection, in another pa|)rr, we now proceed to in- quire into the nature and symptoms of Cholera, and the causes hy which they are induced, and the laws by which they are governed, and endeavor to ascertain whether they justify the conclusion that it is a disease sui generis. Disease has been defined, " A derangement of the function or structure of an organ."* The performance of function depends on the normal action of the capillaries of the respective organs, modified by peculiarity of structure. If the due performance of function depends on the healthy action of the capillaries, by a parity of reasoning, a derangement of function, which constitutes disease, must depend on the de* ranged action of those vessels. Now, the action of an organ as a ^ whole, which is its function, and that of all its capillaries, is iden- tical, and constitutes the function ; and e eonvtrao what an organ as a whole does, that will all its capillaries do — they, then, it may be said, perform its function. " The noiseless and printless feet of time" move not less stilly and imperceptibly in their rounds, than di) the various organs in the body, in the healthy performance of their respective functions ; therefore, in health, rvery function is performed in such a manner that the individual has no kr.owledge of it, or of the organ which performs it. When the capillaries of an organ, and the fluids they contain, are normil, the sole causi which prompts the former to action, is the mere simple mechanical distension occasioned by the latter; but if that st.ite cither of the fluids or the cioillary vessels is disturbed, derangement of function ensues. From the altered condition of one or other of these (the fluids or the capillaries) disease arises, and the human body is so constituted, that change of action from the normal to the abnormal, if con- siderable, is perceived, and the perception of that change con- stitutes feeling; hence pains, aches, and disagreeable feelings, * Dcrnngement or structure Is soeondary— if tlie rosnlt of disturbed fonction. If primary, it is the consequenea of violence. In neitlier of these respects will it come wittiin tlie scope of ttiis inquiry. .'/- . Il to in- J»'y |ed, lat or CHOLERA, CONSIDEKBD AND EXPLAINED. 5 which comprise a large and very important class of symptoms. The inference drawn from these premises is, that if the action of an organ is pei'ceived it is a sign of disease. If the sensibility of vessels is changed or altered, morbid action ensues, although the fluids should remain the same. On the other hand, if the fluids are contaminated, or altered in their physical or chemical properties, morbid action as certainly ensues. How ? Changed in either of these particulars, the fluids make a novel, strange, and consequently disagreeable impression on the inner surface of (he capillaries, which stimulates them to contract — the only real action of which they are capable ; hence the rigor which ushers in malarious, infectious, and most endemic diseases, and also cholera proper, particularly in its cold stage; but in the former, as for example intermittent fever, small-pox, and measles, this contraction of the capillaries is general, and is soon succeeded or followed by a spontaneous relaxation. Hence the febrile excite- ment which ensues, and likewise the various kinds of inflammation that follow in train. In these last, small-pox, &c., the contraction is only general, and is followed by a spontaneous relaxation ; but let us remark, and remember too, that in Cholera the contraction of the capillaries ia universal, and not as in the other diseases usually followed by the spontaneous relaxation of which we have spoken — the non inoentua of which, taken in connexion with the univer- sality of the contraction, famishes a' mark of distinction between it (Cholera) and them.* When induced, as it sometimes is, almost exclusively by the concentrated energy of its own peculiar or spe- cific cause (if such a cause it ha.t, is superadded. Again — those predispos- ing cuuses may be so accumulated or concentrated, as to become in thoHiSi'lves exciting causes, by which their respective diseases are produced, with little aid t'rum any other agent as an exciting caufe : — or indeed the common exciting may become the predispos- ing causes whicli give the system so strong a proclivity to the dis- ease in question (Chol^fB), as well as others, that it will be induced by even a very triflidfjafiplicationof its own peculiar cause. When attacks of Cholera are brought on in cither of these ways, a more favorable result may be anticipated, than when chiefly induced by the concentrated energy qf its specific cause. The reason for this has already been assigned. These, with many other considerations, go far to show that Cholera is very like other endemic diseases, which have never been suspected of being infectious or contagious. Like most other diseases. Cholera has its predisposing and excit- ing causes ; — a proximate and also perhaps a specific cause, and is probably a disease aui generis. The predisposing causes produce a state of body which gives it a proclivity to a disease, which is technically termed the pre-disposi- tion. As we progress we shall endeavor to show what is the pre- cise condition of the system whrch constitutes the predisposition to Cholera. The predisposing causes are of two kinds, the common and the specific. ^ » / « .; ._•.... .., I. THE COMMON PREDISPOSING CAUSES urn)-. Tend to produce other ailments as well as Cholera, and in all cases act in the same manner. All the causes belonging to this class are indigenous, and under certain circumstances to which we shall allude become exciting causes. Poverty with all its attendant ills, privation, starvation, bad food, bad air, bad lodging and clothing, previous sickaess, affections of the mind, intemperance, fatigue, exposure to cold, night air, &c. ■-■*.'.v*".i.* WV>»i vij. «!" ^S«fl«.'H./ , St CHOLERA, CONSIDERED AND EXPLAINED. sen he ch, 08- me aes ing 09- diD- ced hen nore That these cauMs ar« all indigenous and invariably present in every place where Cholera has pieviiilod ; that its prevalence has been commensurate witli their existence, und that it ha.4 ncvt-r pre- vailed to any extent, ilat all, in the absence of these causes, — are facts of the highest concernment and furnish matter for profound consideration, not to medical men only, l>ut to all, ^nCi particularly to our city authorities, who are principally responsible for the exist- ence of some of those causes,, and moreover for the consequ.-nces that will inevitably accrue from the neglect to have them removed should the Cliolera prevail in (his metropolis. Impressed by the import- ance uf this subject, we shall examine, aeriatim, but briefly, these causos; and explain the manner in which they act in predisposing to Cholera, and in co-operating with the specific cause in the pro- duction of that disease. ■ We start with the broad comprehensive proposition, that they all produce one common effect — a general contraction of the capil- laries over the body, which constitittca the predisposition. The paleness, if the capillary contraction is 6nly of short continu- ance; — the emaciation, diminution in size, weight, &c., if more per- sistent, are proofs sustaining this allegation. In the production of that effect, each cause operates in its own peculiar way ; therefore we shall consider them singly and in succession. 1. Deficiency of food ; or htmger, and its effects. When food is being taken into the stomach, the pleasant impireasion which it makes on thft pabte fanses tha capil-' laries and their pores to relax, and allow the fluids to pass into the fauces, &c., and when it is received into the cavity of the organ, it makes a pleasant sensation there which causes its capillaries to relax, and the organ doing: as a. whole what all its vessels do, re- laxes, and continues to do ao until its muscular coat is put on the stretch by the mechanical distension of the food, and the sense of repletion is experienced — an intimation that enough has been eaten. The pores looking into the cavity of the stomach also relax, and the gastric juice is secreted. Digestion begins, and as it progresses the Btomach contracts and forces its contents through the pylorus until it is completely emptied. It may now relax spontaneously, which prevents the s^nae of lounger from being perceived ; but /? y .^ ^» a r^ I 8 CHOLERA, CONSIDEHXD AMD BXPLAINEO. I u this relaxation will be followed by an increased admission of blood into its capillaries, and especially into those belonging to the tnus« cular coat, and the organ now again contracts painfully* and g'iY»:. rise to the sensation of hunger. ''f>:^ If now, food or anything which makes a pleasing impression on the inner surface of the stomach, or a pill of opium, whose narcotic influence blunts the sensibility of the part, which is equivalent to a pleasing impression, the organ as a whole relaxes, and the sensa- tion of hunger goes off. If nothing be taken, and the meal time is passed, the stomach relaxes spontaneously, and hunger ceases to be experienced until the approach of the period for taking the next meal, when the stomach contracting gives rise to the same painful* sensation. Now, the receptioii of food is what is intended by nature to cause this change by which hunger is removed, and. which we have no doubt contists in a relaxation of the vessels and of the stomach as a whole. If this physical agent is withheld, the capillaries of the stcoiAch will become more and more con- tracted, until the patient experiences a sort of feeling as if tfie stomach and bowels were fastened to the back-bone, ^^■^^ii.,^i:p^jsi The food withheld, tiie capillaries ^ver the whole body doings sympathetically what those of the stomach and bowels do, that ia, ' contract, hence the pallor which is always, sooner or later, the concomitant of hunger. Again, chyme and chyle are not formed, and consequently not absorbed-~the vessels of the viscera are destitute of what should distend them and become permanently constricted — hence the emaciation. When this state of the ^rstem, • ' which constitutes a strong predisposition, exists, the slightest possible application of the specific cause will be sufficient to bring on the disease. Or if the Choleraic agent exerts only a vetf' moderate influence in conjnnetion with the predisposition induced' by the predisposing cause under consideration (deficiency of food), the addition of any of the commonly exciting causes will.iosure ait- attack.* 3>8trt %irmach as a. whole dues, that all Its vessels do, and they admit more blood ; hence the secre- tion of the gastric Juice which commences soon after the reception of food into the organ, and conUnues until K is all digested and expelled flrom it, when after a certain tiir.s the contraction Is again perceived, the perception of which con- stitutes the sensation of hunger, which is commonly most argent, when the usual period for taking food has arrived ; or » little after, when the contraction is greatest If food be still withheld, the stomach relaxes spoutoneously, and the semie of hunger goes ofl; bat returns at the approach of the next an%l time. The stomach may be made to talw on almost any habit o! periodicity which will best suit the business htbits of each individual, the vessels in other and distant parts doing what those in the aUmentary canal do, and tnr the same reason— the want of material for distension ; emaciation becomes the lecoBdary aad Invariable ceaeomltant and iwalt of daficieiMf of food. ,1 ^V^/"4'/ / N ii '■ * 1 \ I i' 10 CHOLEBA, CONSIDERED AND SXPLAIKED. of any one of them may prove an exciting cause in the case of any individual upon whom the choleraic poiaon ia operating, so aa to give a slight indisposition only. ■< r!i»' t'Oi ''«.•».•: j ,t)•J;«•.;,-.1^ a? 4. PreviouB aieknesa has been found a strongly predisposing cause, the effect of which is a contraction of the capillaries, so very like that induced by the foremeiitinned causes, as to render further comment unnecessary. 5. Affections of the mind. — Fear ; anxiety and dejection of spirits, which are species of fear more persistent in their character, pro« duce contraction of the capillaries, as is proved by the pallor of those subjected to their influence, and therefore powerfully predis* pose to the disease. When excessive, these aflections and pas- sions very often act as exciting causes, and more especially so, if the predisposition has been derived from the choleraic poison, or specific cause. This passion, fear, above all other disturbing causes, is the best calculated to produce the disease, for it not only causes the capillaries to contract, but induces the pores and sphinetera at . the same lime to relax— hence the diarrhoea, and diabetic flow of urine, which so often aflect persons^ubjected to its influence, and so far as my own observation goes, it was the most powerful pre- disposing, or frequently exciting cause of the disease. In 1832, the predisposition caused by this subduing passion was so strong, that almost any exciting cause, as a night's watching, or a meal of im- proper or indigestible food, was suflicient to produce the disease in. all its horrors; — on the other hand, when the prediapositio.i pro- ceeded fVom other causes, and particularly the specific, a fright, or anything that occasioned a greater sudden mental depression, was sure to excite the disease.* * This passion, by turning the attention inward, and fixing !t on the stomach and lx>wels, has, in addition to the general contraction of the capillaries which It induces, a great influence as an exciting, as well as a predisposing eunse. One ladjr in fall health was introduced to the bedside nf a pitlent in the worst form of Cholera. AHer witnessing fbr a few minntes the snflbrings, she became sick, and desired to be helped into avther room, where she died of the disease in abont five hours. By mental sympathy, her .attention was fixed on the same parts in her own person as were aflbeted in that of the patient whose snflaring she witnessed. If Inquired of, the timid will tali yon that they are prooo to this exercise of the attention, and eiptrieM* an ajggravmtion of the abdoninal nneasi- ne3s whenever they think of the viscera alhiiled to. ^^.wy 9yf CHOLBRA* CONSIOEBBD ANJ» fiXPLAINEI). 11 6. Intoxicating Drink*. The habitual use of these furnished one of the strongest predis- posing caus g of Cholera. An occasional fit of intoxication, in such, as indulged in this most pernicious habit, was of all others the most 4, certain exciting cause of an attack. I cannot call to mind a singlo instance in which an habitual drinker, after getting drunk, escaped an attack, or one who recovered from it. Although it may not produce any palpable derangement of the health, the habitual use of intoxicating drinks, even if moderate, as in the case of temperate- drinkers, so called, induces an irritable state of the capillaries, vbich inclines them to take on morbid action from trivial causes, and that condition prevents their resuming healthy action when the disturbing cause is removed. In other words, slighter causes bring on disease in such persons, which is not only more difficult to re- move by medical skill and remedies, but also more likely to destroy life. For the reason assigned, it will be easily understood why habitual drinkers are so much more certain to be attacked ak:d destroyed by the disease, than the tee-totaller, who so uniformly goes unscathed.* He that takes a drop of anything that can in- > toxicate, except as a medicine, has in the opinion of the author : " taken a drop too much." rt^iUv>riUi:^m^:.9^y&?m,^r,..^^m>^o 7. Hemorrhage. •.\^..-\.. r:'..C. ■. ,.,•..,.. >:', •'>;■> This debilitates, and exhausts the system, by the withdrawal of its fluids — consequently produces contractioq*of the capillaries commensurate with that withdrawal. Spontaneous haemorrhages are more dangerous and much more^ likely to give the predisposition, and, in fact, bring on the disease,, than such as are accidental or produced by violence. In the for-, mer the pores are open (a condition analogous to that which actn. , ally exists in Cholera), and allow the blood in its entirety to escape, . and the vessels continuing to contract, keep in contact with what remains, be its quantity ever so small; but in this case all the con- stituents of the 'blood equally alike escape ; and there the analogy ceases. In Cholera, the colorless portions only are strained out, * It t« said that now and then on* of this claas has been attacked— but I have' not the shadow of a doubt that such had been guilty of some In-^mdent act, -, violating tlio lawi of health, and by so doing invited the attack. . -I III (^/i^P9^'^ ? m CHOLERAi COTTSIDERED AND EXPLAmSD. 1 ■ ! r'f Li ^'1 [<» and the residue, partaking of the nature of renous blood, remain* in the larger vesselsi, and acts as a poison on parts with which it in in contact. In this, as in other instances, the contraction of the ocapillariea constitutes the predisposition— the flow of blood the predisposing cause. In spontaneous htemorrhages the capillaries of the part whence comes the blood are, from some cause or other« over-distended, which prompts them to contract, and if they do not contract violently, the pores will relax and allow the blood to pass, which makes room for more and more to be admitted into the ves- •els ; so that the fluids of the body, in accordance with hydraulic principles, finding less resistance in that direction, would all escape, if proper means were not employed, or nature did not interpose to prevent such an untoward result. In both the accidental and spon- taneous hemorrhage, as the contents are withdrawn the vessels contract and keep in contact with those \^hich are left. 8. Exposure to cold. i rfpwf« -*«?,« All are familiar with the fact that cold produces contraction of the capillaries, and so becomes a predisposing cause of Cholera— but many instances have occurred in which it has acted as an exciting cause. In such the predisposition has been the work of the speci- fic, while an additional degree of contraction, produced by the ex- citing cause, exposure to cold, ushered in the disease. ^ 9. Expoattre to the night air. It seems to have been a well ascertained fact that Cholera, like endemic diseases, "generally makes its attack in the night towards morning." No reason known to the writer has been assigned why this time for attack should be chosen. To him the following exposition has seemed the most philosophical. Natural sleep is caused by the relaxation of the capillaries of the brain and nervous centres first — next of those belonging to the organs of animal life— and lastly, of those appertaining to the organs of organic life, botin a ' less degree in the latter. During the exertions of the day all these vessels are more or less under the influeiice of the will and other exciting causes, which are wholly, or in a great measure, abstracted and cease to operate during the night ; on that account they forego their resistance and sufier themselves to be distended, by which t t* ! ^/^ff^ ^ CROLKRA, COirSIDERBD AffO EXPLAIItED. It the parenehTtnatous substance of the brain is compressed and sleep ensues. Commensurate with that distension and compression is the progress of sleep from slumbering, dozing, moderate insensi- bility, to deep sleep, coma, tec, and in the same degree is one function of animal life after another interfered with and suspended, until the abolition of all is complete, when the body, failing to be supported by the muscles of volition, subsides into the recumbent posture, which facilitates the additional flow of blood into and re- tards its egress from the brain. Moreover, favored by this position, the heart continues to force the blood into the capillaries of the brain, and likewise into those of other parts connected with animal and also organic life, whose organs, although they do not suspend their operations during sleep, perform them less actively and vigor- ously, and in that way share in the benefits of sleep, which consti- tutes the only kind of repose they can enjoy, but which is never- theless essential, for without it the*fa)achinery of life would soon cease to move. By the concurring influence of the forementioned causes, the natural and ordinary sleep which we are now considering is ren- dered more profound, and might be detrimental, and even fatal, if nature had not devised a method by which it is commonly terminated at the proper time. The distension caused as above described, continues to increase, until the vessels of the brain, and, indeed, of most other parts connected with animal life, become more and more distended and stretched, till active resistance is excited ; and then contraction, which causes uneasiness and some- times pain, awakes the sleeper. This period of energetic contrac- tion arrives sooner in some individuals than in others, but generally towards morning, when people who "follow nature" become uneasy and begin to awake. ' Thus far all is well — the relaxation, distension, compression, contraction, and attendant circumstances, as detailed, are normal, and would induce neither cholera nor any other malady without the concurrence and co-operation of another exciting cause or extra- neous agent, which prevents the contractile effort just mentioned fVom stopping at the point where it has performed the duty assigned, i. e. when it has wakened the sleeper. This cause is a I I I I i 1 ^/'<^,r>^P S' / i /- u CHOLERA, CONSIDERED AND EXPLAINED. Jl 1 ,1 ,1 change io the temperature uf the i^osphere, which takes place •imulraneously with that ia the bodj. This atmospheric change consists in a fall of temperature and consequent condensation and depositor moisture during the night, and particularly the lattefu: part. Owing to this diminution of temperature in the surrounding- air, caloric leaves the body, which causes the cutaneous capillaries to contract still more, and with increased energy. Induced by the joint influence of these two causes, to which is usually added that of other predisposing and exciting causes, and, abnre all, that of the specific or choleraic agent, this contraction, " about three o;'.;} four o'clock in the morning," ushers in the nocturnal attack of cholera, and likewise that of many other diseases, beginning with . a chill/ With respect to them the contractile effort, as in cholera, does not stop with the awakening of the sleeper ; but, influenced by the co-operation of the predisposing and exciting causes, whether of fever and ague or of any other disease, it goes on with incxeasing energy until those affections are induced. In cholera, although the disease commenced at the time stated, the cold stage is Hot often v fully established until after the lapse of several hours. So the,;, cold stage of fever and ague and of other fevers does not often ; ; manifest itself before nine or ten o'clock in the morning, or later, according to the tyoe. It will be seen that this view of the subject is in strict accorditce with those already taken in regard to the predisposing and exciting causes to which allusion has been made. The coincidence of this contractile effort of the capillaries at that period of the twenty-four hours when the temperature of the atmosphere and the condensation of its moisture are at the lowest point, secures that degree of capillary contraction which, with the co-operation of^ the other predisposing and exciting causes, renders the influence of the specific poison so certain, that persons if only slightly predisposed will be attacked at the time specified. Many, it is true, ari3 assailed during the day, but in such cases the disease springs from some special and strongly exciting cause, as intoxica- * tion, fright, over-exertion, &c. ,^ ^ tiij- J >• l*. * Thts view of the subject suggests the propriety of an extra blanket at night applied nt least over the inferior eztreinltles. *" *) f If. OF THE SPECIFIC CAUSE OF CHOLERA. Concerning this agent we are in the dark ; but are much inclined to consider it a predisposing, rather than a necessarily exciting cause. In whichever light it is viewed, it is consoling to know that it is seldom, if ever, so highly concentrated as to produce the disease without the concurrence and co-operation of some one or more of the causes belonging to the class, which we have just been considering ; but when so concentrated as to become the rqal exciting cause, it seizes its victim without the least pre- monition, and hurries him with relentless fury and awful celerity to " that lone land" from " whose bourne no traveller returns." Bat it is comforting to know that such instances are very rare ; and that, although millions may fall by the sword of the de- stroyer, yet the cases just alluded to are almost, if not quite, the only ones necessarily fatal. Without offering, in this place, anything re- lating to this strange mysterious agent, we shall proceed to analyze the phenomena which it produces, and try to deduce from them something concerning its nature, and the laws by which its influence on the human body is governed, and the principles of practice on which we should rely in the treatment. Here, however, a difficulty meets us un the very threshold — it is that of discriminating between the phenomena which proceed directly from the specific cause, and those produced by the modifying influences of the other causes; and also, between those induced by other causes, modified by the choleraic or specific cause. The premonitory eymptoms, as they are technically called, arising, as we believe they do, from the common predisposing and exciting cause.i, furnish the best and moat characteristic mark of distinction, which is of the utmost practical importance. Like the predisposing and exciting causes which we have been considering, and also like those of epidemics and endemics, this spe- cific cause or choleraic agent produces a vehement contraction of the capillaries throughout the whole body, especially thoso portions of t] h / / ♦! 16 CHOLERA CONSIDERED AND EXPLAINED. i IfSil it which belonfi; to animal life ; but in one respect iti eflTeet diflfcra Trom that of the others, and ia indeed peculiar to itaelf. With thia constriction of the minute veasrls, it also eausea a relaxation of theporea, particularly those openini; into the stomach and bowels, throuKh which the colorless, aerous, and aaline constituents of the blood escape into those viscera, and leave the system destitute of materials essential to the performance of the vital functions. Thia lest circumstance, the relaxation of the pores, we repeat, ia the great leading mark of distinction between the efTecta of this and the eflfects of the other caunes, which we have considered as predisposing and exciting, and, indeed, of all other morbific agen- cies ; and in that circumstance, viz. the relaxation of the pores taking place simultaneously with the contraction uf the capillaries, consists the peculiar and specific action of this choleraic agent, and it is this anomalous and u'.lque effect which constitutes chole- ra a disease mi gentria. '*■'!' ** «»' It is true that we have the contraction of the capillaries, and occasionally a relaxation of their outlets from other causes, as when cathartic medicines are administered for when' causes of diarrhcea exist within the alimentary canal, — which irritate the mouths of the exhalants (as tobacco irritating the extremities of the salivary ducts causes an increased flow of saliva), and cause them to pour out their contents, hence the diarrhoea fVom such causes. But the diarrhoeas from fear and the application of cold to the fl"rface are more analogous to that produced by the specific cause of Cholera, than those produced from the causes just men- tioned. In all the cases mentioned, the diarrhoea is generally either mucous or purulent, and therefore does not much involve the capillaries which circulate the albuminous, serous, and watery por- tions of the blood ; neither does it affect so great an extent of the mucous surface of the alimentary tube. sii* Let us now examine the symptoms and phenomena ; 1, with t view to their cause ; 3, to the proximate cause of the disease ; and 3, to the treatment. "«i»i In a great many instances, perhaps a majority, the disease aeenis to commence in the organs of animal life, hence the languor, pale- ness, and contracted state of the features which often precede an attack. Thia Choleric expression was so remarkable that the 1 CHOLKRA, CONSrDBRBD AND EXPLAINED. n ifftra this •on of wels, its of ititute tions. sat, i« if this eda« agen- poret llariea, agent, chole- eecession of the disease wa» often anticipated, and in dome caaea, as the writer believes, prevented. The shrinking of the cutaneous capilluricfl which belong to animal life, constitutes a most remarkable feature of the disease, and is the physical cause of one of its prominent symptoms— the sensation of cold. In Cholera, this sensation is no error of perception, for the temperature of the body, internally as well as externally, is excessively lowered, and the capillaries no less excessively contracted, as may ba inferred from the coldness of air breathed from the lungs, and the corrugated, shrunken appearance of the surface. We know no ap^lisAce to the body that can produce this effect. External agencies seem to be utterly incompetent,— the cause must then be one acting from within, and here again we are constrained to acknowledge our ignorance of any substance taken into the system which can produce such a result. Nothing but caloric leaving the body (and in Cholera it escapes with a wonderful facility), can produce this general reduction of temperature with which the capillary contraction seems to be exactly commensurate ; but the mere abstraction of caloric does not— cannot produce the phenomena of Cholera, because life would be extinguished before the capillaries of the internal organs could be made to feel its induance; besides. Cholera, like intermittent and endemial fevers and diseases, invades the system at times and under circumstances which preclude the possibility- of an abstraction of caloric which could per ae produce the shrinking of the capillaries and other phenomena. The analogy must not, however, be permitted to escape us. Cold applied to the body, or more scientifically speak- ing, calorie alstracted from its surface, produces a contraction of Um cutaneous capillaries, and also those more deeply seated, which forces the fluids inward upon the capillaries of the mucous membranes, and causes them to be slightly over-distended, but not enough to induce the pores opening into the intestinal canal, to resist, and hold fiut, because, owing to the unvarying warmth of the part they are ever ready to relax, and do relax as the capillaries contract ; hence, the looseness which is so apt to follow the simple exposure uf tha nude body to the cold water, or the cool air pre-, paratory to bathii^ and axplaina the reason why cold is so often an exciting cause of Cfadara. In tha same way, aqd on the satne « CUOLEEJi, C02«8IJ}£R£Z) AND EXVLMKZD. * i III :l . principle, is the quantity of urine increased and the desire to mictorate from a similar exposure. Analoefous to this effect of cold is that of fear, which produces a contraction of tho cutaneous capillaries, and a relaxation of the sphincters; hence the diarrhoea, and desire to micturate when per- sons are much under its influence, complaints said to have been prevalent among the higher otBcers engaged in the late " patriot war" along the Canada frontier. Men of great laxity, they were undoubtedly thoroughly predisposed, and would certainly have had Cholera, had it been at all prevalent. This explains the fact why fear is one of the most powerfully exciting causes. The specific cause, whatever it may be, produces a peculiarity of eflect which constitutes Cholera a disease sui generis ; but it must be admitted that the causes of other diseases do sometimes produce analogou* effects. Some have supposed the specific cause to be a change wrought in the constitution of the blood ; but that hypothesis falls to tfa^ ground when we consider the fact, that the disease is very certainly arrested and cured in its premonitory stage»,by remedicB which: cannot be supposed to operate any cl\ange vrhatevor in the physical or chemical properties of the blood ; and moreover, tli«it it is occa> sionally recovered from in all its stages, under the use of meadui which effect no such changes. Besides, it i9 said that persons in perfect health have been attacked — and also that recovery is now and then sudden; facts inconsistent with the idea of the existence and removal of such a condition of the blood.* Man in his wisdom ia prone to look beyond tl^e .simplicity, of nature, in the explanation of the phenomena which she present*, and more particularly so, when the phenomena of disease are con- cerned;, but the writer, after much reflection, jias at length settled down upon what ^eeipa to him to be the most simple and Qommon sense view of the subject, vyhich is that the specific capse of * That the blood does undergo nhanges daring the progress of the disease, is not to be questioned. That fluid drawn soon after the attacic is natnriii — bat if at » later period, "darli, black, tanrj^— thicic, ropy, syra^, semi-eoagalated,*> changes owing mainly to the straining out through tlM pent, of the edorlesa and ui;ous ]|orUpnto(.the.li|ood, as the dlwase advancad. -'. HI :.0 =*;.•' Wl CHOLERA, CONSIDERED AND EXPLAINED. 19 esire tu duces a of the )en por- ave been * patriot ley were lave had fact why »peeifio ct whiclk admitted BDalogous i wrought Us to th9 I certaioJiy icEi which.' e physical it is occa- i of metiDs have b«fln Iden; facts I of such a uplicity. of e present^, tse are con-^ igth settled, id qommon ic cause of Cholera is the concurrent influence of all or moat of the predispos- ing.and exciting causes of that malady, while those agencies whoso tendencies are to counteract that influence are absent. Not that the concurrence of all is necessary to the production of the disease in each individual case, but that the existence of all, or nearly all, is necessary, as in other epidemics, in otder to render the disease general. When these causes exist in any place, it may be expected that Cholera will soon be there. When they are removed in season (and they are all indigenous, and under our control), the disease either does not make its appearance, or soon disappears. When it breaks out under such circumstances, the timid stiould flee and the poor be removed. We have shown in a former part of this papery that the predis* posing and exciting causes all concur in producing a contraction of the capiUaries; but that the disease was not produced, unless the pores opening into the alimentary canal were relaxed. It may be a question, to what class of capillaries do these pores belong f We answer: not to those which perform th€i ordinary Ainctions of secretion or excretion, whiok' pertain to the lining membrane of that canal, but to those that circulate the colorless fluids, as the albumen, serum, and fibrine— constituents of the blood. When the contraction of the capillaries over the system which belong to this class takes place, and the above mentioned pores connected with them in the mucoUS' membraoet relax, we have Cholera; Another question arises. How are wo to account for the coincidence of the contraction of the ca{)illaries, and the celaxatiMi andepening of th« pores ? . • We will venture to Suggest that the coocurrent influence of the causes to which we have alluded as the speeific canse, when it pro- duces the disease, does it by disturbing the equilibrium between some of the imponder9ble agents which pervade the human frame, in common yrith everything else, a disturbance which is capable of extinguishing life, or greatly deranging its functions.* ' i^- ^ 'A he disease, is atural— but if 1 -coagulated,'* "the ccriorISM * Perhaps philosophy may yet disclose what will be la perfect keeping with the simplicity of nature, that these imponderable agents called caloric, light, galvanism, electricity, magnetism, toe., are only ii^odiflcations of the same aipnt, and governed by the same laws. Probably thjs opinion now prevails. V f I' I ' P'll ■ ' • it ^i - 30 CHOLERA, CONSIDEBBD AND EXPLAIITED. ■■-/■'■■ ■■'.'."•" '■' " SYMPTOMS. ■-"■^■'■'•■J ■ •» t /•.'»<•.:.' In Cholera we have nausea, vomiting, and purgin)^, with violent cramps in the stomach and gripings in the bowels, also dreadful spasms in the muscles of the abdomen and limbs, and various other symptoms not imputable to the specific cause alone, and there' fore explicable on other principles, a consideration of importance in relation to the treatment. " ^"if }"■■;'■'■■.'■ "^" 1. VomUing and purging. — What the capillaries of the stomach and bowels do, no matter from what cause, that will those viscera as entire organs do; therefore when those vessels contract and force their contents through the pores into the cavities of these viscera, they (the viscera) will be prompted to contract as whole* by this contraction of their vessels, and by the contained fluids, which act by their irritating qualities, and likewise by their bulk, in both ways exciting the stomach and bowels to violent e£fbrts for their expulsion ; hence the vomiting and purging, and, when violent, the cramps and gripings, so characteristic of cholera. The quan> tity of contents produces mechanical distension, the natural stimu- lus to the muscular fibre, hence the muscular coats of those organs take on abnormal actions which are so painful and overwhelming. 2. Crampt and npasma — Now, according to a law of sympathy, when the muscles in one part become inordinately affected, those in other parts, from similarity in structure, are in like manner affected. In Cholera the muscles of locomotion do what the muscular tissues of the stomach and bowels do, consequently cramps and spasms manifest themselves in the limbs, which result from the contrac- tions of the capillaries of those muscles, in accordance with the law that muscles as wholes do what all their capillaries do. These cramps are, however, very unlike the spasms in epilepsy and con- vulsions, which are instituted by nature as remedial measures for relieving the congested state of the brain, by deriving blood from that organ into the muscles of locomotion.* In Cholera these * This is on the principle that Increasing the function of an organ within cer- tain liinits augments the detenulnation of blood to that organ, hence in epilepsy and SQuvalilons ths abnormal action of the mustlas causes an Increased quan- tity! tedi thall thatf Insti opilJ CHOLEBA, CONSIDBBBD AND EXPLAINBD. 31 iriolent readful irariout I there- ance in itomach 1 viscera act and of theae I wholw 1 fluids, r bulk, in fibrta for 1 violent) 16 quan- alatimu- le organs helming. ympathy, , those in r affected, lar tissues id spasms e cOntrac- B with the lo. These y and con- saMures for jlood from tlera these a within cer- •A In epilepsy iroased ^aan- irregular movements arise from the violent efforts of the muscular capillaries to follow up their contents, which are being so rapidly withdrawn. They resemble the convulsive motions of animals dying from loss of blood. 3. The Small Feeble Pul»e—\i owing to the contracted condi" tion of the capillaries of the heart ; a condition sympathetic of, and analogous to that of those vessels in othri* parts. In this case, the heart, doing what all its capillaries dc. becomes so contracted that it cannot send the blood to distant parts with sufficient force to overcome the contracted state of the capillaries (its antagonists), over the whole system, even if this extraordinary capillary resist- ance did not exist — hence the pulse not unfrequently ceases to be perceptible several hours before death. Desperate as the case may seem, if the capillaries relax, the patient may recover. It is then proper to keep up to the last external warmth, dry friction, &c., which promote relaxation. 4. Dyspntfa.—" The Dyspnoea, the high and rapid breathing, and intolerable sense of oppression," arisu from the contracted state of the capillaries of the lungs, and also of the muscles of respiration, sympatheticdlly produced ; the former excluding blood from those organs, and thereby preventing its due aeration; and the latter, the proper performance of the respiratory act, so far as it depends on the apparatus essential for that function. 5. State of Mind. — The capillaries of the brain, the organ of mind, like those of other parts, are in a state of inordinate contrac- tion, as may be inferred from the constricted, uhrunk, shrivelled, and pallid appearance of the face and features, which is usually a sure index to the circulation of parts within the cranium, be- cauie both derive their blood from the same vessels. The state of tlty of blood to be derived to them, and tn the tame proportion as Mood is admit- ted into them is it withdrawn from the brain— hence the relief experienced by that organ. In this, natnre does what the practitioner does with h*' lancet, leeches, scarificator, pedlinviain, trlctluns, Uc. A resort to these means proves that he has rightly interpreted the indications and language of nature. In many instances a l^jeral dose of opium, when immediately preceded by a fall bleed- ing, by the general rslaMtion It produoea, puts aa end to the convuUloni or oplleptlc paroxysm. . , 11 I r 92 caOLERA, . m *i CHOLERA, CONSIDERED AND EXPLAI.NEU. 23 circulating in it.* Deprived of blool, an nrjnn or part becomes insensible. The stomach, when in that predicament, is quite n" in • sensible as the surface to the strotrj;cst stimuli. f This insensibility <*f the stomach does not usually occur until after the vomitinj^ and purging have ceased. Notwithstuidinsj; the coldness of ti>e surface, tongue, and breath, the patient frequently comphins of a sense of heat and burning at the stomach — pircumstances expliiinable on the principle that extremes^ often produce similar results. 7. Deficient Secretion of Urine. — Omn^ to the contracted state of the renal capillaries, the blc is excluded from the kidneys, and no urine is secreted ; and frnra a similar condition of those vessels pertaining to the bladder, that viscuti, doing what all its capillaries do or have done, is found as a whole in a state of extreme contraction. I have seen it not larger than a butternut, and containing not a single drop of urine. ;■ -v«- •v. / . ; 8. Secretion «f Bile. — The veins, hepatic and mesenteric, are gorged with dark-colored blood — i necessary result of our theory of the contraction of the capillary system By tlie capillary contrac- tion in other parts, the blood is forced inward upon the veins and capillaries of the stomach and bowels, and its thinner and more subtile portions are strained out through the pores into the alimen- tary canal, while its thicker and grosser parti remain in the veins. Now these veins having no valves, and little support from the sur- * The sensibility of a part being uindlficd by the state of its circulation, holds as well in Iho nornai and healthy, us in the abnormal and morbid condition. Wit- ness tito bones, curtilages, fibrni^ membranes, Sec, which in a natural state ezclnde red blood, and are insensible, but if red blood is admitted, as in inflam- mut'on, they becorao excessively painf«i : other parts, as the ends of the fingers, iip^, &c., replete with vessels circulating arterial blood, are acutely sensitive, both in health or disease. t This insensibility of the skin during the state of coll.ipse, as It is called. Is in some iiistiinces so great that blisters, and even cloths wrsng oat in boiling water, m;tl(0 little or no impression. The capillaries ennoot relax. i If we apply a piece of frozon mercury, or a piece of iron, heated as ranch above blood heat (i.e. to 137| Fah.) as the mercury- when congealed is cooled beluw, the subject of the exi)criment cannot tell by the feeling which is the heated iron or the cooled mercury— tlie sensations and effects will be llio game- in both, a blister will be the consequence. This is fVilly substantiated by the testimony of Capt. Parry. Bee Narrative of a Voyage in quest of the North Pole. i !l r 24 If I Hi! :l;f!i I CHOLERA, CONSIDERED AND EXPLAINED. rounding viscera, and also little or no help but rather resistance from the pulmonary and cardiac vessels, are incapable of moving the blood along their trunks, hence their engorgement. In conse- quence of this excess of blood in the portal and hepatic veins, a re- dundancy of bile is suddenly secreted, and the gall-bladder no less suddenly distended, or over-distended, and therefore cannot and does not empty itself through its excretory duct into the duode- num, and is consequently found full,* and no bile in the intestines, and moreover none in the profuse evacuations during the progress of the disease. How in such cases could calomel affect the liver.' 9. Dark appearance of the Skin. — When the surface of the body exhibits the dark blue appearance mentioned by writers, and universally witnessed by all who have seen much of Cholera, the mesenteric, portal, and hepatic vei, i are seldom much gorged with blood, and vice versa — they are generally distended with that fluid when that appearance is absent. This dark-colored appearance, although mentioned by writers as a symptom of cholera, is by no means uniform, or according to the writer's observations, even general — but rather the exception than the rule, and occurs only when the visceral veins are undistended. When absent, the inter- nal veins are gorged ; — when present, comparatively empty. Our theory explains this. 10. Msence of Vomiting and Purging. — Cases are recorded in which there was neither vomiting nor purging ; yet the stomach and b wels were full of the rice water fluid. In such, the emptying of the capillaries of those organs had been effected mainly by the relaxation of the pores wi.nout much contractile effort on the part of the capillaries. The exhaustion of nervous power had prevented the contraction of the capillaries, and consequently of the organs themselves as wholes for the expulsion of the fluid. For the reason assigned, these were the most fatal cases. The writer does not remember to have seen an example of the kind. • The doctrine Is— if a hollow organ, having an outlet, net inordinately and violently, us It is certain to do when suddenly ovcr-dUteiided, the sphincter will not only not relax but hold the more tightly, and nbsoluu^ly resist the passage of the contents, and retention of urine, as in the case of the urinar)' bladder. Is the consequonco— so also is th« retention of bile, In the case under conttderation. sistance moving n conse- ns, a re- r no less nnot anil e duode- ntestinea, progress He liver ? ce of the riters, and olera, the rged with that fluid ppearance, a, is by no ;ion8, even )ccur9 only \, the inter- tnpty. Our recorded in the stomach be emptying ainly by the iffort on the 1 power had sequently of of the fluid, cases. The the kind. lordlnntely and 3 sphincter will t the passage of y bladder, is the inslderatloa. CHOLERA, CONSlbEHED AND EXPLAINED. 25 11. Manner of Evacuation. — In manner, the puking and purging were unlike that exhibited in any other disease, if we except Cholera Infantum. The matter is ejected from the mouth as with a pump, and from the anus as by a syringe — in both instances it would seem to be 'accomplished by the exclusive efforts of the stomach and rectum, without calling into requisition the muscular apparatus ordinarily associated with these operations, and conse- quently in many instances without much apparent uneasiness, and certainly without that pain and suffering which occur, when parts belonging to animal life are brought into action, as in severe vomiting and purging from other causes. -. ; 12. Stage of Excitement and JVature of the Diaeate. — ^From a consideration of the predisposing and exciting .causes of Cholera, the conclusion was drawn tliat they produced a certain degree of contraction of the capillaries throughout the system, but (^specially in those portions which appertain to animal life, and r.at this con- traction, i. e. the predisposition, might exist in a greater or less de- gree, and fbr a longer or shorter time, without the accession of the diseasci) which usually followed the appkcation of some strongly exciting cause, or by the accCkmulated or concentrated energy of the.predisposing causes, which it was hinted might in roality con- stitute the specific cause ; — and moreover that unless the pores, connected with the aforementioned capillaries opening into the alimentary canal, relaxed, the phenomena of Cholera would not present themselves, and we no^ add that not unfrequently diarrhoea' (a consequence and proof of the relaxation of the pores) of a premonitory character, in almost every case^preceded the attack of the iMsease proper, and that this premonitory diarrhoea, although it greatly increased the predisposition and danger too, by emptying the vessels, was not characteristir'.- so long as mucous or fcecal matters only were dischargedi but inabu^.Iy became so when the discharges began to be watery ; indicating that they (the discharges) were from capillary vessels exclusively appropriated to the circulation of the serous and colorless portions of he blood. On further examination, we find that the analogy betwee a the pre- disposing and exciting causes of Cholera, and of febrile diseases, is very striking, and goes far to prove that the former is 'also a febrile disease, although it does not often exhibit the phenomena 2 i I t - « V. ♦ -,^ 1 . 1 - 1 •< r no CHOLERA, CONSIDEilED AND EXPLAINED. Will which usually characterize that class of disease%— indeed the resemblance is so strong as to challenge the conviction that it . legitimately belongs to the same family, yet it must be admitted that in nearly all cases of pure Cholera, so considered and termed, the stage of febrile excitement never appears. How shall we account for and explain away this seeming para- dox ? In VU diseases of a febrile stamp, commencing with i:hills, whether infectious, as small-pox, measles, &c., or non-infectious, as intermittent, remittent, and other fevers, the rigor depends on the contraction of the capillaries, and the succeeding hot fit on ths relaxation of those vessels, spontaneously or artificially induced, which follows the chill or rigor, during which the pores do not relax, nor indeed do they during the hot fit, and not until the heart becomes fatigued with its own exertipn and' acts with diminished energy, when we have the sweating stage. But in Cholera, while the capillary contraction is universal and intense, the pores loo](ing into the intestinal canal do relax, open, and allow the watery por- tions of the blood to pass in ten thousand streams, by which the system is drained ; and the capillaries, exhausted of their contents, cannot relax, but are actually compelled, by a law which obtains in the vascular system, to continue contracting more and more in '' order to keep in contact with whatever fluids remain. Henca the inability of the capillaries, in most cases of Cholera, to relax spon- taneously, and also our inability to induce them to do so by artificial means, thevefote the febrile excitement does not take place,* but as if to establish the doctrine of identity of this disease with fever, yielding of the capillaries does sometimes take place, and a series of consecutive symptoms follow: — the disease then assumes the type of conges; ° e fever, which is not uafrequently fatal, although some- *The ca^tllatieg, like ooved, if practicable, and their effects, t. e. the contraction of the capillaries, obviated. During the prevalence of Cholera persons should be particularly careful to avoid exposure to coldi which exerts a powerful agency in producing that contraction, and to keep themselves warmly clad, rather m«re so than usual, or than may seem absolutely necessary, the propriety of which will be obvious from the certain tendency of warmth to keep the cutaneous capillaries relaxed and distended. During the night care and caution should be taken to prevent exposure to cold or . damp; "by night or noon" they should be most scrupulously guarded against. It is not necessary to particularize in this place, as the exciting and predisposing causes have been considered at great 'ength, to which the reader is referred.* Various methods of treatment have been recommended, adopted, and praised, among which is blood-letting, calomel in large — enor- mous doses, calomel and opium in doses small or liberal; tart, emetic ; stimulants, — a^i large quantities of brandy, ice, Jic. So far as the author's observation goes, when th'e disease has fairly set in one method of treatment is about as good as another, and none of h ( * Radishes, cucnmbers, pease, which we observed prouaced Cholera in 1833, mora certainly than any other vegetable dish ; all unripe fruit, decaying vege- tables, &c., oysters, lobsters, clams, most fresh fish, veal, tec, should be placed in (he same catesory— improper food. ■ , I -r » ; i m CHOLERA, CONSIDERED AND EXPLAINED. them of much value, except bo far as they tend to keep up hope and confidence in the patient * Others were, however, of a differ- ent opinion, and have reported considerable success to have followed their respective modes of treatment. We shall, therefore, examine briefly into the grounds of that success. Remembering that relaxation of the capillaries, on the one hand, and stopping the e? ';> > '' - ^ ■■ During the cold fit of an ague the capillaries are so contracted that the fluids which circulate in them cannot reach the pores; hence the dry skin, dryness of the throat, and consequently thirst, paucity of urine, and a'usence of all tendency to discharges from the alimentary canal. If this condition of things could be produced in Cholera, the same r^ult would certainly follow ; and I doubt not it may be sometimes brought about in that disease by blood-letting,^ which, by promptly emptying still more the blood-vessels, causes in them a more vigorous and sudden contraction, which prevents the fluids from reaching the pores ; and furthermore this sudden addi- tional contraction may be all that is wanting in order tb secure the spontaneous relaxation which in common, ordinary cases so readily follows the extreme contraction of the capillaries from other causes. Governed'by this theory, the writer was led to adopt the practice of blood-letting in the cold fit of intermittent fever, as recommended by Mackintosh, and in every case with entire satis- faction. He has biten seen the fit stopped before half a pint of blood was-drawn, and the whole disease cured, as it were, from that moment, subsequent fits being prevented by proper treatment. His reasoning was, that, if the capillarries could be made to contract * It is said that in 1833 it was announced in Quel)ec or Montreal tiiat a cer- tain individual, not a doctor, had an infillibie remedy for Cholera,— that he administered it with the mait wonderful success, — until it was found out t^ be nothing but Anely pulverised charcOal and milk. The confident, the certain expectation of being cured by it did more for the patiert than the remedy. CHOLERA, CONSIDERED AND EXPLAINED. 31 only a little more, the period of their utmost contraction, which ordinarily took place immediateiy prior to the commencement of the hot fit, would be anticipated, and the spontaneous relaxation immediately follow, and such was the uniform result. On this principle, benefit from venesection may be expected. During the prevalence of Cholera in 1832, not having sufficient confidence in the principle as applied to that disease, the practice was not fully put to the test. In the few cases in which it was tried the result was in its favor ,~-80 much so as to incline the writer to think favor- ably of it. •■>.•'!-.' '■J'.' '•■.!.. J Large Doses of Calomel. Some practitioners gave calomel in^drachm doses and some by the half ounce, and as' they say, with advarttage. If beneficial, it must have been because the calomel in large quantities and too heavy to be ejected, came in contact with the pores opening into the stomach and bowels, and stimulated them to contract and stop further efi'u- sion, upon what principle I cannot tell. The solution of tart, emetic, which in the hands of some practitioners is said to have been followed with considerable success, acts by causing a contraction of the capillaries of the stomach (its true physical efiect), which was sufficient to prevent -their contehts from, reaching the pores, and also that additional contraction spoken of under the head of blood- letting. Which is foUovved by spontaneous relaxation. ^^ <^'a<,^. (,-,__ Opium. If we could get narcotics into the system in sufficient quantity to prevent the capillaries feeling the impression made on them by causes which induce their contraction, or woul^ incline them (the capillaries) to forego their contraction, they would relax— perhaps so rapidly as to becomt^ over-distended, when the pores would resist and stop the further escape of serum, &c. When opium operates in this way, it is very efficacious in arresting internal hsmorrb;iges, especially from the uterus. I have often seen opium in small doses, as a single grain, beneficial when given immediately after each ejection from the stomach or rectum. 82 CHOLERJi, CONSIDERED AND EXPLAINED. ill CURABILtTY OF CHOLERA. ■J . n ■ ■ f, I:' '.I It 1 fi iiiii' 'Hi-. The principal reason why Cholera, when once fairly set in, is ho unmanageable or incurable is, that all remedial agents introduced into the stomach and bowels are prevented by the aqueous maiter, and its frequent ejection, from coming in contact or remaining long enough in juxta-position with their inner coats to have any medici- nal effect whatever. If this be a correct view, prevention is almost our only hope ; and it is good to know that this may be accomplished by the removal or avoidance of the predisposing and exciting causes, or by attend- ing to the premonitory symptoms, particularly the diarrhoea, which in every case that came under the writer*s notice, preceded the accession of the disease proper, and which according to h)s expe- rience was always under the control of medicine. In Cholera, as in diarrhcea and dysentery, there are three indica- tions. 1. Constringe the pores. 2. Relax the Capillaries. 3. Keep the patient perfectly quiet. ^ In the diarrhoeal stage, the writer found the acetate of lead and opium quite adequate to the fultilment of the first and second indi- cations. His method was to give the former in unc and a half or two grain doses, with two-thirds of a grain, or a whole grain, of the latter after every discharge, or as frequently as the exigencies of the oise demanded. A single dose often answered the purpose.* Calo- * Having employed the acetate ot lead as an internal remedy more llian any otiier praetltloner within tlie circle of his acquaintance, the writer feels it to be his duty to add a few observations la regard to its value and safely in common diarrhcea and dysentery. Uis practice in thoee couiplainis, and particularly the inttet If severe, Is to confine the patient absolutely to the bed and In the reciimlient posture, from which he should not depart even toe vacuole the bnwiilsor bladder. If allowed to sit on the stool, as Is usunlly done, the action of the glutei muscles, through the fascia connected with the sphincter nn^ muscle, nnd also the perinetn fascia, which every anatomist will understand, tends to relax and open the pas- sage, so that while it facilitates the operation, the very thing not desired, it also favors the descent of tlie intestine, and If persisted in often produces prolapsus. When the ptitieni is not allowed to have a passage, except In the' recumbent posture, he finds more difiiculty in accomplishing It, and is, therefore, more willing to resist calls to evacuate, in which he should be ttroogly urged to persc- are, fcca havll Inqii fallil mati ezisl cans thai ciplj con I '■^^^s^mit^ pt-S; mn CHOLERA, CONSIDERED AND EXPLAINED. :)3 mel, ia doses of ten or fifteen grains, with three or four of opium, is not unfreqiiently prescribed for the purpose of proinotint; the , Tere. If there ts nauiea, and gy any oflbntiye matter in the • )macii, It should be removed by an emetic o( ipeeac apd sulphate of aine. Eachewing all cathartic medicine, I begin with the acetate of lead and opluni. If the .disease is severe the first dose should consist of two or three grains of opium, and four or six of the acetate, after which the subsequent doses may be regulated, as to quantity and frequency, by the exigencies of the case ; but 1 have invariably found It best to malte a strong and decided Impression at first. If the primary dose, so far as the narcotic Is concerned, ts larger than the case actually demands— no matter— the system will be the more amenable to subsequent doses, which may therefore be smaller. By adopting this methttd, the leaa medicine on the whole will be required, and the disease moro promptly and certainly cured. Boole practitioners are in the habit of giving calomel and opium in dysentery. In my opinion, all the good that ii done by that combina- tion is accomplished by the opium, while I would not be answerable for the mischief done by its adjunct. Why give calomel 1 We are told th^t it is to correct the secretions, and particularly those of (he liver. In all cases of fever as well ae dysentery. In which the secretions are morbid, the acetate of lead with opium is a better medicine for effecting a change in them than calomel, or in- deed apy of the preparations of mercury. The diarrhoea and bowel affections which so often make their appearance in typhus and typhoid fevers, and give both the practitioner and patient so much trouble, and are so dangerous to the latter, should be met at tHl very threshold— not with calomel— or cathartics, but w\jjk the above-mentioned remedies, in snfflcient doses effectually to control them, nalhartlcs, and particularly calomel, should be most scrupulously avoided. Deprecating the approach of these untoward symptoms, i have not unfrequently let patlenU with typhus fever go five, six, and sometimes eight days, without imy evacuation ft-om the bowels, and never had cause to regret It. In such cases the physician should ^Iways have the sagacity to discover when a Idxatlve is re- quired. With a little educating the nasal organ will give the hint, ana generally "emell out" the necessity for opening medicine. In dysentery, physicians are, I know, much in the habit of giving cathartics to bring away the lumps of faecal matter, technically termed scybain ; but, Jn the early part of my practice, having great curiosity to see these offdnding matters, I instituted a rigid course of inquiry and observation in order to detect them ; and, after a considerable time, falling to do su, came to the conotusion that there must be some mistake In this matter, and that cathartics were not required for the removal of what did not exist, and of course left off ordering them in that complaint, and have had no cause to regret the omission. The most abundant experience has satisfied me that In dlarrhosa and dysentery the bowels should be kept still, on the same prin- ciple that 5ve would keep an inflamed limb quiet. Injections, except such as contain anodynes and those very small, should not be given. E^en the latter, 2* I f 34 CHOLKRA, CONSIDERED AND BXFLAINED. I h •ecretion of bile, dec. If the state of the liver and gall bladder if> a« has been described, we would in candor ask how calomel or any other medicine can emulge the liver. On another account, we think calomel in the early stages altogether objectionable. We have no drog which is more apt than calomel to excite an excretion of flujds into ihe intestinal canal— the very thing of all otheM in Cholera, or in cases tending to it, to be avoided — ^just what should be prevented or stopped — why then give calomel ? That this prac- tice has been sometimes successful is undeniable; but the success we apprehend yvas-owing to the opium and not to the calomel, but in spite of it ; the former did good in its own way, and moreover obviated the bad effects of the latter.^ The acetate of lead may be cothbined with a sudorific, with great advantage.* To answer the 3d indication, the patient should go to bed and remain there warmly covered, twenty-four or forty-eight hours, after the diarrhoea has entirely ceased ; and he who will not do this, should be told in the plainest language by his physician that he will not be responsible for consequences. Within the twenty-four hours i I ■-'.I , as a lenenil mie, t&onrjl b« omlttwl. Sndorlfliis contaiaing optnm are of great imporUnce. Venavectlon, cupplog, leecbiug, fee, fee, ai demanded by tho exigen- cies or each Individual case, iniut be ruanried to. ]dnc^|||gei for noiulshment and " grain8 4. , - • ' ' M,- ■;< -;, •';'i .'ii' II". ,v Camphor, > '^ _ i^-s ••■tnJjtilRHiiiU Acet. of lead, 3ss. Mix intimately and divide into ^ equal parts. The patient (In bed) is to take one, and the others in succession— s^y one after ea«;h evacoation from tlie Imwels. When the dlarrhtea has stopped, which it will generally do after the administration of the first powder, the pswders may be taken every 6th hour, th* acetate being left out.' ' . -f CHOLERA^ CONSIDERED AND EXPLAINED. a5« dder i» or any nt, we J. We cretion hef6 in should is prac- •uccera mel, but nor cover I may be betl and it hours, )t do thiH, it he will our hours ■ mi^'v are of sreat f tho eitgeo- Uhment and itofliacb and wweri uon%, I nothing bat iver of digea- iven In small ng graen.tea, . ,'• taite, may be morning, le of ibe best Id not be 4I«- «d) Is to take lion firom the I do afler the 6th hour, the II {5>cin» nift'm. after the cessation of the discharges, a laxative of castor oil (the best) or rhubarb may be directed, if deemed necessary,— the patient keeping in bed a day or two after its operation, in order to make the cure certain and permanent. The recumbent posture will be of great utility in every case, and in many the line qu& non to a happy^ result, to which the quietude and warmth of the bed no doubt con- tribute much. When the symptoms peculiar to o much was done by doctors and nurses. ' They seemed to think that this gigantic disease, this " monster malady," could bo cured only by main strength, and therefore gave nature no chance ; whereas the most judicious course in many cas^s would have been " to stand stiU and let ftie patient get well" if he could. When we do not know what to do, wisdom dictates that we do nothi%. We do not mean to insinuate that patients wouM have recovered if they had been less severely doc- tored ; but we do say that/many were doctored top much. I ; i. '-«iic i ! • -S. .I.v^ 1? < V: ■••?' }", > * ii.-'-t -*■•.:'=; , •..><;» ■■■,„• ;,vv:- - /., . ' .. ' ■ ■*■■• ;■',•' , ■ ■• ■- ••.';'- ' >^i'.4:'i7, .iT.-^::'' .f/'i>'t ' -'- ; ' i',- I'l^ '. < ., ■■ - ,/ i !:■; . >>~u t '*'>■'!■.■ K-ii ■"••■ ■•';•■'.-..'' 'v. . .: : ' ;»^»i ji';;^!'-. T-i- :« l#v • .;':.''i'';-jif'«-^' €■•'■*?»■ * ■ * ' -. • • * ' ' ■ ■■ '.■' '■'■'■■.if t ■ ■ ■■ ■•;.i '.''*, :*''i ',^-->r.:i r*;^u-;r? -„ •'.■')V. ■ -.>_-». ..-. • :_.;.■ ■. -.rf u ''M*'*' ^'''■. ■■■:.■■ . K : • ■*,• .•■ .• M ;. ^-;M s'i-5;4:.h \\,--y ■» : A;.f\.-ui •;: ^-• ' I: * , t ; *^'.^"i"*S APPENDIX, Under existing circumstances, cholera furnishbs a subject which ' very properly engages much ot the attention of the medical profession, not only in this city, but probably throughout the country ; and it is to be confessed and regretted that the op'nions of the faculty in regard to its nature and mode of propagation, and also its treatment, are far from being accordant and settled. Dis- turbing and deranging the business of a. whole community, and c&usin o3S of life and property beyond calculation — and hovering, as it docs, at this time, over this city, or actually (this paper was written in December last) prevailing in it, as some believe and assert, its modf of" personal communicability" is a matter of grave and solemn import, well calculated to excite emotions of the deepest interest. In its mode of communication, is it not reasonable to suppose that it will act in obedience to the laws which govern- other diseases belonging to the same class ? Is it then contagious ? Is it infectious? The reader's attention is asked to what will be offered in relation to these interrogatories. So far as the author knows, the views to be presented have never been entertained by any other person ; he therefore solicits that they may be considered with candor.'l. i'-*'.^ Af i>«-''\«i'>. 9f^i'^h s^ssej (■! t«aU.rjj«iWf^ ' ^ ' ■ .. ■ fc^itj.t«>!> ..;i,^ig CHOLERi CONTAGIOUS? Its cause, like other epidemics, is unknown to us, consequently we can gather no information from that source ; but with its phenomena we are aU familiar, either from reading or personal observation, and by comparing them with those which essentially and invariably accompany diseases, known and acknowledged to be ' stl" , jf^-- ^^A^^* i,, >*: ■h'r n^.5 isr.t^* .,4 --■;h";,f' .fVl- . 7 '"^ ''4 .vA.t ■! *.■■> * ' ■<.'?^}? e ?J :U'« rTAfj roi TS> 'M*^'.-^ '^r. i*.1»V>.>. r \f^ 38 APPENDIX. .! ! 'ft contagiou!! diseases, we shall probably find data sufficient for the solution t)f this question. In order-then Co set up a standard, by which to try this " monster malady" in this particular relation, we must ascertain and determine what is a contagious disease. In scarcely any instance is the language of common conversation, or even that of. ordinary professional parlance, sufficiently definite and exact for scientific purposes, and this circumstance, probably more than anything else, has been the cause of so much dis- crepancy of opinion and angry discussion among medical men in respect to the contagiousness of this as well as of other diseases. Even contagion and infection, familiar to the profession as house- hold words, hare never yet b^d precise and definite meanings attached to them ; in many instances they are regarded and used as synonymous and convertible terms, hence the confusion and uncertai nty so apparent when these topics are discussed ; on that account we see gentlemen, in attempting to av^'ti one error, continually running into another. The only -v / o< -"ping these evils is to fix the meaning of those terms, iHiC^ men we may determine what is a contagious or what an infectious disease. Contagion is the transmission of a disease from one person to another by contact, i.e. through the medium of the touch. Now, the skin is the only part of the body designed by nature tu come in contact with surrounding matters — with the material world ; it is therefore the organ of touch, and consequently the seat of contagious disease; it must be so; for how can one individual come in contact with another, so as to communicate a disease, which is communicable by contact only, except by touching his - skin? It must be skin to skin, so that the matter capable of producing the disease, can pass from one skin and fix itself on another. This may be termed communication by " direct contact ;" but the disease -lay be contracted, imparted, or communics^*-*;'' by wearing apparel, or sleeping in sheets to which the ci, . ui^^ '-Mr' cause adheres; in that case, however, the cause comes 'n i -ci with the skin of the individual exposed. In both instancv^ b- cause and the subject may exist, but contact is the nne qu& nan ot the disease. We say, then, that a contagioue disease is one which attacks the skin ; is always produced (if produced at all), in all persons, in all '>» TV" I ^' 'T^r AI>PBNDIX. »» For the lard, by ion, we Irsation, Idefinite Irobably ich dis- tnen in liseases. hcuse- aeanings nd used sion and on that e error, ng these we may ase. person to 1. Now, i tu come world; it e seat of ndividual Bi disease, ching his ■ apable of itself on contact ;" licf -■ •' by "n ■■ ii"3i ancv^ b- u& ncn ui ttacks the ons, in all climates, all seasons, and under ail circumstances, by the contact only of the same, sing'e^ identical cause, which cause affects all obnoxious to its influence, always in the same way and manner, but which never contaminates the system. A disease which never conferl on the individual who has been subjected to its influence, or rather, who has once had it, the slightest immunity from subse- quent attacks, but which of the two renders him rath»?r more susceptible, somewhat in proportion to-the number of times he has been affected ; a disease tha^ never gets well of itself, and therefore •• has no tendency to a spontaneous cr"e ;" a disease which " is never developed ("pijotaneously, and is not epidemic or endemic;" the cause being obviously insufficient for such results.* Always arising from thft'same cause, it'is ever the same. By way of illus- tration we take scabies as an example — a complaint whose contagiousness is unquestioned and unquestionable— with which all are familiar, either by pergonal experience, or ftom personal observation, and is therefore well suited to o.!: scientific interest, comes not within the scope of our present purpose. We shall take, for examples and illustrations, three diseases, with which all are familiar, and about whose characters for *< personal communicability," there'is nothing equivocal, ambiguous, doubtful, ur uncertain, viz. small-pox, measles, and cow-pox. We have selected them for one other reason,— they are held to be contagious ; in h , 4 42 APPENDIX. i) ' 1 1 »>■ the tvfo former are also consideted tob^ infectious as well as conta- gious, while the latter (cow-pox) is pronounced " only contagious, not infectious" by high authority in these matters ;• a proof of the very loose manner in which professional men have been in the habit of thinking and writing on these topics. But are these diseases contagious ? 1. Is small-pox contagions? Does its virus produce the disease by simple contact, direct or indi- rect ? We will not demand of our friends, the contagionista, a categorical answer to this last interrogatory ; but say what they say, that there are three ways or modes of communicating the disease with tolerable certainty, and also another, of very questioA- able character, which we will proceed to examine. 1. Small-pox may be communicated to the foetus in utero, and that too when the mother, having previously had the disease, re- mains perfectly free from every symptom of that distemper. In this case, the varioloas matter is received into the maternal system, and transmitted through it to the foetus. As this excludes the pos- sibility of contact, pr of any artificial means of communication having been emffloyed, it niay be emphatically styled " the natural way" of getting the small-pox. t '..--> r- j t ; t...:, j, ;,..., . 2. By inhaling air impregnated or tainted with the variolous poi- son, which is diffused through it in a state of the minutest possible division. In this way, the matter is conveyed to the pulmonary absorbents, taken up, ^nd carried by them into the system, which in process i>f time becomes contaminated and poisoned. By this method a much greater quantity of virus finds its way into the system— hence the greater severity of the disease thus induced. •In this case the matter comes in contact with the surface of the body, and also with that of the mucous membrane of the bronchiae. The former (i. e. contact with the surface) constitutes, as we have seen, the very essence, the sine qud nan of contagion; but we have, in addition, its contact with the pulmonary tissues which makes " assurance doubly sure;" yet if it is not absorbed no disease * See ElliotioR's Practice, by Stewardson, p. 444, nnd also p. 309. t It is impossible to furnish a stronger proof of the fact that infectious diseases (a certain species of them at least) do afford immunity flroro subsequent attaclcs— or In other words, destroy the ■usceptibillty of the system to the impromion ma«le by that particular poison. It 'i APPENDIX. 43 is conta- itagiouB, [)of of the the habit ntagious ? ct or indi- ponists, a vhat they rating the questioA- utero, and liseaae, re- ;mper. In lal aystem, 69 the po9- munication the natural iriolous poi- :eat possible 5 pulmonary stem, which 3d. By this iray into the tus induced, jirface of the he broncMae. tutes, as we gion ; but we issues which ed no disease 00. 'ectious diseases jquent attacks — impression made will ensue, as would have happened if the afTectioa had been of a contagious nature. Although in contact, if unabsorbed, the matter excites no morbid action whatever, and is therefore not contagious. 3. By breaking the cuticle and bringing the liquid virus in cob- tact with the cutaneous absorbents, which take it up and convey it ' into the system, which becomes contaminated. Communicated in this way, the disease is much milder than when communicated in the "second mode, because less matter is received into the system — the effect of a poison nr of a medicine being in the common sense way of reasoning and philosophizing somewhat in proportion to quantity or dose. This is called " the mode by inoculation." 4. Dr. Gregory tells us that the matter of the pustules or scabs may be applied to the unbroken surface of the skin or to the mucous membrane of the nose, and be absoVbed." " This," he says, •' ij called the mode by contagion:" " but," continues he, •• it must be admitted that the terms contagion and infection are often use! indiscriminately to express the silent, or as we say casual reception of the germ." Coming as it does from the pen of a distinguished professor and author, this quotation may be deemed and taken as a (air specimen of professional accuracy. It erhows clearly the difficulty we wish to get rid of. Let us examine Dr. Gregory's "mode by contagion." "The matter of the pustules or scabs," says he, "may be applied to the unbroken surface of the skin." How is it to " be applied to the unbroken surface of the skin," while the cuticle remains entire ?* If the cuticle is broken, and the matter applied to the unbroken surface of the skin, it amounts, de faeto, to inoculation, and absorption of course would follow ; but if there was no absorption, then there would be no disease, as we have already affirmed, and have a right to infer from Dr. Gregory's own statement; but if it had been the matter of conta- gion the specific disease would have ensued without absorption. " Applied to the mucous membrane of the nose," how, we would * The cntiele is mi insensible ^^unorganic body," which (accordint; to Cruvell- hier) is moulded upon the "surface uf the dermis and its papillffi, lilie a coat of varnish, and protects them from the action of external agents ; and we add ra^ro particulafly of such "external agenU" as are capable of being talcen up by the cutaneous absorbents. It ii'unnecessary to recount the experiments wliich have been made ftom time to time, in reference to this que»tion of cutaneous abMirption. ■,•-. ■>' f 44 APPENDIX. 'i '^ aik, could it be so applied, and the effluvia not find the way into the lunga — bo absorbed, and carried into, and throughout the sys- tem ? Again, if " applied to the unbroken surface of the skin," and kept there long enough to infect the system, through the unbroken cuticle, would it nbt 1i!cewise find its way into the system by the p 'Imonary absorbents ? Suppose the leg or arm of an individual, or indeed the whole body, covered with the scabs or the liquid virus, or exposed to an atmosphere saturated with variolous matter, would he be affected if the cuticle remained whole— the head being excluded, and the air he breathed *' pure as the breath of heaven," or at least untaint- ed with the miasm of small-pox ? We know of no instance on record or not on record, in which the disease has been coifxiunicat- ed under such circumstances, and we do not believe that it is communicable by contact* so long as the respiratory organs are insulated, and the cuticle remains unbroken. :.( \.s% jahUpjkiii/.' We shall push the argument no further, and therefore refrain from examining the two other diseases named. Suffice it to say, that like small-pox they are infectious, not contagious : that they tre produceu by the absorption of a specific virus, and exhibit symptoms of fever and inflammation, and a regular series of phenomena ; and that they afford an immunity from subsequent attacks, and have a tendency io a spontaneous cure — circumstances which separate them as i^ an impassable wall, from contagious diseases. Like small-pox, the vac- cine disease and measles furnish perfect examples of infectious maladies. If they are infectious, then others which have not their charac- teristic features, or, indeed, a single symptom in common with them, cannot by any rule of philosophizing or of classification with which we are acquainted, be arranged with them, and called infectious. If so, are we justified in pronouncing cholera an infectious disease ? ' Besides, it is admitted by all, that cholera may and does break out under circumstances which preclude the possibility of its having been produced by the absorption of a specific virus, and also that it terminates in a manner different from what it would if produced by a specific poison ; that its progress, spread, stay, and departure, are all unlike vf hat might be expected of an infectious disease. If cholera is not produced as infectious diseases are, — ^ifitdoes not T apAndix. 45 ray into he Bys- n," and nbroken by the e whole' id to an affected and the untaint- itance on x»unicat- that it is ■jans are rain from , that like ) produceu ts of fever ^ that they Bt tendency masl^/an X, the vac- infectious exhibit the same or analogous phenomena, — if it does not march in the same train, and is not followed by the same results, where then is the propriety of arranging it with them as of the same nature ? If I were to show you, kind reader, a piece of metal, and tell you it was a specimen of the California gold, would you take it to be gold if the yellow color and other attributes of that metal were absent? ■■,.;.'' • Z^- - : So, if I were to show you a disease, and tell you that it was infec- tious, and you should ask — was it caused by the absorption of a spe- cific virus generated in a living body ? — has it usually exhibited symptoms of fever and inflammation .'—does it afford immunity from subsequent attacks?— has it a tendency to a spontaneous cure ? — does it originate spontaoeously ? — is it uniformly or generally fol- lowed by the same results ? No. Then I trust you would not pro- nounce it an infectious disease, for the plain and simple reason that it did not exhibit the phenoAena or possess the essential attributes of a disease of that character. .p^... '**i-i. air charac- with them, vith which infectious, us disease ? 1 break ouk its having also that it roduced by )arture, are 96. fit does not ,■-' t;.', \ ^. "M- * :»..... ••'I-'/'.. , .^ ; •f.'v''^- V:j^ 'V'> tliTN.'-'. • f/!, ■: ' ,' 'j> ■ I ,1. '■ V ■•. ;- ;,'■'■ ' '■,;■ ••■■-;.' -r ■ ;. n\ ^r 1,',/ - '• - i • f.^V' v.i| X ■'. ^- ,■ . { 1\'*). ],:;- .-.,.:. C;*., r.i7 vXy '.. ■' .' ' ■, •«' :"••. . - ■,. . '" V'uV. Vr ' f .1'. .• • •■ .111 i H ■ «:.;•'•• . .'''i,''*- />*'-'.Vj. I'V'ji •'•: ■■■^ ■!■: G' "iv.! f^(..T.;i< L,.,f >> ■i"-- . » 1 1 1 . THE HORSE: • ■ ■ ♦ HABITS, DISEASES AND MANAGEMENT, IN THE STABLE, AND ; ON THE ROAD; ADVICE TO PUR6mA8ER8. ■«■ i- .>'- ' >: a NEW YORK: DEWITT & DAVENPORT, u "^ TRIBONB BUILDINOt. , f: ;' . 1849. 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