IMAGE EVALUATION TEST TARGET (MT-S) .^^^v^^. 1.0 I.I us 140 25 2.2 120 1.8 1.25 1.4 1.6 -< 6" - ► 1 • riioiogHpmc Sdences Corporation 23 WEST MAIN STRFST WEBSTER, N.Y. H580 (716) 872-4503 m^M^^^^^^^KU & CIHM/ICMH Microfiche Series. CIHM/ICMH Collection de microfiches. Canadian institute for Historical Microreproductions / Institut Canadian de microreproductions historiques menon of the disease; fend to the same source of information u^e would refer the profession, rather than to any ingenuity in the.^arrangement of facts or arguments in thi» paper. We have not undertaken the task of guidmg popular practice in Cholera, unmindful of its im- portance— neither from a confidence of superior qualification, but from the want of some prospect of a similar publication from a more able pen, and from the fullest confidence of the correctness of the general principles, and superior efficacy of the remedies recommended. , During a laborious and unremitting practice we have not been able to prepare these sheets for the press in a manner satisfactory even to ourselves ; but that it will be the means of greatly diminish- ing the mortality of the disease, and amount of domestic afiflictions, which we, in common with so many of our fellow men, have shared, is th(? sincere wish of THE AUTHOR. St. George's village, Dumfries, May 1 835. ii ESSAY ON CHOLERA. I Cholera literally signifies <* bile flux" — when ftpplicd to the disease of which we are about tol speak, nunc could be more inapplicable, because the bile in the course of the disease is suppressed. But from its having been so universally knownj by the term ^'Cholera,^^ we must consent still t retain it — but only as a w«wc, and on conditio that the reader will fully divest his rnind of an^ preconceived opinion, of its being a disease, on frinating, or having its scat in the viscera !of tb abdomen. We should now be understood that all our re marks, and precautious, are intended to appl to persons occupying situations where the Choi era is, or is expected to become epidemic ; or t persons that have been exposed to its epidemi influence. It is supposed that covering a vast extent o Country — perhaps surrounding the world, an im pure state of the atmosphere exists, tending produce Cholera. This may be called general t . fection. In certain situations local causes operat to increase this contaminated state of the atmosi phere— and this may be called local infection. T the union of these we apply the term Epidem\ influence. Of the cause of the general infectio we pretend to know nothing — but it would seei^ that the local infection is the product of heat an| humidity, holding in solution a quantity of miasirl^ or exhalations of decaying animal or egetabll -..»,r,^5= stvuv^v. we ijiiu V nuiCra iias prevaiiOFi most in the vicinity of great water courses, an- in low and marshy situations. I „ ..^.Mummm T t The inland town of London, U. C, the pW.fi lof our residence in 1832, stands upon a pcninsniii iformed by the junction of two main brandies of the Thames. Here the diseas(^ Imd apparently n ispontaneons origin, and prevailed with great vir- |ulence and fatality. I The general infection we consider Insufficient to render the disease prevalent—hut j)roducin«j jsporadic oi' scattering cases in persons who hap- Een to be in a certain stale of ill heahh, or having high degree of susceptibilixy. }| The most striking and melancholy example Hvithin our knowledge of the generation and cf- jfectsof the local infection occurred in this vicinity in the summer of 1834. J On the 28th of July, 1834, Galt, a village on jbe Grand River, U. C., was visited by Showmen iwith a Menagerie. It was exhibited under an nwning of canvass, nearly enclosed at the sides, hnd drawn together in a conical form almost to the top. The day was excessively warm, and the fcrowd suffocating. The exhibitic- lasted about S hours. It is estimated that about 1000 persons : Ivere present, and diat not less than 500 of them 1 died of Cholera within ten days. The population n*om which the asseniMv at the exhibition was composed, in the Townships in the vicinity of I Gait, is supposed to be about seven thousand. I i The first case was in one of the Showmen, who I Hckcned on that day, which was Monday. No ^nher case occurred until the following Wednesday morning — on that day not less than thirty were kttacked, all of whom had been at the -show. — The greatest number of cases were on the 1 hurs- iay and Friday following— but new cases occur- •ed for several days. In speaking of an attack, ve here allude to the time the patient suj>posed . . I* ,7''^«.^'"«K'' 'ength of time the disease! la^^etl af or this event »vas about sixteen hours I' pur .ays previous to the exhibition of animal: at (.alt fwo^dnldren olMr. J. G. on the GovH ernor's Kond, 12 miles south east of Gait, were! attacked with Cholera, one of which died. Oi !£lf™ »''"■'' ^^!"' •^"'>''> '^^» "^^^e" of what w, shall c"^«''e(! ventives of the disease. ! GJ The smoke and fumes of burning tar can have no other effect when iruialed than to render the k, process, and benefit to be derived from respiration 1)1 less perfect. y Chloride of Lime, and some other substances U have the reputation (undeservedly in our opinion) r of destroying or of rendering the epidemic mfiu- h ence mert. i heir operaiiou m luabi ainst i.^ wx j •e limited, for the air in a room or house, if at all V ventilated is displaced by the slightest current *ansed ;ctal)lc "or the (?peat- ' a yuti as one noH)id e form B Other he sick produ- Accor- agiout. r other r cause in may fluence obser- idily bo er ima- the pu- jorance as pre- an have der the piratioti ^stances )pimon) ic influ- l^r» %TtSll»tr if at all rrent. Some have imagined thai a quantity of infec-l tion may become attached to the floor, walls, or furniture of a house, as it sofnetimcs does Im contagious diseasSes like the small pox. Althouglj we never entertained any fears of Cholera from this cause— yet all houses whore this or any other disease has prevailed (and occasionally at other limes) should be well cleansed by general ablu .dons and whitewashing. Oj (he first grade of Cholera, During the prevalcnv;e of Cholera, (and gcner- xilly for some Time previous to its appearance,) in any particular town, village, or section ofl country, unusual morbid sensations are experien- ced by many persons, inhabiting such situations, which have commonly been called **premoniton symptoms." Many, if not most that are affectel with these never have the disease fully deveiopet At all—while others that have but few of these symptoms, and these few so slight and transient as scarcely to be noticed, have serious and evej fatal attacks^still these symptoms are producei by the same cause as Cholera in its aggravatet« form, ♦hey ought then to be called first grade ol Cholera. The symptoms of first grade of Cholera are thi following :— A faint, fluttering or trerabling sen^ sation at the heart, headache, dizziness, ringJ ing or buzzing in the ears, cramps, generally oJ the calves of the legs, which occur mostfrequent ly in the night, an aching and numb sensation it body, sharp pains, loss of appetite, indigestion, Sickness at the stomich, ati uneasy, full «ensatioi li f 10 : :)fthe abdomen, or heavy moving pains and iirr- j Igularity of the bowels, an opjjrej^sion of the chest, j^giving rise to frequent sighing, or to an inchna- jjfeidn to make a more full and deep inspiration, ,i('ri longer and deeper breath,) than a common •i^igh, a sense of weariness, and exhaustion upon j^lasing slight, or but ordinary exercise, and if the jjpxercise be continued often producers afaintness or j-fluterting at the heart, a tight, oppressed or heavy jjtsensation at the pit of the stomach, a sense of Jicreeping coldness on the surface of the body, and Jrisometimes short and " hot flashes" of fever — the 'j «:nouth and tonj^ue have sometimes a more soft j^ljand slippery appearance than is natural — and ;^ialso of a more dark and dusky color. ^i This lengthy catalogue of morbid sensations lapplics to their appearance in a considerable num- |ft^er of cases collectively. They seldom, we may ;^i5;a^' never, all occur in the same individual — in- jldeed it is not common for but. few of these symp- jitoms to affect ih^ same person. j;:i Treatment of first grade of Cholera. — It is not j-^always necessary to have recourse to medicine for <|this grade of Cholera ; but if the symptoms are ^ severe, and especially if there is distress, or a .iheavy oppressive sensation, at the pit of the sto- rtmach — or if there is a heavy faint or fluttering ,-sensaiion at the heart, it wiU'be advisable to bleed r a pint or more from an adult ; and if the bowels , larc not regular give lb or 20 grs. of Calomel— IjjiAfter this it is often necessary to give some ]in teaspoonful doses three or four times a day J If there are wandering, or cholic like pains in the . Mv-T^ vicj ^ivfj « uu»e (^tWu ui liiree leaspuooiuiaj I II rr- rhrst, cliiia- alion, [union npon if the less or heavy use of y, and r — the »re soft I — and sations e num- e may ^1 — in- symp- is not ine for ms are s, or a he sto- ittering o bleed bowels unci. — ; some jinnine ; think endix,) a day. s in the ouiumj i 11 ■ of Elixr. Pro. once in six or eight hours. It wili allay the pains and afterwards operate as physicJ producing bilhous stools, if; after a time, th4 symptoms return,^ recur again to the same trcat4 ment. I Caution—The tight, ojjpressive, or heavy sen- sation at 1 16 pit of the stomach— often called "ai" load at the stomach"'^the loss of appetite, ori some other symptoms, sometime induce person J to take an Lmctic. This should be avioded- neither should any nauseating or cathartic medi-! cines be given, except Calomel, Elixr. Pro., Hieral ricta, or some other warming physic. 0/ the second grade of Cholera. The grade of disease we are now to descrihp fndSf "'' chiich-en-but som^^imefyoil and less frequently adults. It prevailed extensive lie n '3-^ if" "' "'" T' Cl'olera" prevailed Culi^ ■ ■; "'"",. '""'^'^ '"°'"'^ extensive thai, Cholera in its worst form, whicii was alriost en .rely confined to the town, while th s n de Si of Cho era covered a considerable ex.cnt of coun t>y. It was also prevalent during the time ot Cholera in this vicinity (DumfriesTin '34 hn -th.n our practice it proVed fatal & IVn^ The symptoms are— irrecularitv of tho hn.v.i, and often wandering cholic like Si, Tl™ ' uations from the bowels are 1st y n lucou of the color pnd consistence of thick creani-an 1 .hi in %^r!oiiVnrL""!'""""^ "'"'^'^ '^"'' "^'ack blood "diSrJdT;'f"°"'T^°T '^'^'^'^Wood alone aischarged, or mixed with but a small propor- ' -:'jf' ,.^, :>f 13 .§."uon of mucous. The tongue h^'^ » *«/'. ^^^^'^^ H?"'«msr or ffrea*V appearance, which as well a, the ^i^K and inside of the mouth, all of a darker hue t(« r/lan natural-or all of a rfar/c Zta«(c« cofor-son.e- il^'^tiraes the tongue is covered with a coat of exceed- if s „g sn.ooih,%hort. and thick fur, "h.chis o a pxi ° •-1. „„i„.. »r.f^ f s nhvavs mmst. ihc pa- a- soaie< '^"brownish color, and it is always mmsi. 1 he p /'"tient has commonly much thirst, though sonr. ^«^ tinges it is quite moderate. The surface oi the _ ^ J*^'' body is for the most part of the time cool, or col- j iJ«" der than natural ; but there is commonly some • U'^ irrcKubr paroxysms of fever that last only two or «"■& hou?s. often not so long. For some tunc | li^l previous to the sitting in of this grade, some o^ tb^ i '^ first crade or premonitory symptoms are present, , i «^ such^as loss of appetite, indigestion, irregularUy yi^' of the bowels, and the weak, fluttering sensation m at the heart. Both the severity and duration of ■ J'^' this second grade (when uninfluenced by mtUl- '*° erne) is liable to great variations in diflferent pa- i , Su-sonie casfs terminate fatally within ^^^^^^ c^l three davs alter they are thought to be serious^ "^^ ill— others linger eight or ten days and often re- cover. Treatment of the second grade of Chokra. If the disease is but slight, give to a child Irom 3 to 7 years old, (and others in proportion to thetr age) 2 teasp^onfuls of the Elixr. Pro., and line- cissarv repeat in 5 or 6 hours, or two or three times.' It will almost always al'^y ♦*>%P*'f "' uneasy sensations in the bowels, and afterwards JroduL bilious stools. These should be followed by strengthening medicli.es, sucn as iiUa»u..„ - tincture in teaspoonful doses, 2 or 3 twes a day, and if the state of the bowels require, i. e. u tn?y ,-sc ••ni ,s« i-a I. ai moothf as the ceT hue -some- jxceed- is of a 'he pa- somC» : of the or col- ly soni« two or ne time le of the present, igularity ensation ration of by meUi- srent pa- in two or seriotisljr often re- 'hild Irom )n to their md if n€- 3 or three B pains or ifterwards le followed mes a day, c. if th^y I 1? continue out of order, alternate theu&^ofHux- ham's 1 incture, with tb^ EUx^r. Pro. fpr pbyw^l But if the disease is more severe, and there arc " discharges of whitish, or cream colored mucouj irom the bowels, and the patient mostly cold, ha^ ving only *'hot flashes" of fever — or if the lipJ find tongue have a more dead and dark appear- ance, or if there is sickness at the stomach, an( much purging of an J kind, efficient means shoiih be resorted to. One or two small bleedings wi' be of great service : but whether this be nsed oj not, Calomel should be given in doics of 8 pir V grains, once an hour, until two or three doses % given. If the skin, as well as the lips and tongue are cold, or if the last is quite dark op purple, or 8 grains of Capsicum should be glv^n wUl each dose of the Calomel, and hot; ginger tea ro»j be given between these doses. After the la^t dPJ of Calomel has been given about 3 hours, if doees not operate, follow it with a teaspoonful fllixr. Pro., and repeat this dose once an hoi until it operates as physic. Dry beat f by warmin] flannels) should be applied to the surfa.ce of tl body. In many cases the above must rcp( once in a day or two for some time. Most c< liipnly something like a regular continued fev< comes on after the operation of the pbysic, whic in bad cases is a good sign. If there sbould nj be much regular or,conlinued fever, some strengt| cning medicines should be given for several even while it is necessary to give the C^Qi and other physic. Caution^ — Give no Emetics or other sickemj inedicines — neither any othei physic than t| kinds u'c have mention ad- or some oth<»r of wairming nature-^nor opiujgj, in any l^rn) e^ci there are severe piiins in the bpwels, wheft 5 ,gjj,j^b««»<«««**^'^ 11 i?tJO drops oflaudanum may be given and repeated H^ lifter an hour if the pain continues. If Htj Of the third grade of Cholera, ■v^t We come now to speak of the third grade or^ i fully developed Cholera. It is the only grade of if^ihe disease that has usually been known by the jl'^liame o^ Asiatic Cholera^ or Cholera Asphyxia, \^\ To guard the uninformed and unwary against il' its incipient, insidious, and fatal attack, is the i'^ pi'incipal design of this Essay. ^ 1 The reader must not rest with but a cursory t perusal of these precautionary lines, but the dit- I !j ierent forms of attack must be attentively studied ; |j(^ Diherwise while the mind reflects upon one form |V^ n which it apprehends the disease will approach, \^ t assumes another, and thus imperceptibly and M lisguisedly secures its victim. A ^ • jljl The variety of symptoms by which Cholera V nay be developed may be divided into four % l^ji 1st. Regular Attack — By commotion in the 'lowels and diarrhoea, "2nd. Irregular Attack — By a diarrh";.« '\t the stomach. Aftei- this interval, which in dif- ''J*fet*rtt cases varies much, there «* a sudden call to ■ mol It is now watery or very thin , and it pas- a or Ifefcs from the body without effort and with i f sudden gush. This is attended with very little o n ht) m\(u The less pain the move danger. Ihis 'stool h soon followed by another, and another, iVhlch are now or soon after attended by vomi- ti'Wgi»paSrns,&c. . Sl^^i Sottitlimes this form of attack vanes consider- ■^VfeblV frtiifl the above description- slight cramps ^iWthe toes, sickness at the stomach, and even Vl^omiting sometimes precede the first purging. In ! bthei- cases these symptoms occur after the first f^a^acu^vlons, atld before the watery ^diarrhoea. ^ I^Afeaitt, after one or two watery stools, the diar- l&l^f the head--some patients have spoken of this ' l5istress a% attending the general tremor. The intensity of this distress varies in different cases **om the most extreme ^ufifbrmg, down to that ft which accords with the general description. 7 ^ iji tike ieconu lornai or •frrzguiin ^f>vu.^'*" * y*^ ■ ^ is bv ti di&f rhew of tkt*, light ct)l(rrei otffreytih < alwife. Afcfetfagh wo have plhtsrf this gi'fcfle scc- i idif- ill to pas- It h a ;le or This >ther, ^omi- $id cr- amps even ;. In first rhoea. diar- miach val of iiours. e. by fit one • four ve de« there gh the of the aching of this The t cases to th^t greyish It oud ]n the licsrnptig!), it U firsi Li Aequency of| occurrence. As iu ihe regular attack, this is com mouly preceded by somo of the first grade or pre-| monitory symptoms — ami particularly by nause or sicknevs at the stomach. Ivlany times there \ the commotion in the lyowtls, but this is k?ss dls tlnct, and not so uniformly present as in the rcg li.'ar attack — but a loss of appetite more nnirorni: precedes this than the first form, if but little n no pain attends diarrha^a, the danger (as in v-- first form) is greater, and the nearer it approaclie to the watery relax. On the contrary, if there |. considerable pain and griping in the bowels, aiv the stools very feted, the immediate danger somewhat less, and may be cured by less efficien means. But such cases often unexpectedly run| into a watery stage — the pain, griping and fetor of the stools diminish suddenly— and vomiting spasms, the watery flux, and other alarmin symptoms come on almost at the s»me time. I some lew cases the vomiting and spasms have pre ceded the truly watery stools. The continuance of the thin, light colored or greyish stools before the occurrence of the wateryj flux and other more alarming symptoms, are liable to great variations in different persons. Some- times only two or threeof these occur before thf watery diarrhoea, and is soon followed by col- lapse, the whole within three or four hours.— But generally it continues "off and on" for a day or two, sometimes four or five days, before th watery flux— and in some other casej it has dis appeared without the use of medicine, or was cured by very simnle means. During the continuance of this diarrhoea, that precedes the watery, the patient has usually a sense of weakness, and trembling, or fluttering , ^^I't the heart, andsometimesrnausea and vomiting ; *Sl»ut frequently woiihl call himself well ; the most l!|jnconvenience he suffers beinj; from the weakness. %As in the first form of attack there is sometimes Tithe iiKlescribahie distress, but from our own ob- -Ijservation conclude i^ does not so often occur until 'Jjnear, or at the time the watery diarrhoea com- '^mcMCCs, or the sitting in of collapse. f^ . ■ . . i' Of the third form, or Constipated Attack. '%^ We have so denominated this from the costive y^ state of the bowels for some time previous to :but a fearful prelude to that disease. Vi It is true, tlie bilious relax frequently subsides ! #of itselt; or with the use of very simple means, [.iVand the patient subsequently suiiers but little ex- ijiicept from debility and wandering cholic like ' .ipains— yet in perilous times, this bilious state o ilthe bowels mav either gradually or suddenly, and 'a ID the patient ilnperceptibly, glide into the watery iiMiarrhoea. We say imperceptibly, because as the 3fpairi and griping diminish, the patient considers lhi» case improving— whereas if the pain and gn- ^h)ing be diminished, and the stools be thin and ot '* a more clear yellow color, imminent danjjcr is .'betokened— and the truly watery flux wdl be J 'likely to follow in a short time. h In all the forms of a the vomiting does ji sometimes precede the dia. oea, or comes on at V? the same time— and in some few cases, spasms l^^bavc a])pcared equally early— such instances, J however, are rare, but some sickness at the stom- I acn 15 niosi ubuuiiy p-itscij!. ^viiv^ ■— — - — , H begins. Short paroxysms of fever, or wlmt is ' usually termed **hot flashes," commonly precede the diarrhoea— the' for the most nart of the time •K J, ., 1 part I :iu)l- Du- liar- rally yel- ■piiiii sick- un i> been , it is )side» lenns, le ex- liko Lie ol* ', and ratery as the isiders id gri- and of gcr i!> all be g does on at spasms lances, 3 stoni- arrbopa s^bat is ^recede le time 21 the sui lace is colder than natural. The tongue] has a soft, moist and smooth a[)|>earance, ami of darker fine than natural, 'I'his appcjaronce of tb( tongue we consider a pretty j»'c indication of strong predisposition to Cholera. When children arr attacked with Cholera, (i. c] »3d grade) or Cholera developed, the vomiting usiudly takes place at an earlier period than iiiu adults — in them it is sometimes the first sign (► illness. The first cases in this vicinity (the chil dren already alluded to) commenced with vomil ting, and such was the general aspect of the littH sufferers, that by their parents they were though] to be suffering from some vegetable poison. It should be noticed that these attacks wer] shortly after playing (wetting and washing tbeij heads) in a tub of water. We have now described the different sympton by which Cholera may be detected before, or the time the disease has reached the stage to whic we have arrived in our description, i. e. the wal ery diarrhosa. The reader may rest assured that very few cas( of Cholera occur (in ihis country) but what wi^ fairly class with some of the forms of attack d< scribed — and this description should be familii to the mind of every person who expects to prepared to detect an incipient attack — yet thej may be sometimes cases occur in which the sym] toms of the different forms of attack appear blend with each other, forming what might , called a complicated form of attack. These, ho^ ever, mav be readilv recognized bv anv obserl ing person, who will give the above deiscfiptii and the existing symptoms a dne degree of attci tion. 'iBsmmie, S9 We should mention thai some cases have fallen [sunder our observation (and more iiave come to our knowledge) in which persons addicted to |,[ the use of ardent spirits, have in that state, of J|i|dehility which always follows preternatural ex- Ijjicitement, i, c. when " cooling off," after a de- l^|ibauch,(* V^] '''« strictest •I'^ir app«an,..ce resort wirou?defc '\"^ "M edies MOW to be rpr„m^ ", , -^ '" t^'e rem-l -ould be preferibie roT r.tt th' ^"""''^'^ S'-essing, the delay of .,? i ^ '^"^^''' '" «"<^e pro- 1 ;^'eatme„t be corn.ne^S vervfc'?"- J^j'^e ease, ,»ud. less medicine wil7 be rL '" '^ ^'*- feet a cure~20 or 30 graTr of cT'^'^, '° ^'■- halfapintof hotginffer ,^L „^ Calomel, witli diffusable bvadd inJa fmiii ' "'^ ^^'"''^ ^d more rum or whiskev l^T ' .*l"«"'"y of brandy medicine no,v to be presrrL^n ^^ ''°'"'^'' ^^ that stage of disease aESSltl'''''''°P"**'' '« ihoea, or the verv ^„ J?^ "'"^ "'^ watery diar- -ay becon:i^:jyfnrie-' ?--th[s 96 i When we recollect that the f ^^^^^f ^ nk-^ sudden and unexpected advances }*^ i.oulc b decUled and efficient in the applioat.un SieSes, and if in their ^^^^^^^^l^ it nil, let it rather be on the ^^^e oi excess, e.^^^^ LlWnf the pure Stimulants, lor it f ^^^*^^^; IT «».*itv nf these are eiven than is suuuj «»'^^ ^luantityol t»e5^;;\.f ,,• _g^ only some addi- l"„Vwe';rrc i e , Sr :'rh.aps'a slight and ^^i S^ 2 "?30 drops ol so.«e of .he -senUB^o^ *'■ Sof nepperm'.nt. cloves, o-onganuin. Tnej*""^ " ; ^^ks, and avoid stepping on the coW A^ -^ )ji «nn'"S " necessary, to relieve the pLin' ""^^'-P'^^'- ' n.adea"„;oKrero"^fS '''\--^'-" !-. «""' is commencfd ^hP P' "Sr^i^efore the treat getic tneasurS should t "'' '^'',""" ""^ ^"cr 'i".t be constanU^Xd ,^i[irho; fl '"V'f '"^ • tl,e same timedraw blood fr •l^'"'"':' ^'"'^N black, and flows wWh Aur , " '^ ''"ck and slowly from the arm •i,'"""-^'.' «"'>' '^^'^Jif'nJ "ntil it flows a STr ^m .Td f "' (''^■°" ^»">, color. Give 10 av cT ? f °^^ "'"'"e ^orid -f Capsicum, afd^fo^br i ' i''" T" '^"^""'y about 40 drops of oil of nl'i '".'"'«ii««e/y with have been down about t^n'^^-™""- ^^'^^'^ '''eso o'^getting blood first iv J"' ""'''• ''"j"" ^^'''•^d make a large opening inTh.^*""' ''"'' '^^ """•« to "-•'fice in each Trm, fnd bv rulh"' "['" """^^ «« ul..mately succeed. ' 'it:rt^°/'!.«™^ -«r -" cAcrtions liave sompf!,>, " """' "■'"& condnu- crowned with succei TSw ""•^'^P^<=f<=dly been '' *'"'"''^ encourage the atten- 1 1 1 9| 1 sa t If voit succeed In bleeding '■r ants to persevere, n ^^l'--^ ,,, become 4oas to cause it to flow ^»^*^ >^ ?." . .\" i „,,.i ^o as lu Y ,ian.rpr IS ereat y dimiiHshctl, ana tidiorc florid, the aanger is w J , ^^i^t^ined, Wje continued, particularly ^^^^^ y Comi^to ^;fJ^taiBed in the fJ^^f\J^'"^tn in. this way. i;,il be repeatedly <"J«"ed «»« yv f5S^r^en;^ttw£Sniand ' ,! give no drinks for some "me^^' „j Capsicum Between the doses of taloniei anu >. in teaspoonful doses. .i,.,,i j „ico be civen Tlie most;)«« astrmgents should also oe g in conjuction with ^1^ stimulatit . lake equ : « parts of the tincture «f l^/V"' . Jf '"Sle "poonful ,11 Guaicum, and mix-ofth^ g^ *^;^e re- ■' in a liUle f-f- re;acuat S- nl^or less : : ^HTL '■ t" fore.S treattnent will. very sel- ) i S'omlvil of curing &-^^^Y7^>S^s cS^ ed to while blood can be, and actually is cjraw orue and ned, imu- ently («n- louid legs, I, , ^^ jtn 10 this h •y h»lf i voiu- bc re- edicinc is >vay, ly after a tea- ajust to 3cl, and Fipsicuni i of pep- /, Mijrrk be given ke equal Lnd Gum spoonful case re- re or less very sel- ls resort is cjravvn 1W irt a full stream, and until it becomes more Jldrid. Jiut if the^atientprevioas to, or during the course || of this treatment, should take emetics or otb^r nauseating medicines, or opium in any form, in sutHcient quantities to have any sensible effect, they may counterrxt the beneficial effects of the rcmetlies here recommended— or at least render a favorable Issue more doubtful. But even when| blood cannot be drawn, or if emetics or opiate hove been injudiciously administered, the forego ing plan perseveringlj employed, affords the pa tient by far the best chan e for his life. There is one other variety of Cholera in ^vhic sudden and dangerous congestions occur 'withou being preceded or attended by the common symp toms, as vomiting, spasms, &c. Believing it t be prod(K?cd by the same cause, we have called i Primary Cardiac Congestive Cholera, Of this va riety of the disease we have seen but two oases for which nee Appendix No. 1, and 2. ^ PATHOLOGY. For the ipurposc of popular instruction v might remain silent in regard to any theory— b courtesy to the medical profession alone wo^i be a sufiieient reason why we should devote few pages to an explanation ot the theory o disease for the practice in which we have so c fidently laid dow^ rules for the non-professio reader, with whom that practice must necessar be mostly cmpyrical. In the intended brief investigation of thfe/, thology of Cholera, it is hoped that all U^\ preconceived opinion as regards the nature of disease will bfi w^ioily laid aside, and that V (I sa judge the case as it ihall actually apiwrar from n'l 5». investigation of all the facts, and not from an/ M preconception, founded upon a partial view of the W^ numerous circumstance* connected with ilie dis- ease. These prcliminarj remarks rnay seem unneccs- -l^ sary, but our only intention is to prepare the ,,fWi mind of the ri*ader to give the varied phenomena ^^ of Cholera a full examination— not of a single an at the ] it im- A. with / irrita- ns, we find Mich A variety «nd to discordant sensations, «s to lie wholly irreconcilable with any kno^vn latvs or usages of sympathy. In theabsencc of all evidence of local inflamation^or Previous or exis- lirK arterial cxcitement-^without even the slight- cst'lndioations of a phogistic diatkesis, ihrougb what medium can these morbid mipressions, thesi .nervous irritations be produced, but through ih iricdiufa of the circulating blood. Before fully entering upon the modus operand c.f Cholera, we should lake a/"™"?ary Jiew o the three principal excretions by which the bloo h continually discharging its i«^PVj;f ^J-^'^*^'' the luncrs the liver, and kidnies. The lungs ptr {ormint the double function of decomposing at^j tnospheric air, and robbing it of its vital propcr| liesi-the oxygen --and at the same timedisenga|| cine (Vom the blood a part of its impure aiid noxi fous matter-^hydrogen and carbon--but th blood not being fully decarbonized in the lung has an adjuvent or supplen^entary organ in tt liver, which extracts another portion ot this impu rity in the form of bile-to be like the manuit of the farmer, converted to a useful and import ant purpose. And last, the kidnies like a wast^ weir to the system, clears the blood of such si perfiuous matter as is of no further use. We ought also fully to consider the mutual i flucnce and reciprocated action that exists b tween the nervous and vascular systems. M' only of the mechanical action of the blood ye scls upon the nerves, but the chyraical qualiti of the blood itself, must be to a certain degr pure, or the proper energy and inflluenee of t nerves can never De mainiaiiiuu. i^ciiu^i «.= we forget that a gland cannot act upon imp< feet blood— or if it contain heterogeneous or * I jiji tranijous mattier — Gven though that^lmd uas r«- ^i CGiving its usual degree of nervous energy. iiii ' The form called liGgular Attack is perhaps the 1^ least complicated form of the disease. We tliere- |# fore select that as a sort o^ pathological text. i' I« whatever the atmospheric purity consists, hihe effect of it when inhaled, is to incapacitate ,_|ithe lungs from fully perfornving their excretory lifunction. A small portion of the hydrogen and 5»arbon, which in the lesser circulation ouglit to be Sljj disengaged, passes to the left portion of the heart; ■i#:Wnd is again sent the rounds o( the general circn- iti|^lation. But the retained impurity is so small in i^*i>jtJiintity, ihat no immediate mischief results from j i 3 .t. After a few days (more or less in proportion \ fbo the change the blood undergoes in the lungs) jt^Slhe impurities increase and th'^ir action upon the i!l' \iiemes in various parts of the body in the capillary i^ circulation produces the varied morbid sensations, {^y^he first grade of Cholera, it'^^c The liver is the orgun upon whi^h devolves the f '' ask of clearin?^ the blood of thifr impurity— but in t-' consequence of its action upon the nerves, their V -attfiuence is diminished and the secretion ceases, i Ut the same time the whole sympathetic system 'If nerves suffer-froffi the same cause. Their en- : \:.\ffy is diminished^ The blood now accumulates V ^-»i the venaportea^ and forming an obstruction to jjlievenou* circulation of the abdominal viiera — i^):issolves^ the scrum exuding from the inner sur- \AciR of the intestiace, produces the ivatery diur- ji|Ujji! In consequeneeoftheimperfmion in the chym- Ppal:part of respiration, animal hem is not fully ^ ^ tenerated. The tem^peratore, not only of the sur- V ' iGp of ^ the body, but of the WoO(l Itself 1$ diinin- ' ^ibed. I i • [IS the liore- iisists, citatc rctorv n and t to bo heart, circ'i- iiail in 5 from ortion lungs) on the oillary itions, t^es the -but in 5, their :eases. system eir en*- lulates tion to •era — er sur^ y diar- chym- i luily he sur^ dimiw- This together with its obstructed course throughl the liver, and the gross impurities it contains, arel all circumsiances iiighly favorable to its dissoln J fion. And the absence of valves in the veins oi . the abdomen, and the want of bile in the intesJ I tines to excite their inner surface, are also as iaj ' vorable to the regurgitation and effusion of th J serum. I When this paralyzed state of the sympatheticl nerves occurs, and the liver ceases in its functionJ tiie process of digestion also ceases — the contents;! of the stomach and intestines are only an extrane- I ous substance, which irritating their inner surface 1 (m( hanically) increases their peristaltic motion : the discharges previous to the watery diarrhoeajj are the consequence. i Another iiiost important organ that suffers froml the want of nervous influence is the heart. 1 \ia force of its contractions are diminished, wh^rebyl congestions take place not only in the great vein^ connected with the heart, but in the venous por- • tion of that organ itself ; and these congestions! further diminish and oppress its action. | The imperfect or smothered excitement which] often precedes the disease, appears like an cflfec^; of the heart to overcome these incipiei* conges^ tions, and the "hot flashes," a sensation produced| by the action of the impure blood upon thenerve^ in the cutaneous capillaries. That form of attack which is by a diarrhoea c thin, light colored or greyish stools, there appear to be an effort of nature to supply the diminishec or suppressed biliary secretion from thegastro-en-| teric mucous membrane. In these cases the ner-i vnus enero'v ig orrnduallv imnaireds and when fur-S ther diminished, this morbid secretion ceases also,? and is succeeded by the watery effusion and diar-|| I 6 S4 ihoea. This substltulcil moil.id srnotion (•mim't ,ii be much unlike that which takrs plncf m ( l.oU- ,.j' .n Morluis— liiough Autlu.rs speak o. this as a * vitiatwl biliary secretion-and though wo soine^ 1 times :ncct with a few discharges (.( vU.ated bde by vomitings and purging at the commcncemmt ot Cholera Morbus, yet when the disease is lauly established, no evidence can be drained that ar v portion of the evacuations are the product ol hepatic secretion. . . This idea miglit seem to support an opmion en- ♦pttaincd bv some, that Cholera is but an aggra- vated form' of Cholera Morbus— yet m ll'etwo ,..-,, diseases there arc marked discrepences. Uu- iii'pain and tormina of the bowels and fetor of stools, li/ indicate not only a different state of the sympa- Cthetic nerves, but in the nature of the matter dis- Itlj'fchr'sed from that which exists in the watery li'l' uliarrhoea when the evacuations are without pani *".inthe bowels and the stools without the feted ii'f' 11 smell. Besides, the watery flux isnot the product m.o( A secreUon, but is simply an effusion of serum ( '^Of serum as it existed in the veins and on which !.'-k no subsequent secretory process has been per- i 'i formed— or in other words it is a heamorhage. .^:» 1, Previous to 1832, Cholera Morbus, however '■severe, even when it proved fatal, (so far as we l^ . Aiiow) never merged in the watery diarrhoea- It ,liis conclusive then that Cholera Morbus (as it oc- iiscuiredin this country previous to '32) is essen- .J' ' .- ...*.w t% ./~^1 ^1.-.'_ . .r. M o avft 1 1 /^ H OC trip 't tially different from Cholera, inasmuch as the "jforineris not attended with that paralyzed state llloftiie great syrapathetics, nor the dissolved b^ood 13 nor watery diarrhoea, that so umiormiy atten^ fjfji the latter. »»" holt' ; us a ome- [I bile nit <>r fuiiiy It a: y ct of 3n en- le two ilu* stools, ym pa- ler dis- vvatery ut pain le feted product serum. I which ;n per- iiage. lowever ar as we loea- It as it oc- is essen- as the ed state ed b^God ad In the constipated state of the bowels whiciif sometimes precedes the Cholera, it would secn^ that the secretory function of the liver only U diminished, and the blood continues its circula- tion through the gland. But little or no bile, how J ever, is poured into the duodenum, a sluggish peristaltic motion of the intestines ensue — proba biy in these cases the blood becomes more highly I'arbonated, which together wih the retained and hardened feaces increase the watery flux when it| does occur, and is a sufficient reason why such i'ases are unusually severe. r The bilious diarrhoea that sometimes precedes the watery diarrhoea is a regular effort of nature to tree the blood of the impure matter by an in creased biliary secretion. The vomiting and spasms usually occur about! the time the secretions become suppressed, pr i present previous become greatly aggravated.— i Whenever the blood becomes unfit to furnish fluids by the secretory glands, it transmits th„ capillaries with difficulty, and in them is brought in more immediate contact with the extremitiesj of the spino-cerebral nerves, which thus irritatin^ produces painful muscular contractions — thel cramps. Hence they generally first attack the' parts most remote from, and least under the imn mediate influence of the heart— and thus by rub- bing the li/nb affected, the stagnating blood isl forced through the capillaries, and temporary re- lief obtained. The capillaries are endowed with^ a great degree of sensibility and contractillity— 1| otherwise the blood would cease to be trausmit-j \Gd through tubes so innumerable and minute The difficulty wiib which the blc )d pervades , these vessels in this stage of the disease, and asi we have meiitioned, acting upon the nervous ex-f -# .remUics produces d.et«^»enun^^^^^^ ^ heat, while the P»«-^,^J' ^t yc'hclensibili.y of ral— owing to the ^"'^ ^*; "'- , ^^^l^ too, to- i the skin is greatly '"'''•^^^^''-redoi of saliva gcther with the ^^PR'"**'^^! f "^, uv and pecu- ?"^f :aeTr at'lL'rarre^x^^^^^^ sc- trofeJ^thS. n.uth attd feace. as « them moist or wet. ^.•^''^"^"uttVs sometimes S^rS nraVSbepd^^ -vi- EoV gastricor ---tV"ett:ineo«s in- Kow it is known that .^"f.'* "°. ' nsation of ^'"^^^"^hTlkiVi's'e "n t Sr han SSerien- ted the general nouce and «onder «' .^^^.,^^„ Whenever the »mperfect>on in a has existed so l«ng-«Vsta« wSh ie nerves amount, in degree to * ^t''" ,^J,7j,„ ^^ddenly) can no longer •'"''"'^f' ";^X "' \o the glandu- heCfeilre is in the hepatk -c-uon , \h^. succour to the decarbonizing process «)«^ off, the necessarry change >« the »""£ di^nished peifect. not only -/-«,te h Xd h« now nervous e»ergy, bu^^^bc;;;^^^^^^^^ ^^^ ^^^^^ ueoomesu »"'"•":».;" hp incaDacitatedto the ac- ' : A. '< J. '1 ■'1 yit of natu- ty of o, to- saliva peeli- ng sc- ;eping id the ctimes as evi- ous in- tion ol* perien- , when nder it ally- Bcreting las exci- faculty. ilizatioii he blood e nerves addenly) glnndu- ntioned,) n. This being cut now less iminished i hat now nd carbon to the ac- e accumw- ver should in a short time (perhaps in a few moments) evfry other se- cretion is suspended. From blood so highly con- laminated, no gland can secrete even an imper^ feet or vititiated fluid. When we recollect tha combined with this (of it itself insuperable disad vantage) is the greatly diminished nervous ener fxy— this phenomena ceasies to excite our surprise for no other effect could be expected- a prion Fhysioligists have couipared the glands to manu facturing establishments to which blood is brought for the purpose of having certain mechanical ami chemical changes performed upon it. This simd- may be continued in illustrating the suspension n the secretions in Cholera, In health they (th glands) are well paid (i. e. receive a due degree cl nervous excitement) and are supplied With maj terials properly fitted and prepared. The work goes smoothly on and is properl] performed— but when their pay "s much reduc^ and at the same time more labur is required < accoiint of the imperfect state of the material there is a general "turn out" (revolt) the who business is suspended, and unless the pay is rei dered adequate to the labor, the whole conce must inevitably fail. Now recal to mind the first morbid sensation view several cases collectively. It is not ni( ^ evident that the disease even in this incipiei state is co-exteisive with the whole vascular afi nervous system ? The disease progresses aj affects the secretions and all secretory glands ^ implicated. i In coin cidence with these circurr.siances. cdj c'iriA*. tVi<» t^fCant rxrnflurf^A hv r^snirinff the COntali inated air at the Gait show, and the appearancl of the blood—drawn early in the disease, betc^j any diarrhoea takes place it is more thick a^j •1.x. 9% iblack than in healih— later still more so --and ' •/. thus increases until it becomes so thick and highly 1|i carbonated that it will not flow at all. ^ %'^^ In the absence of all evidence that any other .■ft^tcause could produce these effects— such corrobo- ",^l^ rating circumstances must go far, very lar, to ^ (lis bring the whole difficulty homq to the blood— to \\^jt$ imperfect arterilization, not as a secondary Msikct, hut primarily. U^, Few observing practitioners are unwiHing to Jr fadmit that the fluids in the course of many dis- S lipases undergo changes by which their essential i-l^Jciualities are altered and depraved. But in Choi- ir^'sra irnuriiies exist first in the blood itself, and that i.i -too without its being the result of any change of litf ■ iiction in Us vessels. .1 .tl Early in the disease the vascular system be- Jlivl^Qines implicated from the action of this retained jpCwpurity upon the nerves which it aflbcts most |ijibrcibly in the capillaries. A diminished action pllf /Ae heart and congestions follow, which plainly ^^ denote the directly sedative quality of the exir- (■.'«:m <:)'Ving state of the bloo^. jif|i Before answering any objection that may be -^Lroughtto this theory— we ought to direct our ^) • ittention to the tvvo difftrent systems of nerves. -Jl^he spino-cereto^al destined not only to supply he various parts uader the control of the will, i^7 ^J'S,^ ,, , ' ' j>ut to form an intimate connection, particularly /'f n the stomach with another system— the great ' "'.lympathetics which ^^y »• ,.-Vi 40 L.eir power that the usual rcciprocatec) influence . ' bftweCthen. and the spino-cereb.a» is supc.e- 't AJ^lnA thus the brain escapes uninjured. t. '''t^n Uhas been alleged that if the pfoxnna.e B causf of Cholera was an imperfectio . in the che- f'S function of the lungs, -the inhalation ol '^oxygen gas would prove an effectual remedy 'tfl whereas it has not been known to produce any fSrnror beneficial effects. In the treatmen of f;'^aTS every disease, the curative plan must be #dSed ^to the proximate cause, but to its i*«iSr'T^ cause ofCholera is a dimumt.on of ■ IfhP Scretorv functions of the lungs-contamina- i'-lited blood-diminished excitement-congestions, !,#W.,jte(l mooa u secretions are the effecta. Hi^^mCd congestions, and open the secretions, il if " sifXe opinions^ve have re^" ^^es- }^fpect conclude that a speafc mrus ^^''^^^l^f^'l • ''4e blood with tl- oxyf n and yet do^^^^^^^^^ the ectSy ji'^; the Diooa wuu tuv. w^jb^-, - ^ .i^p^ not r<^ sider the disease contagious-^ uut ^oes "ot ;;^i|sSfic virus in all diseases pn)duce specific e^^ %'P sU in the sma]l-pox and measles. ;| ir'^mmSytSe practice of -«>« holdup this .,r.; opinion has been eminently successful bcauie i'^! they were convinced that this poison ^^ich they ' ^suppose enters the bloodproduces the same eflects -i^'^CUrbid matter which we beheve ^ gene- " .i; rated ill the system itsdf.and retamedmit • ti Bv some the "premonitory symptoms ai ited lu tne sysiem .«>..•,."— „,„„.« „rc not i Bv some the "premonitory symptoms are not ^•. considered as any part of the disease, "only show- ^i' WaSiosiaoli to if'-and yet all acknowl- ' ,t'l"A! "v.Z m hA the effects from the same cause. ;^ ;^iii;;%r:;;;inion these morbid sensatbns^^e tne ' .'^diseaseitselfin its incipient state. At least tne '•4 lucncc I perse - XI in ate le che- tion of einedy, jce any lent of II list be Lit to its dtion ol' tamina- restions, : effects. oxygen taneous- neTgy— tns. n to res- y enters not con- not the ^c effects, 4 ding this because hich they me effects 5 is gene- 1 it. s" are not nly show- acknowl- me cause. IS are the least the * 41 I first grade syniptoms should bo considered as| hi aring the same relation to Cholera as pneumoi Ilia does to elKiision or j>hthisis — >^nd as pneumoJ Ilia often spontaneously subsides vithout produ-i cing cllfiision or phthisis* so the premonitory sjmpt tonis subsitle without producing Cholera. All knowledge of the existence of th(^se symptom^ .should be sufllicicnt (not to alarm) but to put all upon their guard—for not only these but all api ])arent stomach and bowel complaints Irequentlyl merge in the watery diarrhoea. The general and| most iroquently fatal error is in mistaking thci disease in its forming state— -but few ever sup-! pose they have any thing of the Cholera untili tiiey are actually '- 'dmedb the more co«.mou increased secre ton ■% ^mli'^tro-entevic "'-^o- ^-^c^ - ; i'' vitiated mucous-and wien the P" 'f' ^"»^^' ^ V "safe more complete, i reflux of blood takes cous '1 he pcculiat appearance ot the msirtc oi rniotlth, Ipsnnd tongue the aljse^eor tie „o..oi tpnrlprness discoverable by pussin^ u^ aSS^en and the m^^-^J^^''' ^^'" sufficient to distinguish it from Dyscntei > . \ . 1 i ... . a' * J ■■1 ■ V ilgt c^ or when by \\\it ncc, is iih the ho had tacKed, ve have giving a earaiico in con- /// icere ^ainiiiesi; tlaXf BE- i y, prcv- diffcrent and situ- the vena I not sub- secretion ne but by I conges- )od takes 1 the nu- counts for with niu- inside o( nee of the ^ssing the stools arc 4^ TUICATMENT RECONSIDERED. ' ! When the theory of a clisenso is correct, it supports, and U; supported by tlie practice. The most conclusive evidence of the correctness of the prcmis'es hero set forth, is in the efRcat^ of th practice they Indicate — which is to rouse the energy af the sympathetic nerves — to restore the secretions (iiid to rcmovi congestions. These are the primary and cardinal indicalionl in the cu Cholera. I In the aia.. ^d machinery of man we perceive ft systern o; causes av.1 e^ jtsso mutually connected and niuiually depon ant that wo oannot understand the operati»n of a single isolate*} part without reference t»» the whole. So in this disease, ari|i fulfillinj; the indications of cure, all must be viewed relativelyfi as cause and effect — for no one indication »'an be fulfilled and a cure performed without affecting all— and the different indi| cations should be fulfilled simultaneously. The object of bleeding is to prevent or remove congestion;^ or in other words to increase the power of the heart oVek- Ih circulating blood. The principle is plain. I5y diminishing th b^»dy to bo moved the relative power of the mover is increase! It IS apparertt then, that bleeding is necessary, not only for tl plethoric and robust, but also for the aged and infirm. Tl feeble and metteclual efforts of the heart must be assisted h hbstractin^ a portion of that fluid which clogs and impedes i motion. It is true the aged and infirm— the debilitated em grant will not bear — neither do they roquirio so large blpedinj as patients of an opposite descnpticm. But the ))rlnciple— ti object to be attained is the same, which shpuld be born m mi and abstract such a quantity as will enable us to excite a nif vigorous aotion of the heart, by the use of pure stimulttilts, a\ thus the congested vessels will be unloaded. We have said that the distress at the pit of tho stomach, i uniformly present before or at the time" the pntiont is takj down, strongly indicates the necessity of bleeding. This se sation is generally in the situation of the somihinar gatiglid and may be considered Ftriclly a nervous riilection. But if tl! nerves are thus injured, a corresponding dimuniiion in the a| tion of the heart, and consequent congestions njay be exp^clel as well as an entire failure in the function of the sccretu glands— but sliouhl the glands partially maintain their woiit| secretitms, before they could sufiiciently purify the blood, t ctiuu oi ilso huart )Vould be so impdiicd tijai congebijons wou nsue. The preoept to draw blood until it flo^ve *^ ii fi iream,'^ 18 intended for that advavwjed stiigi; oftlio dis6^.s6' J '*''huh blood iu prucuri'd with dllliculty. It uut-uufrequcnif ■ 41 iliappens that after congestion, have (aU«n place the Moo.l ffupon opening a vein Binrts suddenly and flovvs freely. U »- ill^ec* H Jo* thus freely, the pulse m\\ sorneti.ncH fa.1, Rrmv fli„K we and tremulouH. Under such circumstancea it li safer ^ (as in other congestive diseases) to draw it slowly, or rebtram mmit until the action of the heart be excited by pure stimulants. #1 The uniformity with which Calomd promotes the ^ecretion^ •-"^naiticularly the biliary, naturally led to its employment tor that j.tf purpose in Cholera-and it has not disappointed any reasonable t Reliance that has been placed upon it. But to the neglect of !!•%! powerful, and in many case- indbpensible nux.harie«, some *l|have placed their (jependance on Calomel a one, or wha i^ Llwor^eihavo joined with its use such narcotic or nausea^m^ ^Jinedicinea as to counteract Its efhcacy. So depemlj^t are alt ' .tglands upon a due degree of nervous energy, which is so de- ^^"jCieesed and inefiVcicnt, that with the Calomel should be joined fy\he most pure stimtilnnta^th^ IB, such as are unalloyed »*itb ;i% any narcotic propertiea. These excite the nervous energy \:/y and render the operation of the Calomel upon the liver much ^ 1 i^^ , more speedy atM^ certain. In the mgnificant term of a patient !^' "the Capsicum makes the Calomel take hold. .... W ^^' A professional friend, and gentleman of well merited celeb- i#i;ntY, prefers giving the Caloinel in small doses, lest larger i-l! ones induce nausea and further depress the nervous powen- 'ijvBulwhen the importance of early opening the secretions is ^;Vf considered, land as we have no unfortunate precedent when r'S'pure stimulants only have been joined with the Caloinel. we tf I' cannot but look upon the most efficient measures a» the roost "^ safe ^ ,:'^ In the impaired and irregular biliary secretion and conse- '3 * 'quent uneasy or painful sensation in the abdomen, which often ' ; I precedes adocided attack, and which seldom fails of following '-,] one-lhe E/Jxr. Pr(;. is Bingularly efficacions. We have so ' 1 : uniformly noticed its anodyne eftects, as induce us to believe ' : * it a most valuable and well adapted stimulus, and so certainly iji doesit eubsequently produce bilious evacuations, that under i^'jl' these circumstances it may be said to have a epccitic action on Uhe liver. ^ , ,. . r. .,r«r«* Having denounced the use of several medicines beretotore used, weV've our reasons forao doing by referring to their operation in connection with the pathology. i W The absence of bile in the excretions has induced some to •^^L prescribe Emetics, in the hope to stimulate its secrmion.— -:*j Others have supposed bile of a highly deleterous quality was ' . ^ retained in the biliary ducts of tho liver and gall-bladder-and • V. that the iDJarious and highly depraved quality of this bile acted :0 e MootI ir al- » grow, is satet reutraiti hnts. iretion?, fur that isonabh jglect of i», some what i* useatinir t are nil s so Aer* )e joined yed M'ith J energy ur ntuch a patient ted celeb- Bst larger power. — retions is ent when lomeU we the most nd conse* hich often ffoUowmg Q have so to believe certainly that under c action on heretofore ing to their :ed some to ecreiion. — quality was adder— and iibile acted a 4L5 as a poison to the system, and have presciibed Emetict to dislodge it. Without recurring to facts and arguments to |MOvo tho frtlacy of iheae premises, the c/aci of an Emetic only need bo considered. Whenever nausea is induced t depr«s««-d or diminished action of the heart is sure to follow in Choipja all acknowledge the dangerous depression in the action of heart. Whatever induces nausea^then, increases th disease, so far as the action of the heart is concerned — and als. increases the serous effusion and diarrhcea. Of such import ance arc these considerations, that with a knowledgH of indi t;e8tible substances in the stomach, we could not recomment], an emetic to f ject them, lest more danger be incurred froir further Bit'king the heart's action. The safer course being tC| cxchethe nervous energy, and raise what in other circumstan ^ res would be considered an undue degree of excitement, wher the offending matter could be evacuated without danger — bu' should it, be thought necessary to dislodge indigestible substa. res, the most safe emetic would be the sulphate of zinc (whit vitrol.) Several cases of Cholera, where emetics had beei given, have come under our care, and more have come to ou knowledge, not one of which survived the disease. Scarcely leas injurious are such cathartics as induce nause though their hurtful impression is not 'o suddenly made — y^ if the disease is somewhat advances ,..iey as surely increas the profuse discharges, and their injurious effects are of longe continuance. • • . . To allay the spasms in Cholefa a most unfortuhate use h., been made of OpiMw. Ordinarily, spasmodic action is th result of nf- ous irritation produced by some irritating sul stance or matter, remote in situation from the muscles thus spa modically affected— and the use of Opium as an antispasmod in Cholera, has been predicated upon the supposition that tl spasms were produced by ai accrimonious or some other poi ouous quality of the bilious or other matter acting upon tL stomach o other internal parts. But in Cholera cramps ai produced by the direct application of the irritating matter ( the extremities of the spino-cerebral nerves, (see p 35.) At th same time the effect of the poison upon the parts supplied by t sympathetic?, are suffering a great dimunition of power— or i other words the effect of the poison upon them is that of a na cotic. Now i( opium be given in sufficient quantity to affe the spasms— the nervous depression— impaired or suppiess secretion, and congestions are all increased. The too co mon idea then that the quantity of opium may safely be app tioued to the violence of the spasms, is a moat gross and du. gerous €ri(jr= 40 I II 18 evident from tha works of Dis. Rush and Armstronp, i ithat opium baa not been found a safe medicine m the vHlow ^^^^|ttndt>pl ~ ■ ' .^----i u „« t>phu8 fever, where they were attended with great venous 4 But in the morbid bilions or other secretions which are at- ^,*i tended wiih pain, opium in small dosus is safe and uHejiH.— r I After a decided attack of Cholera it is commonly several days 1 '%! before ihe functions of the abdonfiinal viscera become rej:ulated. PPTo relieve the pains often attending ibis slate of the bov^rels. opium is very necessary, esp-jcially if the Elixr. Pro. tails ut ( i^j^fhav- g its uiual anodyne effects. 31 With some person! cold water has bad the credit of curing Cholera. Every case within our knowledge where a recovery ^^ was attributed to the use of old water, large doses of Calomtl '^M had been previously given, to which the cure, in our opinion, >U waff^ attributable. , . i am It is a well known fact that cold water, when taken in large ^^m quantities, has a tendency to produce sudden and dangerous ^1 congestions, especially in the intemperate, who are also most it liab^ to Cholera. Its use in Chol«ra, therefore, is attended ' with much risk, and many more cases could bo adduced ot Us ■ evident bad effects than of its supposed efficacy. n ),-H' 1 '. ; ON EXCITING CAUSES. •'.''fill ■ , . . . il lat. Cold. The temperaturo of the body being ditninished '<^; from the imperfeict generation of ahimal heat, abstraction of ' ;!iV^ caloric from the surface is one of the most common causes of i ^j ' tke disease becoming suddenly aggravated. During rest and %: sleep the circulatioa becomes more languid, and upon expo- ' V. ;i «ure to the cool air, the vomiting, flux, &c. are excited. ji*^;' Ud. The depressing passions of the mind— but few are y^ wholly unacquainted with the distressing sensation which grief, I ' f ! fear, er great anxiety, p-uduces at the pit of the stomach. Any of these depressing passions have an almost direct influence m inducing a depressed state of thu system of nerves prmcipally concerned. 3d. Many articles of did have been considered as exciting Cholera. In the impaired stat^ of the digestive organs, they become incapable of digesting almost any substance— and sometimes the gastric juice possesses sonie.accrimonious or otli- i:i- ^ \^\^ ^e ^^^\*\nrr o /.o rkfi i» iniia rtT Hpnrnved anbetitc- and at o'thers a full meal is taken after undue fasting and fa- tigue. These are all circumstances under which the disease is likolv to become developed. Kut ihe fault is not so iiiuch in the diet as in the statu of the digestive apparatUJ. A course ofstimulalinjj dftrh,-.trnGnts, tonirs, and ppi!inps CalomehhoLld »»o resorted to, raflu-r than ntfrmpt to -■Iiide tlio disoaso by nv'»idin}ir a numeroMs list of proliihitod nrticlrs. We would not h*^ indorstood thai iho usd oriinripo or othor indigcstihle ruU stances «re not improper and attf^nded with danger— or llsr.t when the digestive organs are weak, hglit euBily digested food i^ not most proper. But our protest is against that general system of starvatiot, which in some instances has been so injudiciously recommen-i (led and adopted. If the appoiite continues unimpaired, andj the habit of body unchanired, the accustomed diet should noti he ahercd. Under such cirrumstances a regular and usually^ nutritious diet is the natural and certain stimulus to Iho wholoj nbdominal vjscora, whereby all the natural and healthy func' linns of the system are pronnoted. We should have mentioned in its proper place that in tlir dantrerons consecutive fever of collapse w© have succeeded by Pfiiall and repeated bleedinfrs, mild stimulants and tonics— con-i ^estions and local inflamation existing at th.e same time. In proportion to the importance of our subject wa find upor rovirwinjj it but a bare introduction. Some irts requirinc much rofloction and length of discussion— the limits and in tention of this paper admit of little moro than a general posi sition. To the arguments adduced to support our opinion oi the proximate cause of Cholera, many might be a Jded. The] tact that the elementary principles of alchohol are principalh; hydrogen and carbon, that it is indigestible and enters th« blood unchanged— that it produces a disease (mania a potu I strikingly analagous to many case^ of the consecutive fevo of Chalera, and the marked susceptibility of the intemperaU to the disease, are all grounds for arguments in support of ou hypothesis, strong and convincing, and if properly advancer! jnight be interesting to the profession : but as they would bii devoid of interest or use to that class of readers for 'which thi hook is written, we present it to the world as it is, untinisheij and unsightly, but in humble confidence that even in this statii it will Perve as a **Beacon" by ^vhich to f uide upon safe anusUoir Jtlstitulioii. and for maHy yea.« previous .,1 umoinmo., p.ujd '•:" uihealth, was attacked in tho night (IM) Au^v) "bout 12 o r Um k, ^^ cwiih great distreas at tlie I.eurt and o|>|)i.'.sH..n iii l.touihin.! i The day previous fhH hafUeveral time« " kn,s, h^and trembling and quick beating tu the heaK/^find also ieli # I >^the same when she first awoke. We saw her w.thn. an nour 'li: PThe eu/tace of the body, particularly Die extrem.iH^s, wh.o 'W Icoid, (but not the coldness and clammy sweat common ; . r*if OCholera,) the pulse frequent and opprasned, uiM. nn orca^mn- lilj^ ^Hal inte.mi88ion~lhe tongue and mouthalillle darker color tn^n UM natural, and rather moist, somewhat llnrBty, and an ' 'weight at the hearr-ihe panting or laborious breaih.n): jll^" Iresmiibling a person completely exhausted by running li*'<'i' ir..^,^»ti.A nrltW Hrink- fiwallowod with avidity, from t When i/"j: Ipresented with drink, swallowed with avidity, from the riere.. ii»i X'' Isity of constant respiration. The firet remedy used was Uee- ; I '; dine 20 oz., followed by mild aromatic* and slimulanis, with 'a«r j fhol applications to tl.« feet and legs. It gave immetliate re fll^Mlieft/tho distressed and oppresBcd breathing, but there was 1'^ * llitlle alteration in the pulse short of an hour-th..^y th^^n beg«n ':fi-\:^\ 'to rise, in three hours bled again, and gave a large dose, dO .hV '^ «CT8. Calomel. A high fever through the day with full bound- V-l '.^ iD2 pulse-the sxcitemera declined in the evening after a thor- ":Vi^ ouch operation of the Calomel. The two following days the t?(f excitement was marked by great ?rregulanty--t he medinries ft' i \vere moderate stimulants and laxativee. Castor Oil ^nd an infa- * ' ,;i sion of Sennp. She lecoveied without any otherc fficulty ex- 'iif i:ept un.i9ual debility. She has up to this tune (May) cn- ^ ;1 ' "ed perfect health. . , , , r.o ** i i i ■ I"' . D. B., of Beverly, a stout, hale lad, of l8, was attacked ^'' yilmuch in the same wav (as case 1 ,) and had the same synriptoms ■^m^ the day previous. When he first awoke, feFl much sickness, :H'J but vomited only once. Saw him in two hours. The distress \ ; i and difficulty of breathing very great, and the pulse barely per- Igi • ceptible. The treatments the same as the first case and with ^^ j |d the same result. ___— H l^^j ~Elixr. Pre?.— properly elixir proprietatus, is prepared by in- n ''K iusing in three half pints of spirits or strcMig whiskey, 1 ounce H , ^- of Gum Myrrh and the same quantity of Gum Aloes. SI 'M' nmham's Tincture is prenared by infui-ing in three half ' '!.' Dints of spirits or whiskey, 2 ounces of Peruvian Bark. 1 cuirce \^i of dried Orange Feel, and half an ounce oi v irg. onake rvooi. -' ?• if The above, and all medicines we have named are common, :' J ^i ' and known by the names mentioned. ohu&^ COM let likin.nn 1 oIko fell I tin hour, ijos, weio )mr)tt)ri ; i orcatsioii- color innn an **au)ful hin^ most g. When the rn»rep- was l)lee- lanis, wtti) nediate re there wus h^n began ;e ilose, 30 full bound- fler a thor- ig days the medicinM nd an infa- fficulty ex- f May) en- As attacked ! symptoms h sickness, he dietreBS barely per- ;e and with »ared hy in- iy, 1 ounce 18. three half rk, 1 ource jnake Root. e common, f: