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Tha following diagrama iiluatrata tha mathod: L'axamplaira filmi fut raproduit grica i la ginirosit* da: HaroM Campbell Vaughan Memorial Library t Acadia Uiyveraity. Laa imf gaa suh^antaa ont ttt raproduitaa avac la plua grand soin. compt^ tanu da la condition at da la nattati da l'axamplaira film*, at an conformiti avac laa conditiona du contrat da fiimaga. Laa axamplairaa originaux dont la couvartura an papiar aat imprim4a sont fiimis an commandant i par la pramiar plat at an tarminant soit par la damiAra paga qui comporta una ampraima d'Impraaaion ou dlllustradon. soit par la sacond plat, salon la caa. Toua laa autraa axamplairaa originaux sont fllmte an commandant par la pramiAra paga qui comporta una amprainta dimpraaaion ou dliluatration at mn tarminant par la damlAra paga qui comporta una talla amprainta. Un daa symbolaa suivanta apparaltra sur la damiAra imaga da chaqua microficha. salon la caa: la symbols — ^ signifia "A SUIVRE". la symbola V signifia "FIN". "I Laa cartaa, planchaa, tablaaux. ate., pauvant Atra fllm^a i daa taux da rMuction diffArants. Lorsqua la documant aat trop grand pour «tra raproduit an un saul (AiehA. il aat film* k partir da I'angia supMaur gaucha. da gaucha i droita. at da haut an baa. an pranant la nombra dlmagaa nteaasaira. Laa diagrammaa suivants illuatrant 1^ m^thoda. 1 2 3 ,\'.ii-» -i^ 1 J 32 X ' ' :• > :»v ,>,, ■ «/^«---^it*i.:^.^ite;xL^: :'■ -- 1.1 .^ " - 1' . - . ■ ■ ■ PCACTICAI. .OB^ERVATIOm ■'7 malignant Cholera IVEW-koRK. 'I DE8CRIBIN0 THE STMPTOUS AND TREATMENT 09 THE DISEASE IN ALL ITS^STAGES. A itetManu*! eu«t, and a variety or{aforaM«i^«piMtod-«M| ABdUlttftntiTo of the ra^Mt, 'M • IVtatON, MTAt »4VT. ^***^^*"* i ' i '>iirM.t)m.t yic:^- ■ a =^ s„fc» V O. ,< . . ' 'Ik '■"■l. If 1- " ( "^: ►•■v;, .-l-.i , . / / . ^i>U I t- '.., •^1 - • - • 'X •t f S -V ««■- -TJ-- i^ », ,. .1. . IK^i ,■;■■ >r>i'>V. :-li' - / m •■% ;«i^^ / ■'i •f MHmrif 9f JPnMMMl #i< ^ < iHi dw, #r« Ccntna HoATd of H^tn, Halifin,K«Ta Scotia, Aufo** Mill, i^M; Tbia QMr4 baTJQf biMii ia(!»iaMd Ibat William Qowi^ Esq. M. D. SurgeoD In th» Rojriri {favff, «n4 an tfffnt^f^ij Membtrof (he- Boards a c«n(|e■»aft•CIl^^ MMMonal )in4 Jiro* fpfaionalrapttUtiAniaBd Bbarao40r»tia alHNii^pn)Mi4 1^ (hf JJaitad 0lat»», tot tlM •uvfvsa fff ioUaiiii^;4«(QrQwUqn jijl^ ■racardto Spaan^icCbolera, ^ lUfolwad anaaimovily. That tliif Baaikl MMM^tfiiHir Mr ^HWt all Heallb offiaars, Boanb of Haallh, l|a««iil f)^^ ikmeni^ and panf at in anlboritr \/f^ tfua Uipitad iltal^;]^ iacintato Hurt jaaAlt nan^a inqiiiHaa after 4nCoi«mtJipiil M wpiaiaUir iDtasailine t# tliia proviiMo. H aPil^M iM^ttMtvtb^BoardJiai wxoftifaelioa. t(o4of. • nMMlfiit Mn^^4mUti nf» ofM ,^o iB% a»a iMifn * »hna» f' f t»w>piwl^ jn fWUniiW ' tJtt, /^ In baM£«l.tii»^iili»l0Mlii)0l)H(Ni)$l William Co|twtllr8feiitai7. «, .^ ^i > "si '1» 4 ' V. DfrnnfO^t LetttK Halifax, 13th September, 1833. On being acqaaiated with mj^ intetition of vititinK New Tork, for the purpose of obtaining information reganiinK lUlifnaot Cholera, you did me the favour lo requejit th9 Boahls of HeaUh and other ciTic Authorities in the United - Statei, to facilitate nnj inquirie*. On my return, I hare the honour to inform you, that youi; introduction procured for me every, attention and every facility that could gratify or serve me. ^ Mr. Wells, the Mayor of Boston, and chAirman of (he Health Comraiasionere, was most courteous, frank and ohl^ngy but thttt city, though in the freeest communicatien witii,Kft(rX9rl|, iad^f^oe^u^ed (to.th&pvp^flawingqf the botels) by thousands of its citizens from the first appearance ef the disease there, in the end of June, bad nothing to show ' me on the ilst of August, but empty Ciiolera hospitals, these certainlj^admirably appointed, with a finish not to be ezpect« •d in such temporary establishments. It is (rue, however, that ten days previously two cases of Malignant Cholera liad terminated fatally in the same house, at Boston ; that this house had been visited by a sailor not many days from KewTork ; and that his clothes had been washed by one oC the two sisters who died of Cholera. Yet it could only be Terified thut this man came from New York j it not appear- ing that either he or any of the ship's crew had had Cholera. Leaving Boston, I arrived at New York on the morning of the 93d,and without loss pf time J waited on Mf. Bowne, the Mayor, and iPresident of the Board! of Health. This officer Madilydidvihat WBl necessary, gitripg me an order of ad- nissioh to all' the cholera hospitals, and a letter of introduc<»: tion to IJoetor l$tevehs«' the President of the select Medical Cbuneil Co the Boird of Health. > The way beiing thus opened^ it only reroiiiniBd for me to ui|cei the bestoiei of the time I eoUld conveniently remain in Kew York'. By wastlag none, and exelusively devoting myf self tp the pursujt on which I had enteredVi have^ been ena^ bliidjto collect from the praietieeof eight hospitals,as witnessed nyaetf/or iinferm|»d thereof by the respective physicians ; fj^mi^'ownbbaervations on the' greater part of 260 pati- ents eonteined in these establishments the first days of my being in the city, and-on the majority of 100 more admitted intd^ttnimdnrii^ the time of my stay, as well as on a few in i4^.itt practiee '; but more isspeoialljr firom a fized and devtited attention to the eases and detaila in a particular Ws|Nth1 (Crosby street) wber* the disease, in its worst form, seemed at thet period particularly to concentrate ; from the opihUonsaiid ek|ierienoe of the physicians of the hospitalaaod ethew ; imd itom'^the knowledge: of the Medica l conneil, a =^ifgt^^^^'ll%ltpipif^niiii|rT^Kffeve, ev«rjr miestioii of tol^^tdJMmeM&tedwilfti malignant cholera. BtTiag ^btftSMd thfs infirinytiofl, it^wai a matter ef «oih i-*^ • -'""V^ Jt^ J '^ **; ' .;...,>-">.;'.<£4*S5 •i^trilion w'lih mte, on royrctara bitb«r« how b«it and dioaI •atUlaciorily to comoiunicato to you a^d this commitaiij lb* knowledge obtained . I firat ihrouj^bt of drawiof from tbo wholo the several roni- chi4ion« fairly, deducible in mj own jadj^eot from the fact! ae<{iiired, and to five these as the results of my inquiries. I3ut reeling that these would still be cofasidered rather as the opiniontofan indiridual, than the fair and impartial con« cliinions from faeta, and that, eoosequentljr', my ipforraitioh would be UMiess in as far as it ires not followed by adequate praeticalapplieation, I determined to throw into sueh^form as my circumstances and time would allow the diary and caseobook which I kept ; to submit this abridged compila- tion to the Board and leave it td them|o draw the praclicat conclusions i° as regards ezf ems I quarantine, internal roedi<:al police, the symptoms and treatment of the disease ; as re- gard*, in short, every circumstance of interest connected with the subject. ' A»d though in doing this I entail upon ihe Board the trou- ble of reading my diary, and of thence drawing these concju- sions, yet as I have had far niore trouble in collfcUng 'the n-.aterisis that compose it (putting out of the question ih^ disgust of twenty days spent on board a mail boat, and the fatigue of trBvelling) and yet do not regret my fatigues and discomforts, I cannot doubt the Board will readily under* take the'part I have Wt for them. In reference to the opinion that my labours have not b«ton thrown %way, and witliout doing wh»t I profess not to do, drawing conclusions, as the circumstance solely concerns my own feelings, I now freely tell yon, that when f thought of going to New Tork, convinced of the contagious nature of cholera, bolievinf in its ready communicabiiity, aDd uncon- trollable malignity, I was pot a little startled just the day I left this shore, to learn from the papers the death of several physicians, amongst them of one who had gone fiom Boston to see the disease, en his return frpm New Tork, and of se- veral clergymen^ Still, not alone the impatience of ignorance, but also the belief that my intentions were benevolent, and especially the persuasion that I was in the hands ot my Cre* a tor for life or death, determined me in my previous intentions. These (hen were my sentimente on going, 1 have now only to state what they are on retuminf . Still, that it is a disease communicable from person to p«lrson, and that, if advanced 4o a certain stage, it is a malinant and fa|al one ; but that 499 fOf^sons out of 600, 1 might venture to sav 999 out of lOOO, may pass, as I did, with impunity half of'the 24 hours every day in the wards of i well ventilated hospital, filled with i t, on ly b;y denyin|. t hemsejves so as not to deviiiUi from >,_ priMitive sltnpIieityor'irirTog, ffuTifvfog ordinary attentioo to the first obvious introdoef dry symptoms of diarrhoBK or other abdoniflal uaeiiinen, (ailmcnta^ when occurring, of " :^.'.\'Li-Ai'!t-Q.W-^MJ'. U.:.J-.-- < Ih. ihimtt^* Ltiler. Ktll* mcMTMiMMse •■d^ eMiljr contiolUble) poisesMiig i« lkw« t9wf Miily •I^Mfff «| nilM as atsuredlj efficaeiout pr«- vealif M of eJiolera m Taccination is of tmall pox. I d« ml Mjr lbi# b«Mu«» f and Doctor Sawari ha»« returneU MMf, •rfcUcMiM' Chatofth* aavan hahdred madieal pra«- gyp—»» of N«»w ¥yk o»»3r eight have diatf^oT eliolcra, in jMf ■>•* Ibare wi^hMgteet of tbo preberrativa mlaa, or ax- biNnlioa froa* wmnyln^ aad anxioiis aitaniion to tba sick. Tba«««r tlwnisalvet would be stroBg grotii^ib, but I have also tba omMotreat eonrtction of iba whole body of madtcal ob< aervera in tWt tiity, especiaSIr those who have bad the charge •rtb* ward* into wfiieh it'M^s distributed, eM^ lor these pteventire poppeses, and of the authorities who receive re* porta ftvoi those eolplOTed endertbem. SbotfTd the facte that i have gathered produce a similar conviction, noi alone in the minds of the Board, bat in those of the inbabiiante of Nova-Scetie m general, it will, I think beget a valoable confidence, overcome selfish fears, and dif- fOM! a pbihntbropy, when its helping hand is required, that wW repay -ttiy toll*, and by this aleoe more good would be done than I ventured to promise myself, foj I was far from being confident of makingrmyself nsefitl. Tbc Preeidettt of the Medical Council very kindly permit" ted me to snbmit to that body the questions that appeared to me of most iaterest on the subject ot Cholera, and I have been oh?iginghr furnished with answers 1o them. This doeiu awnt of itseif is very important, but it becomes still more ' Taloable ns additional and Weighty evidence eomfirmaiory of the facts and observations Contained In the diary. Tbeaw par»*r» I r^jrerard to the Board, and with them, ^s fafler re; lif^ »o my queries, some questions of the Governor of thv* Suteot New Vork,end'of the Board of Health of that Ci»«' with the replies, efter investigation, of the IMedic&l to»i-^il The Bfnrd ore the competent judges of the value of the Dmry ami of the other papers accompanying It, as well at of the m»nner,uf making them' most useful to the Colninunity, I there/ore wait its determination regarding tbem,^ ittd have tbn honor to remain. Gentlemen, - Xcnw mo«t bumble servant, _. ^Vm, DoifJfKttT. Tor t he Preifdeo t and Members- of tfie ) Central Board of He^ilib, Hk)»ax. 5 i «^ J \ 1 . *. - - -■" . . ' \ 1 . i: \ ^ ..i „ . 11 ' * i ■ . ' .. ^ -v'l. •V 4 •* - \ -I ^falf MkI iaipMrt«aft Df. DoaneUy htruig rt«Mi4)r r^«nfetl tram tlwUttiiM Ktatit, wbera h» ban tad m«n]r^Q|ifMPtttriitMt «r MrsmnNy cxftminiiif many caaeft of SpaimddiA C!hol«ra,an4 haviM«MH oMBic^Mtlie NsuU«f4ii«»kiflkktf»ntth«i«M, m4 %Meb viBlMble inforifMtmi whi«b Im I ' to this Bonriy and the BoaVd havij Resolf«d, ThattiNthanlM«ri Dr. DoiM«ny for Ma very iaU And tW« Boari Wins «f «pinimi «bat tW fMAIfeatlMi ^f CIm £*]?' ^'^ ^- ®«""»«*V ^o«W M «re«rtnMt«MWc« totM HMmtA pro(Malms m wdl i»or«Ut fttiKty l»lli» fMiviiiM •t larg«,afayj*« W^th C04»ibi^'« h«»* often coftie from If .K T» 'k"''^' '"'* *>' *''*■'" '»''"»••* »'"d" or district, of the city bava seni tho.majorit* ofthe eases. I..rf ihl ir"*' *"l*"«''<«'"'»-.inct«diog the ph/sieiaiis.h.Te ill rfuJ A" '"' **•• PT»»"f 'y -vmptom,. ain five narse. fctiro ded. Ona nurse I aa«r in bed tcdky ; she had been taken ill .few hoar. b.for. ; it w.s not wTpected to brte" me bo h.d h.rdlvbeen frc« from diarrhoea since be took up hi. mMance In tl.. Upltal ; and they al| said Ihey felUh. Sior- Mc inauofiee of i cholera atmosphere ; yet th^y say the dis- 0.W ii not contagiou. but atmospherical; that u, iti cause ia w the general atmosphere, . rapidly forms, yet t^e greet mojrtality at the first breaklnr out of the disease In the City, was much owing the total went orpreparation to meet it, m no hou«es were -fixed ori S!l& ft'' V^r'"'^T.'"'?^«°» nurses or attendants provided, thms fully verifviog what one of the Boston Medical ct'^wrdtogSher"* •'^" "•'•-««.. .i«k,4.ing and dead -. On* «/ the assistant physicians of the Park HfotpiUI be- ing on his way to >isU a private patient, liberally invited me to wcomDany him. The patient wan a Negro boy, and we found he bad died en hour before; this my friend di4 not ozpect. .. » ' '"~' ^:i^'5?;7'* t"^»ir ,^f» determined to .hut up two oTthe .ixCholer^ hospitals in thtf city, only two patient, were received Into the P.^k hospital afttr my Wal Four deatha h«ve tiken place iince the 2Sd,ill,l beUeve,frdm congestion or consecutive fever. / •^,»nim --f»«»»« M-^Doctor Jloe, the •|ipe«ntend% phydeiea ofthe spacious, well veptUated ho^ »t tff t&ige ot Oreenwicb, kindly called 'upon me^to*d.y,a«a JSJK^^ wrriedme to he ho-plMioVUMoribed to^ie hM»K2S cholera. Hei. veiT »angulfle,.ndbe|iew;bt hSfceaiSa^ «iUrly .oeM.,ful ; E«w;fer. .oii^epalkiit., be S^JwWSSSi c«»Hapie. Be iiMAkt of4u«Hreitme»ro/ «J»^SeiaJ^ r • A**. «•. wia eeeipMflly leSe^eitbf I ^^^^^Mr #i ,•:'' lympfTnn* \*:(li.|;re»i «athr«ction. If c*n^iita of trirmki* J'tHoim of Catifiiiil t*>«, llnieed .t«i,'cr •ven vrarm ir«(«r ; • Ita tiling Ijie fe*t ill >apni water in which haa bMn inri|a«4 «' qiiunlity of capsi^ciims, and rgbbinu the ftbdomen with C«y« .^iine |M'ppef,\or with w: ointfpcQt coinpoaed of tkia and ti(« IJngl. H^di«. t'wnphor. Frictiona wUb4hiaoiDtai«ii1,M«tba only means xned^y him ifv-lhe ittatouf collapae,4he nMfOHrMl frictions being tiicceeded by rubbing with .dry b'e«t«d cb«lk. fio internarmedicino (or atfeaat te;j. rarely my) btincgivaii. Xamphor, no much lalked of «a • apacific. ha finda fo ba a gooxj antispanmodic. *^* Theiia are only elevan natienta in Ihe Itauaa at preaant, ^none in collapse', anUthfejWfore none in which^Uiara ara tbe . tfharacVeriilic dlttinctlve featuraa of -th»dikaase ; yet aona of thetn appear to mei? a atate of great ^xhabatidnr howavfr th«y may seem to those coiprersaatiwith tbewpmt foroM of tbe diiease comparatively unworthy ornoti<;e. Qthera bavfttba consecutive feVer, apd two have aewre ptyalilm from tba frictions 1 bat have been used. , Id eleven easea tha vrann aaline venous injections have been uaf d, but anly in on« (wfaicih I saw) with ultimate recovery. ^tigtw/ 28/A.— On re|»eatinff my visU (o tbii bosDital to*day, J did not find any case of marked cholera. Of tRoae (hat are in the house part are the aanne aa I aai^ on the 24tb ; otiaars are of a similar nature, and some are actual dyaentery, pr .aymptoma approaching to ibis diseaaa, occaaionad cbi^y by the powerfal action of mercury on the ayst«m. Doetor Am ttills me that by~the diligent use of the campboQatad m^rou- tiaj' capsictim irictiona be bat induced ptialiam in a«alittle ia i\x houri. • ' ^ -r > , . A^i CROSBY STBgkT SqSPJTJil, \ ■ Vmr»dM^Mgu$ti9, 7 p. m.-I haviljuat retarna4rnMttVui- lingCroaby-street choJera hospital. Tbebuildinr now ated for |Mtl|M .— c ire«tio9 "f* the frequent jtcti- is^OR, the. lolling •boulof th« body being done with «n «<»fy whipk eitber indicate! remaini of real itrength; or- i lemportry ezertidn, the eflort of lufferi^g. AU of them had t^iarebcea.av other abdominal uneaiineii,froDi a day t6 » weeic» l^foiw the attnal invailon of the diieue by wbleh they are aoMrproetrat^. ;. / ^ ?. ! 4N« (At^inpon) ba!a the typhoid stupor (not comaV without th« i)«fit Of lordei of typhoe. Tbti is the third day. » Optbaa the mental, weaknesi of lypbus that requiree tnttcii routing to elipit ah answer, apparently from mere ezhaostioo. The i^iee it only weak, not pecoliv ; the face is lit id ; thi Itmgvt eold, as is every part ofibe body ; a deeper li»id, al* veatt blue circle surrounds the eyelids ; the fingers, h*iidfc- .4eea «oi} feet art quite blue, the skill shriveUed-.no poJse, thei action of the he»rt only being just felt ; yet there is no ^■i>eMpirjiUon->-«be makes no complaint \ is conaidered hope. i«is.., Oeta large ^mm of calomel, and aromatULStimulant ,4iBetores. She had also t>een bled. Six without the ^luenese . ., ^ In this hoapital alio, all tb« atUndant^i »«! tiie, a stQp> cocky with an ivory pipe, t)^ fluid flowinc br ^ta own wcigbtand the aippospherJo iH^ssofe from MiMf funnel introdjieed intt stated on the records 4uipi of $acmu. ^i«iii<44lA,>TA.t t, A.M. this roorpiog, I foaiyl tha| ChrM f ftpeata had been received in the flight, and, jtwd ware just potloMcaisiChtin. Qf tbase five, font were mftaicad .one area. 4 jwonsaa* The Ut|frwasrait oUlie face «I tieadep hue,. the fingers and toes longitudinally shrivdled the nails in«irfated--no pulse was perceptible ? the voicfe WM Jow, weak and peculiar— the tongue was cold, aiid the •yea were sunken. His wife was standing by him, but unno'- !!5 u' S! u°'j. *"'***' ^*''*^ ^'■<"" «••»""?» '" ''5' legs and thighs wWchdistrewed him greatly. These were m.ich mitigated by the applieation of ligatures and by diligent fric- tiona, with the camphorated capsicum and muriatic ecid oint. ■aent, by two men with flesh brushes.* There wns neither purging nor vomiting. A scruple of calomel was girtn, bfandy and water being ordered for drink.— A Catho- Jie priest, who is represented as indefatigable in his atten- dance «t the hospital, administered the last rites of religion whilst I was tbere.-f- ■ . *■ Another^^f the ea^es was distinguished by distressing ■pasms m the legs and thigbs,ifrhich were evidently extending •long the bips,loins and back. The pulse was barely percepti- ble «t the wrist, not at all during the severity of irpasm, and .tbecolourof theface waschangingtocholeric. The experienced •ye of an intelligent ndi>ae,saw that in this tnan the symptoms were fast gaming greund, and I heard himlsay to his compa- nion, who was assisting him in rubbing the patient last no- ticed, " let us leave this one, to assUt that of which there h some hope."^Tbey accordingly commenced the frictions, havmg applied ligatures on the thigh*, end there was soon a little improvement in the pulse. This encouraged the assist- ant physician to open « vein. Th^ good effect of the ab- ■traction of ten ounces of blood was most marked: the •pasma entirely and immediately -ceased, the countenance fcecaoae composed, and he boon wtent to sle6p, after intelliri- bly stating that he was taken ill at midnight, with nausea (not much vomiting) and severe cramps, an«f that he had bad a disposition to vomit (be preceding night, whicli howevev subsided. He It, a shoe-maker, at present filling the place of a person who a fortnight before died of cholerar* wemaal«a«eBtfoMiltal. - ' "•?••?"•. ^*« A Cro»bif.atreet JSoapi^" > IS if not impdii!T»irity of pr«dictln« what wUI pravc.to b% a oaie o» malignant cholera during ths premonitory atage ; or avem when its approach is near, until the iuperT«ntioQ.or craMpa, the failure of the circulation, and the ainkini; of IhVtampe- rature of the bot^dinsfnottieally charaetariz* ibe oaae ; be- fore the cold soft tonjrue, the sunken eye, waather-liealett face and shrivelled hands set their fearluUy certain imprais upon it. . *^ ' The foregoing cose ot incipient collapse, induced me to -nsk the attendants whether bleeding wai not frequently re* curfed to under similar circumatances, and I was informed that in consequence of its real or supposed ill effects in tome cases of collapse, it tvas almost proscribed in that state, but that It had frequently produced the igost marked relief iii severe cramps, and in oppression at the prsecordia. ' One of the assistant physicians, generalising, aays 1 roust already perceive that there can be no uniform plan of treat- ment m cholera, so much mnit be left to the judgnfenfof the prar-titioner. - • At npon I again visited the hospital, where for the first time I met Dr. De Kay. Another patient was then just brought in, n sailor lately arrived from Philadelphia. Hchad had gastric derangement and diai»rh«a for a fortnikhf, but only last night was takert alarmingly ill, %Hhj>arging, Tomit- ing ana cramps. He is now pulseless and livfl, buf not, Dr: De Kay says, in fully tbrmed collapse ; the prostration of strength seems less than might be expected with the other aymptoms. The Doctor tbi^iks that from bis vigorous eoii- atjtution he will survive, which I hardly expected to be told.* ^ .Aigus/ 96 —In the morning I found that eleven cases had l>een adotitted from the timefff my leaving last night : and twomorehave been brought ia thisev6ning. Of these thirteen, one 18 actually delertum tremens, without any apparent symptoms of cholera, another is a relapse in a woman who had been in the house before for cholera, four are mild cases of bilious diarrhoea and vcrtniting, and seven are hidifieMBt degrees of collapse, ef which they are illustrative specimena. and as such I introduce them here, abridged from rav tfeUiled notes taken in the hospital. ■ . , ^.approaching Co/^te.'-Gonklln, aged «0, aOer two dara of diarr hoea, was seized at 2 a.m. with increased pui^ing, •TWallne athletic yoang mno, Had ravived to eo^iderably, in Ibe^aftoriieoD, using ib« fiioHoDs and ukiog oalomal aadeaiaa. tkathia father pnd ether friaqdawho aoeompaaied bin. wera told v!J ill** r'"/J! *•»*•''.«'»'?« wtisfled that be woaid do well. Not loQK after this, ahoat 3 p. n. ha auddeftly atartad up. made « oonva|aiv(» effort to get o«r«mpf,tb« |)uif4 M)«i»4U^c](,.«)pit.Qatoral, tongue tepid and furred* voice a. t^hiapeTt JB|Bi|^ieiit Uypr of tbti face, hands shrivelled .Tr*at- VMitikvfl^Qj^kWrT-TCalomel and opium— Brandy aud wat^er for it'ivkt*' %' ■ ■■ ■> '- :•.•'. . ' .<>.\ ^ incipient ,.0pIIapM,-rBrown, aged 26, just arrired at New York from JBiizabetb Town, where he took possession, on iV\r«daead«0^j of a bqme in which four oi its occupants had died, <>f, cholera, Ibf-pveceding Monday.. It^ had been well |ra«be4«;be|bre'oe went into it. From Wednesday iia b«d % diitrrhopa. : > TbU moininc (Saturday) ait II a. m. ho* nitinf indcreinp^.Cf^e on j and when admitted at 4 r n, ih^J^M^eiHrnt /ipeb]|B^,but distinct, and the ak'm and tongue were cold. ;8ame^reatment as Conkliat , . FvUyfyanmi Coj{af)^.--Meggarie, agedi36,waa seizedilast night WiCbVf^i'Mv^* purging and cramp9, attended by gretit Ibirst. Qq a^ixufMQQ. thit merging, the. pulse was feeblct fkin cool,tongu(i Ci)ld, moist and furred; and the face was livid. M l^r.^.. fee appeared weaker, and there, wes constant jaetiUli^Qn*;: ,JLi.u4>i£|e. eyes were Bunken. the fingers a^d taep-Wierehta««Mtl.«iy'iT«lM— -there was much thirst, and he W**.T4|f >Y««tJ%9et At $.r. m/. bad a sere-sanguineoua 4ejee-^ tiol^|lO|,^l|U^(:pQrt n^ii^e. The, treaUnnut the naie,.aa.,i(» tbi( Pf«f^'«g l».9*^4; > ' 'a : , .-!;..- irwfx/fen^gf.-flP^ojWrT-.Olaekin, aged 4^— a waiter ^frem Ilihl^^Afime (sUmf^as seized this moEoing at &▲ if. witb T«|niUi^M4 |Rrgifg;i was bfoi^ibt to the;bospitah*i44>^>«t^ t^ii«9^praimiiCcmiK4i .of cramps. iR ^^e legi, abdomea) aMl tlii«k»'t4li9hlhf PWffiwae .fe«bl«» theekio cald, soft aH^" < •.,..,..■.-,-•:.•.,'.. ..,■,■',! :t4»v.i t^Mvtmm* GpIfff$e,'^hmM Dn&fi, aiged 60 was aeiaedi|t«M |M4i4r()F^b.,i«i9itinfi pmrgiBg anderampa ; the sympteia* U Ml«4«(linlb{fiiinorQing were, caimtenaB«;e^:^uBkeay 4onf«* ^K|lsilrfM|MR4«94deQ, (4cia c9ld||mia6>MnaIl, crampa.; 6 r^iif* Extreme collapse ; lie; unconsciouii.Qfitirerf.sufrouodiiig-«lM i^ pM|MN»fiAB^««iig>jaDd canocti be fvoaed-^the biw^^g jTir Jidumced Collapte. — Mary Barron, aged S5,adautiad ^ixMowrilic. <> .▲tduk^. Bi. the ToieeiwassoWeak'thatlilM bmHvio$Jbitwmlmnkoo&^ gnd when with difficdty raw«(k Mt It^Mii^^ffjMl^^ l"ki«»oDf ttd^ ^Mat la ketjkjhi^ If^ !-J tDiedat^r.M* ^DiedatlO. SO^.'ii' ' >n,.oii to f\tt0 sflBit ucDiMit of Jher CMC/ : OoUaiiiift #%ir#1f4« .UnmI ^ineartj eitrtme. 6 r.M. iS^kiR|^ bapd« ai^, 6n|^f9HUiijfiBl|it4 and blue, lies quit* uneootoipiu $C all •unroniidiog^ol^fcl^ Treat ttient at in the pnBceedin|r caseti* ■.■ . ■.^^y•t■■■, .; Eixtrenu Co//aps#. ~-Prine«i a aegro --.boy vaged 8 j^itntf^mf seized yesterday evening with porging,Toiai(iQg- and «r^iifl and was admitted this morning at 8 a. m< Symf>Ufn» t-ijfcip cold — no palse,exeept ih the caMid«-^tetpik«(i0naa!po«it %§ in the minate, tongue cold and eoft,VQice. hardly peroepjl^^ eyes halt' shut— perfoet ind^R^MiHie to^Wti^^lMiif •rou|i^($ female relation is sitting by him^) yatahsifMf •fter^ificli ronsing v^ryl intelligtbly •••no better.** No urine iiajiaed, 1)9 dejections or cramps. This if the nea«est^ iikp|Mac^ (0 anitna- cd "death that I can soaefilre. ' He aaka fevfitthiogj BV«r jisoves, yet the intellect is iottiQt.f ^»-i v.- e 1 ■ :■» ^tkJhgtuL Ffoiti 7ttsterdiaynsicotiTe lever (sor eallji^) amongst the women, and otte man died oiLtbie the day bofbi;*' . yesterday. All of these easea I'notc, as, H »^9»»m most fytk midable part of tbe malady, making (eis jmpresaipn Ui&o 4Ihi atate of collapse oalybeoauaelesfrlpldly^tal. Tbobi^hft^i semlbling typhus^ there «re soch atrongoilMd^ <^f differencet as to he obvious even to myehort ezp^«aee< . There air« i^ n the dry and brown toaga«, an dssomrikij^aieiil, ^r^embliof the ioparose or comatose atate of typhoa ^ b«ut there, is not' tbe ardent heat or delirinm of tbia dis«ise: j^ indeed ii» heU hardly reaches in the very centre the ttatQral temperature^ and in the extremities an<| othev parti^it is below this, or if a genial warmth does universally difiase itself, it is aeoomput aiedbytiicb signs of amtlloratioa M ghre tbebett hopet' of recovery ; and however aeemiogly tbltrected the |Miti«pi| be froiia all surrounding objectft, if duly rouiod, wo ftr* •oimvwi clearly and iBtel%ibly *« not very w«ip or » ao bjutt^a^l': U thit respect, as well a» in the tirettaMt«ficft< !ii^t.;4Ni4ni4^4 heat, it differs also fVom apoplezY, whidi o|li#f iriitil aipn^ lates ; and copping and bleeding,' so inuch used, do noi-^een |4ip|^ •Died at M. 4»r. ». fiOflled A Ik m; .. /■ / / / «\ *TftetonfQe rootalned tbe same^ bat the pulse beoamo weaker yet she oontinqed perfectly sensible on bein^ roused, until a Jittio time be/ore abedied, at 5 b. m. the following dpy, tOn theiWHi.tho moath was a little sore, she w^s more awake r proBonnoed her better— the tooguestin eontlnoed brown and '^'I!i'A''^*?'".J'** "^''"''f' pB.tbe 28lb. she was arain so^ poA)^, thongb without dilRftuIty roased to retiirrn dhtinot and ap- ^ropriate aoswert ; the extremities were cold, and even tbe tern. pe<«t»eor the body was h«low nataral :r-the tepsoe was rarred dryan(lbrowa.andft livid blue oireiesorronoderi the eves; there waa p«ia ifij^p eplwatriom— (oppped). On the J»th, the skin was ^•''ffl' V/l"?*"?* *arm\h, the ^y 9s remaininfc lastreless. Oa th^Oni. I left W better, a genial'warmth diffusetl overthe whole S3L . ™°»it| ,« *» tta pal * * fOro%»»# w fe hg tht^ th e to frie moist ^nd leM,farf«d<-yet she was still oppressed ty grea< lirely apopJec(i(r, id the lower jaw >an, approaching piipiU were con- Herrtion with to- l>«r»eir,t:?nei«||y *«e pulse was 88, I xcordia, cool or ixteeri oiincei qf ind she was cup- ivarin foot bath, nluied* B of this disease, inrasion, as weU , after two days ZSd August with listressin^when r dejectiortt, the be tongue was f was bled, the and iaudanatn a sinapism was f calomel and v m time to lime i,Ca|)sicum and . and water. She SSrd and 24tb, ^th a sojjorose his symptojm is *^ el^and was bled the coD^estion nsecutive ferer r constitutes a i two following or attempt at •eeamo weaker, Jd, until a little ts more awake, led brown and was aj^kfn son listlnct' and ap- deven tbe tern* ;ae was furred, ;h« eyes i there h, the akin was lustrelesf. On oterthe whole A; "the 'io0^e »sed tjr frea< ^ Crosby- SlrtH Baifital it Mary Reiley, aged 30,after suffering a day fr«in --Frictioas.) On the 23d, the distressing, grcenishi bilious vomiting continuecl— (cupped on the epigastriaro.) / On the 24th, the vgmiUpe was lesf, but the tongue was di(y, brown and furrtiU, and there WM an evident soporose tendency— (Calotnei grp . v. every four bpurs.') Yestefday and tb.day (^fith) tbe symptoms haT« continued nearly as on 4be 24^h, tbe stupor not iacraased.* i€-tW-other case, premonitory diarrhoea had continued Jo!tgeti(a week) tbe collapse was farther idranced on admi»- sion, amSili the symptoms assumed a Jiighet ebaracter. [I anticipate the regular order of my diary, for the saice of placing these cases toge^ther.] Watering, ag«d 98, was ad- mitted at 9J A'.M. on the27tb, having become worse tbe pre- ceding day, with increased purging and vomiting, and in the night with cramps and pain in the epigastrium, i A s«(uple of calomel had been administered to him at bis own hous^. On admission, the pulse was just perceptible, the Jcio cdM, the tongue cold, furred an* moist, (choleric) tbe^untenance sunken.and beceining livid,the conjunctiva mjeeted— (collapse formed) —the dejectiona were rice-water (as defined.) Fric tiens, and starch and laudanum enenata. At 7 r.Bi. the pulse was quick,and the skin warm, the collapse seemed! overeome, though the fingers still continued shrivelled, (calomel five grains eVery four hours). On tbe 28th, in the morning, I Ibund him lying quiet, but soon pAxeived there w»s incipient sopor; he asked, however, in a vbry feeble voice, if ther« was any danger. Tbe eyes were much injected, ^he tongue was furred and yellow, the pulse 114, very fmill, respiration natural, and the skin generallv sufficiently warm«m(cupped ia the temples— ordered a lazahve.) On the 2^9tb, |he pi ostt«- tion and accempAnying symptoms, were nearly as on the preceding day— (a grain of oalbn^el, with thr%B^f Dovnr'ji powder every hour). On the morning of the sbth, hk «|m pearance #as rather better, be answered clearl4, bat smn relapsed into his sofflnoleaff stete, Cbongh U OfA eertsinly more the appearance of natural sleep than be|fof«. > Tbft skin was warm "k^llw as tbe knees, the tongue was moist, Und less furred, ttiT^alse 90, and soft ; yet on leaving bim ia the afternoon, 1 4M>ald hardly indulge any hope of liis t«eovery. He bad been cupped and bled to tbe totmdst ponsible extent. Atkinson^s ^«e, shortly alloded to at page 10,w^ marked, a» far as leawk^bysymptomstbaesttiM same as Satiu»4)afe* ofWateri ^. It terminated' fatally. Mttle *0n tbeiS^tb she wu more animated ; flie moath ^as a j^rct. t9ngpj» ye^^oy iuid fBnyjI^Mie jtylse ioft and skin bf ai > fellow and jTanrw). tfie bnl sn, and on die morninc o^ f a a it irt l Aame |evefisb, and on tiiQ morning pr the ^tb I (baadMr d^- dediy better, wifh the iuipebt irf a patfentbaving bflloas Mftf. On tbe^th I left her fallf oonvalesoent, tbe month sore. \ ' ..^1 IS ■^' n ( ! 1! P 1; Cro$iy-:^'tet Hoipxlat. On mj retorn to the Hospital iothe evening. I found (hat three paUents had been adinitted-a woman, and two men. luall the circulklion is good; they have, however, each had- purging Toraiting and cramps, or at least two of these, that I. the symptoms that threaten, or are premonitory, as immediate preeuraors of incipient collapse. ^^ Though Dqetor Rhinelander tells me, that conjointly with these, only the ayraptoms pf common cholera, a peculiar cfammy ©raizy feeling imparted ky the patient's fkin'enables Hun to pronounce the disease to be malignant cholera, 1 have not yet acquired the tact to discover in the purging and vemiting any thing by which I cooFd positively determine the disease, more than 1 could pronounce from the pyrexia that precedes the eruption of variola, that the disease was small-pox, however much I nwgbt suspect from the prevalence of this disease, and the patient not having had it, that it wouW prove to be variola. The vomiting and fif s that fre- quently occur in the invasive fever of smalNpox, would slrengfchen my suspicion, as «ould the concomitance of cramps with purging and vomiting in cholera ; but as the peculiar eruption only would be conclusive in the one, so 1 could only be satis6ed of the other bv the failings or incipient failing of th? circulation, »!»« ^^e seld.h in the neglect of ineir suffering fellow creatures. uAl fu ^^-^'•tfi':*"?* *hom I have Qientioned at page 17. Sr.e ^bl i^ "'^"T"'"*'? '«^"' was admitted.'^ f t wili Don.NUnn ^ Zf' ''^"'P'*- ^''°"* *''« ^''n^ ^^'ne, Janet brZhl • • •T.'^ ^*' "■^° *'**' '"»* her father in chplera, wa. brought ,n in the .(ate of incipient coJIap.e, after introduc! ory diarrhea for some time. I„ this case/whilst the coun- wrrve't";;!""''''".'^^**'' P"^« imperceptible, the l-„ oZm\ In/hT' ""^ »»•« »onguenot choleric, (Co/am*/ and bS h„* ^V h ''•°'""'! °^ ***! afternoon she became cold and tions* ' this being observed, the heat was restored by fric- 22fwh""?I*'''"'tVi'*^''.°^^''"*'''«0"» (Margaret Ingle., aged strll ' h""?*" '?.''?"5 "? ""•^^ '^•"••'^« «"<* the effects of a srong cathartic onjudicipualy given) when she accompanied rirnt h '"*"*, '? the.house, though told the danger of „eg- A.; 5^k' '=°'"P'«"'t, however little she might think of it. As had been predicted, she was brought in St 1 1 p. m. in a state of fully formed collapse, havioj been bled at home charaJtSrtt-'-II T^?'*fJ«'="<'»'. P«l8e,%kin'and tongue, we"a ,.?r»?/ r ''f "' cho ehc, thou|h the eountenanci was na- had suffered much irom cramps before adraiision.t ed and had cramps ..nee yesterday evening, without any vo- nuting^was admitted in perfectly formed collapse, all the di, «ta?-ard*''oI.''!'hi M.h" 1?" *°™/?". «<"'«'"'««« below the healthy da. .hi „o?f S. ^^^ '.''® •" o«»"o«'««y g'«atly better, and neit day she was fully convalesoeot. without any reuon to apprehend consecative congestion or fever. ■pprenona naSlLTn^lJ^J"'^'" '»' ''^t^t''e •y«"«'» Partly closed.^very SIuYn ttJ^/r^S'"?'***'!**P'«'»*"""'tl.e poise pero;?UW; rnMoK»S?n°'u"?!! !^;!J* "1"^"^]^' About noTnthSeok very I bricks, _ , tMUiniM* A« in"aft""i • """.""Hw "« n«r recovery Wer«-TO- leriainec. At 10, 30-»b« was discovered to be dead, the nan* b«vlngbeen with her only a few minute. bJiwir, «^ *«K I; (■ fi I.) i> |1! so Cro$byStrgtl BonpHal. agnostic tjmptomt beiiig itrongly marked — pulse very ffebFff and indbtioct, tongue cold, furred and brown,, skin cold, hands and fingers ihrivelled and blue, face diuky, eyes snnkeu, ▼oiee entirely g<^9e: he died at 5 r. m. under the usual treats ment. JiuguH 39'-*>To-^day five have been admitted in collapiie,. three fuliy formed, one far advanced, and one extreme. To enumerate the symptoms of the man, a{;«>d 26, (Jones) who vras received at half-paat 1 f. m. in e)itre/ne collapse, nnd diod at S would be to repieat those of the boy Prince at page 15, and the state of many others as the disease gained ground, when I have marked the symptoms extreme. collapse.* And Tory near does this extreme (moribund, but without that labour of theiespiratory organs, apparent agony or pain that hi ether diseases attend this state) stage follow and resemble that of far advanced collapse.— The case of Peter, aged 88, who was received to-day at half>past one, and died at six, might be stated in almost the precise words of Mary Barsons at page 14. In Peter . there was no pulse, the tongMc wa.t ice*cold, the f^ce was purple ; but there were thirst and cono atantjactitationraknost to the close. — Of the three fully form. >ed, one had had introductoay diarrhoea for a day, one for se- veral days, and the other for a week — one was admitted ^^t 8 a.m. and died at IOv.m. — one at 4 p m. and died at 9— and the third at6p. m. wad died at II.— In the three, the pulse I have note19, a perceptible thread, hardly percep^bl<>, and none, (for the apparent strength of the patient is not estima- ble by the pulse i) he who had only a perceptible thread, la- mented bitterly the loss of his boy the day before, a circum" stance very uncommon. In all the skin was cold— in all the Toice n^jis low, but inene barefy audible — the tongue cold — the face dusky, purplish or livid — the eyes sunken, with a bluish circle in one, a female — countenance anxious in one, expressive qf pain in another, and without any marked ex- prefssion in the third— the fingers were shrivelled in all — the na|ls in th^ woman retained their natural colour, in one man they were purple, anB in the other blue.. 8yt6h a>^the varieties in the symptoms, as they present ev^n in the same stages of the disease. One of these cases I must notice more particularly, as Doctor Rbinelander judged it a fit oce for the empbyment of the venous injection. His case (CUmpbell, belonging tQ the Caledonia, a collier) is sufficiently embraced under ~ the geieral symptoms of these three icase8,as I have given them, until 3r. M. ()ie was admitted at 8 a. m.) — 3 r. m. greatly sunk ; every appeai^nceso much worse, that it seems doubt- ful whether he wilt survive to th^ time fixed for #e injec- tion. , 6 r. M. F ace coh ered wit h cold perspiration,, hands jnd fingers lfij^«n«ir, mWS AMij n^ipiiratious 18-- pulse not *An ppportonity was kindly afforded me of making theaatopsi. cat examination of^ this man. Croiby- Street HotpUal. ft not positively to be dittinfuisbtd eren in th« eaiti^tidflf He* vn* conscious of all external •urroumlinr tbinK*! not apptrentljr^ feelin;^ in the least the inciiiott madebT Dr. Rhioelander over fbc median cephulic vein, of an inch ih lengtbViJMBjdissectien bt' the integuments from the vein, or, the aiterla^SM' half an inch madt bj a l|i»cet in the vein itself. (The niost marked' and extreme collapse). The assistants having prepared the usual solutiom of carbonate .and muriate of toda in water, at "The temperature of Wi degree** Doctor Rbinelander's apparatus, described at page 11, was 6lled with it, wbilat.tbe assistani continued to ponr^he warm fluid gently from a jug into the l'unpel,as was requisrte from itv payaing through the opened cock into the vein, the ivory pipe being dexteroas- ly introduced after a few ou'nceH of blood had pretty freely flowed from the puncture, and tlve stream of warm injection hud washed away the hlood from the wound, so that the opening in the vein was distinctly visible. (The effused hlood was cold and black, and the vein wJieoJa^id bare se^oied diste(|ded and full of blood. ^ In abonl a minute, the pulse was perceptible in the cartHid^i ■" two at the wrist, and in four it distinctly beat 96. ^After seven minutes, the nepk became warm, then successively the Joins, back, tbi^ba, forehead and legs. He now awoke from his torpor, looked comparatively animated, the eyes having acquired somi^ lustre, and the cheeks „and tips changed their dasky broWq for a somewhat ruddy bun, h^ linswered " O ! yes, I am better, give me some drink." These«eirects wel-e produced when aboat twenty ounces" had been injected, and it was not continued longer. Dur- ing the operation of injection about eight ounces of bk>od had flown and dropped into the basin, placed under- neath to receive it. A degree of heat sifbsequently extended to every patt, though the feet and hands weiie still below the genial warmth of health. Bottles of warm water were placed at the soles of the feet.f . 7 r. M. The pulse and other symptoms, of it least tempo* rary improvement, noted after the inje«tioti, continue as then. ^ , '' 8p.m. The pulse again muc!^ sunk, though the beatjind restored sensibilitv to external objects, are yet little dimi- oished. 1€l p.m. just dead.| II * A dram of muriate of Soda and ten grains of the carbonate to tbiee pints of water. t [ ceald not belp thinkingr that all the resnscitatii^ effccU here noted^wero piodaced, not l>y the soda dissolved ib the Water j hut by tInBieat commaniaat«;d by this fluid to the body, which if aided by the assidaous and extended appticatlen of exteiital warmth, and the injection itself repeated aa often as necessary, 1 sheald hope to witness more freqiieotly happy cffoote in these so hopelcsfl| ; » •"' ^bf this man also, Dr. JRhitielander kindly' ^rmitted inete make a pos^ mortem examiaatipo, only reqoestiag a cbpy afthe ease and appearaoMs. . <^ ■ n €mky $irHt ttcpitaL I' i ; ^t*||^/ 30 -.^t 9 A. M. Priqei., a negro, agoi i>9 wai mU :;:;. r-i" t'^'^^' '"•'^^'•* '•"••-"'"gconVe, which at • % . wn* t^l^r fu,m.6, not.vith.ta«ding the emplo^,„.„t of tJe t«m«.K nJ. ** ''•"' menlionedat pajje ' and it seemej .JdD.n«li*'^'^'''r •''''' "'■'■"■'-" '" relieve Ji,c «.«.op, nndp»in at the eiwga.tr.ufn ni it had done in that c«»e : it nZt^A ^r"''r °"^"'"^' '^'^•* «'»^ b "'Ptom. had only ma. nifested themselves at 4 *. M.pa.n at the epigaarium; sue ceeded by eatery purging. . He^a, ln(emperL« Th, mo- tberof th.. manr came wiih him. She .fated to me thai she bnt h.Tj;.?r7 '" ^'■'''^^ SrreetHo,f,.tJ»l ..ix weeU since. , but had qmtted on eceounl of ill health, that she'had not been near the hosp.talTor a month, ^he, however, liv.nJ with h!5 !luJv\ ."'*"♦ '^'::**''*'"*='' »*'''^^' **'f'«'-««'«''eral people had died of cholera. She iook>o»«»,ion of this house twen. rLILli^' since after it had been white-washed and tho. roughly fcleaned. In thu and the other eases of cholera that I nave seen m negroes, I hare remarked how much the ex. ' P'""'!,"",/' *^'*""'*"*"*'® depends upon colour, and conse- queo ly the entire want of tiiis distinguishing symptom, so in - ^.c.tlve of the disease, iiulhe J,l.ck: there 'ar.,hpVeTer, suf. fieiyl symptoms without 'this, to decide the disease. About noon^nother case of collapse (thU stage fully form- ablri Tr * '"r "i't ^1!' " *''"• «"« '« W "-ah, aged fh»7 hf • J"-"" "^ ^y ^'' '^'^^^ weepinllTd lame„t"ng that he was surely goin? ; but of this he was wholly re -a rd- less or unconscious. His face and whole body were covered r«'iJ ?'/« ^!:°T';,'''^P"fpi''»t|on (the only casi in which I have .jeen the body thus universally bathed in cold perspiration,) the eres sunken. f,ce bnish, hands shrivelled, in short w.tl ri« I •y'nptoms of a collapse rather far advan9utdp$ieal with whom the „ External jSppeay ■urface the same occasioned I tbin fe? after aeaikyof Campbell, '-^^hunvjfed (See page 20.)-- irpjish and livid— the whole ».*oge»S!i^i«i f dddy patebe*. psfcum fnetloQs. Here is a ca* |M«BK«rone of cholera. Tfnr" Cro$h^'StrrtlHo$pilaL., f^' 6n^ cutlinf (lirough \hi inttgumentt ahd oiuicIm of mv li^ifearf.: — TJ^ durn"mateiw ndhered no^iir.ly to the paritUt Ijom-s that titey wera difficultly laparated without llccratinf itip (h>%|fnj^ itself, were tilled, bat not parti- cularly (I'stendal^ttdyl^enous coloured blood. The substance o( wk l^W^ was tirm', presenting on being aricednodotlc(]^i«nJarlty. The left lateral VentricW coii- *«'««4 a^*«ftt four, «fe ri^jht three drachms qji serum ^a the p'etus cM^l^es was granular, brownisi), not an injecte^net, work.' ''''wine basis tranii there was about half an ounce of serous fluid. . The tight and touch could detect nothing ab- normal in the cerebral nervea. i Chest.— The pleuras costalis and pulmohalh were firmly united on both sides, by old adhei^iona. I he lungs were en- gorged, and dark as in pnemnonik, in both3eides, and iu vo- lume what they are generally found to be itj.that state. //«or/.— Of duly proportroi»«d size ; but flabbyj empty; the sides of the cavities cbriapsed on each other, and the whole appearance conveying an idea of powerlessneaa. Amongst the columnse cariteae %f each Ventricle,there was a ver/^amall fibrinous coagulum, and from all the large vessels that open- ed deperidingly into the cavities, there \va;i an oozing of very black thin blood/ All the large vessels contained black coagula. . - Mdomen. — Before being opened this cavity was tense and rather tympanitic, and on the parietes b^^ divided, this tension was found to arise Irom the inflatiohpf the large in- testines with foetid gas. The stomach contracted, conUiA* . ed about eight ounces ot a greenish, tnrbid fluid, with consi* derable sediment, in which there were three large unbroken pieces, and partly unpeeled, with many smaller bita of water- melon. The inner surface of the stomach w^s tinned of the same colour as U|^fluid contents, and on sponging this off ;t>ie maup^ coat presented in its aspect nothing remarkable, except^flat in color it might ber a little darker than usual. Whilst the peritoneal coat ot the large intestjoee wes genera U )y markedly vascular,and some inches of the deacendtng colon, just above the sigmoid flexure, dark, appniMhing to biack, though still firm,the external coatofihe anvall intestines pre- sented nothing remarkable, either in colour or vasqplarity. Theae contained through their whole extent, frpm the com4 mencement of the duodenum, a large qfi!ii)tUy, certainly quarts, of a dirty turbid fltiid, like diiek barley water, andia .;by the co ni of thtite dbr I fluid. The large intestines contained none pf thta^ di;>r pf any free flaid, at>,d nf ither in them nor in any ottier part, W%» there any feSsiilent mtitter/or «v^n the snelfof anjf. The ■*&!• ','il*u '. \ n \s ^ \y "^^ S4 Croihy. Sheet ^Hoapiial^ f l>MM!reoatoftb«lirge|nte«tm«9«ravcontey with a vfry t«« "»«••"»• pr«Wiii8h mucous. The peritoneum and mesentery w*r««f the sam* colon*- as Ihe small iniesiines, and without inaf[t«dcongMlioi»6f the vmels. After handling these parts and traemg the course of the small it.testines/my hands were covered w«tn » gljtinou«,«colourlfs^ mui-ous, and however well the hands were washed the lea»t touch of these parts again coated them. . ' ^^/'S'/TA ''!*'® «n«'hIed,firnj,not rontainining much blood. Oa«.^/a«fcfer, large, fully distended with an olive.coloi'red thm bile. Spleen, firm ind small. Kidneys, firm, of ordinary size— the secretory cavities rather pale, than vascular : from these cavities Dr Sawers thought he could pr«8s out an oily I \ .«^»'»»»orjf Bladder, moderately developed, containinc about four ounces of pellucid brown coloured urine. On the surtace of the blood, in whatever caviiv effused, there floated smaJl ghibules, which to uj seemed oily. , Having detailed at this length the appearances in Camp, fteus case, in that of Jones (see page 20) it will be sufficient to state wherein it differed from this, and what were in it f ISO the appearances judged to be peculiar to cholera. Being a negro, nothing can be said of the colour of the surface. The substance oPthe cerebrum is softer, and there IS not a particle of fluid in the ventricles, though there are about three drachms in the basis cerebri. In the thorax there are adhesions, old, firm and continuous, the lungs are mofe easily lacerable, and there issues from them abundantly fluid dark blood. The heart, pre-enting the same flabby, «mEt7, collapsed jgowerless appearance, does not contain in , ail KB cavities more>tban an ounce of fluid dark blood. There " t J**^ !™*" ^^^^ coagnlum in the left auricle,and another in the ao^ta. iabdomen, mt at all tympanitic. In full con< trast with the first case, the t>mail intfstincs are minutely wyecled, whilst in the large .there is hardly a vessel visible. A he same tenacious viscid mucous, and' even in greater asundanee, adheres to the hands employed in the peritoneal eayiCf and in tracing the intestines. The rather cofttracted «omach, contains several ounces of a thin, rather turbid nuidr Without much sediment, and without any undigested matter. The inner coat pale, with a viscid mucous coating, coloured, as the fluid contents, brownish. On rubding this off, a few scattered reddish spots present 1 V^lu mtestines, through their whole extent, are almost filled with a fluid resembling the contents of the sto« ouaich at the duodenum, becoming thicker as it descends, until 1 J "••°»'»'«» **»"» in Campbell's. In some places there «re shreddf mucous fii>rj», »nd a quantity of lateritioas or •♦il . "~'"«"*- "»« mncoas coat is crea^ colored, without a f^siel, and ihe valjulae connivenles are prominent, fe ii Mt a oft ea a dV T li e l ar w mt^stTne«,-lri t fa oprirn1g W^ ftculebt t^ntelkls, bnt Uned,"^* in the first case, by viscid mucous. Unnary Bladder different from CampbelPa case, Dr. De Kay's Case$, 4c. pry- ^""fvn i a vi«ry !««i I mesentery and without l these parts hands were id however these parts much blood. ve-coloiTed of ordinary ciilar ; from out an oily containing le. On the lere floated in Camp« e sufficient were hi it lera. I colour of softer, and tough there I the thorax ' lungs are abundantly me flabby, : contain in , )d. There tnd another 1 full con* 'e minutely lei visible, in greater peritoneal coAtracted her turbid undigested d mucous lish. On i present ctent, are of the 8to« :ends, until laces there sritioas or fa colored, prominent, tUatd OT^ , by >i8cid t>«Il*a case, 26 contracted, thickened, and hardly containing an ounce of « brownish sedimentitioos matter, resembhng the contents of the inrfilS •?.■ M^ 'r" ^"^««""««- Liver, soft, easily lacerable and filled w,th b pod. Gall-bladder, half filled wUh very lifrht CO cured bile; gall-ducts pervious, the cystic containing two femall ga I-stones bpleen soft and, easily lacerated. Sti II larger glo- oH fhV. 'r *««'»,i°«>^(fi"t pointed out by Dr. Sawers), to float^ on the surface of the blood wherever effused Here it seems to me. that the peculiar post mortem appear- ancea m these two cases, are only the flaccid collapsed and and the choleric contents of the intesUnes * tnv««n^» ^"""^ '"/• ^"7 °t' Crosby-street hospital, to which I feel mysell 80 much indebted, and which I gratefully acknowledge. It has been my head-quarters, and that not only because the dis- ■XI: i"7"f T '^'y ^} N^"' York, seemed to concentrate nhlrJlw. '^ because 1 fellinviled thither by the kindnes^^nd liberality, indeed by the hospitality with ^hich I was received, for whenever the interest of cases, or economy of time, demanded ^hif nK^^'^ *?^ "'!''^ '•°'P"«'' ' '"^' « «'«>c«'ne guest at the Ubie of the resident physicians, of which I more than once availed ?Ja, A u . : I was admitted to be there when I pleased, and todowha 1 pleased, having my objects always foJwarded by every requisite assistance. : . DOC f OR DE KJIY'S CASES, i-c. Do'Jrfrn!'*^ * i"^? '>'«' to-^^y «ome hours conversation with of rl-r ♦ l^J "^ ?/' '' " ascertained, that the first case r-nT,f ^"n *'*'?;'^'''' "' New York, was in an emigrant from «hn„. K- ^«f ^'"ff =°!^"gion, his expression is, that it is a point about wb«ch he is indifferent, but that he would be very sorry Liinnl! i!u '^^.°'^""*'°'''"«^"» "«^»''« prevail, after having wunessed the neglect and inhumanity consequent on this belief u V^'!u' ^°'«'"^aining these sentiments, he left to Dr. Rhine- laoder the part of their Canadian Report in which the question of contagion .s considered. It is certainly rare, he says, that TJL71 '^"f«°«'=""i» " ^i»* Quebec and =^mr«. ,_wfeen fTe disease was so firtally ravagfJil^ tow^'. and ^ iZ ^ had the ioint rl,;;^! r "^1 T^ «°/"t^"y ravagmglhese towns, and he has Sfew York ' * " '""P''^' "'""^ '''^ *''««'"« commenced at 26 Dr. De Kay''s,C(fses^ i-c' '■ if, i li V The same indilFerence as expressed by Dr. De Kay, on the qiiestion of contagion, I find pervades generally ail the iHcnlly with whom I have yet conversed— so much is this the case, that it is rare (o find the circumstance of its being a first, second, or third case from the same family or house noted on the case-books. Old people dnd children, the Doctor says, are by far the worst cases. Except in such subjects, or those of verv broken consti- tutions, he has not of two hundred cases, in private practice, lost any, using generally.ln the premonitory or precursory svmptoms, CRmphorated spirit with oil of peppermint and tincture of opium, and, if more severe, bleeding. In collapse, bleeding, wherever blood can be obtained, using stimulants, particularly large doses of laudanum, even as much as two or three hundred drqps, with sulphuric ether, and employing the capsicum, camphor and muriatic acid ointment frictions, succeeded by rubbing with warm chalk. He confirms the statement already made of the great benefit derived from bleeding in the Crosby-street hospital, though it certainly seemed detrimental when used in cases of extreme prostration. The venous injection he has seen in, (I think he said,) forty Cases, in four it was very beneficial, though two afterwards sank, from insufficient attention to them. It im- mediately raises the pulse, and reslor6s the colour to the face and surface, hut these efiecis are only temporary. Jiugust 26.— 10 p. M. I have jrtst returned from visiting with Dr. De Kay two private patienis, in a house adjoining another where there lately occurred a case of cholera. The patients to whom we paid our visit, are the mother and son. The son has been some days convalescent from an attack that did not proceed farther than approaching collapse, and seeing how he had been treated by the Doctor, the relations supposed ihey could manage the mother's case themst^ves. After diarrhoea for some days, the severe symptoms came on this morning, but colfapse was completely formed before she was seen. Some honrs before our -Visit she had had 200 drops of landaftnm. We found her with the colour nearly natural, and the body sufficiently warm, but the extremities cold, the pulse hardlj^ perceptible, respiration slow, lying with her.mouth open, in an apoplectic insetisibility, from which she could not be roused, the head and face cold, whilst the epigastrum waspreternaturally warm. The latter, Dr. De Kay says, is a remarkable symptom, in as much as the tem- perature of the part actually rises after death. Part of the symptoms I saw in this woman, looked very much Ii|ce the ef- fects of an over-dose of laudanum. . From our conversation, I have learnt IhsfTno preparations had been made for cholera when it appeared in New Yorl^, that the greatest confusion and embarrassment was the consequence, there being the utmost difficulty in obtaining nurses and atten- dants of good character. No means have been adopted to iso- late infected houses or districts, and no further purifications have -been used than iis far as Tndividaalg clrese7 The ifreeTs wef e (jleaned, and nuisances removed by the city authorities. At a Dr. De Kay''s Case$, i'c. 27 e Kay, on the nil the t'acntty the case, that "St, second, or le case- books. f far the worst l)roken consti- I pmctice, lost Ty symptoms, ture of opium, ing, wherever large doses of 1 drops, with camphor and ng with warm of the great reet hospital, d in cases of as seen in, (I ificial, though theni. It im< ir to the face I visiting with ining another he patients to The son has d not proceed ' he had been could manage or some days, colfapse was i»rs before our mnd her with Hy warm, but e, respiration insensibility, nd face cold, he latter, Dr. :h as the tern- Part of the I Ii|ce the ef- iparations had ork, that the conseqaefice, es and atten- lopted to ISO- fications have ! streets Were^ •rilies. At a more advanced period of the epidemic, a physician, with fiom two to four assMtants, was appointed to each ward, to watch the premonitory symptoms, or introductory diarrhoea, and thus ar- rest the spread of the malady; as well as to treat actual cases of cholera, or to send theiq when necessary to the hospitals. This preventive system, has been adopted as generally aa it can well be done, And it is considered the only means on which the^e can be plncecl any confident reliance for stopping the spread and fatality of cholera. It has been acted on rigidly at Bellevue, at Sing Sing, &c. and I witnessed Dr. Roe performing this duty amongst a body of five or six hundred labourers, who^ire em- ployed by the corporation making a road, and with, he told me, the most satisfactory success.. ^ SELECT MEDICAL COUNCIL. .iugust ^^^To day, I waited on the Select Medical Council, introdaced to the President, Doctor Stevens, by a letter from the Mayor, 'r,!^ conversed more than an hour with the Secretary, Dr. Morton, and two of the members. They seem disposed to admit the personal communicabilily of the disease, as the evidence of this, from its undeniable (as notorious) general spread from per- son to person in the fiame family, house, and quarter, is irrcsist- " able, whatever immunity physicians and others, who are in con- stant intercoijrse with the sick, but who are attentive to intro- ductory and premonitory symptoms, may generally enjoy. The pledgers of the medical council, derive their knowledge of the disease Aot only as individual practitioners, but also as inspectors of the hospitals, from which they likewise receive daily reports, with remarks, and answers to \\batever questions they propose, ^0 that their statements only require faithfulness in reporting and judgement in selecting. Doctor Stevens, tells me that ten days is the longest time he has known before the disease developed itself, after the exposed persop had removed from New Yoric to a healthy village in the country* The Secretary, gays the gene- ral time he has known or learned, is from 24 to 48 hours. Aygmt 27.-H«ying had much coovecsation to day »vith Dr Ste- vens, he gave rfie leave to submit, in writing, questions on all the points ahout which I needed or wished further information, to the Select Medical Council. Copies of these, and of the an- swers returned to them, I append to this diary. The Doctor has also been kind enough to say he will forward to me a copy of public documents, shortly to be published by the council, in which fuller information will be foUnd than they are yet prepared to furnish on every poitit. *Th6 Mayor of Boeton told me thAt in one instance, which came to llio knowledge of the Board of Health, seven d ayg had claped before a person w ho ted teft a ship where Cholera had proved tUtal, Tviis ecizc-d v\ith lli& dacjisev^ and in another nine, go that thej fix ten dnys as the period of quarantine. U ' ^^ '"torlar's Tfiook Hospital. ' CORL^ER'S HOOK HOSPITAL. ^«g««< 25^A -This afternoon 1 visited the cholera hospital at xllll ■ .1 ^•'"' > « lff?P"'-"y «fced, first opened on the . . "fc .0 the v.c.mty of Walnut Street, (a barrack or point street of New York.) There were t,venty four patients, non^ of them .n callapse. so that Dr. Graham' said he had nothing to show me characteristic of the disease. A few were slighter cashes of cholera from the commencement, and three were con- ZITA ti\u """^f'^r^^^ <^hi!d, the sj'mptoms were almost .lent.cal.wUh those of hydrocephalus, the form the consecutive J M *""" ^ ^''""*'!"*=^''^'"«». ♦ This child died in two days. , , ' V;„I ^•* /^'■^^"r'''''' ''*"^'"''' the ointment is compdsed of a pound of mercn- ml ointment to seven ounces of camphor and seven ounces if cayenne pep- per. At CorIiBr'8 Hook abont half the quantity of camphor and pepper to the pound of meiyurial ointment. i^j-h"! w^ ^ii^^il'Sr^rc'^- --"^.,°'"'' " ""' ' '"''" ^" ^ were B3ed, aad^edomel wa^- ofTnrinionfrn. •"""''' ''«' >^°"»' ^» intemperate man, has an appearance 01 mcipient congestive sopor. a hospital at pened on the ack or point atients, none, id nothing to ere slighter e were con- were almost consecutive 3, and oiost- : t frictions, f the pulse Dnstitute the way ptyal- have sore n whom be >d hopeless, le is doing ■ four grain •aham says, 'rence, and ks the con- atio of the of August, '16 121 76 64 ^ 38 noted two •ilapse, 1. e. ! failure of ;ing, voroit- ould heVio have been d collapse, !id of mercn- lyenne pep- id pepper to »lomeI vnm 1 Rppearance Rooklin Hospital. 29 BROOKLIJV HOSPITAL. .August ^7.— To day I pasFcd over from Corlffir's Hook to visit ihe cholera hospital established at Brooklin. This is a litrge, well ventilate^ building, situated, however, neafly two miles from the centre i)f the town. There have been received in all loO cases, and 60 deaths have taken place. After the disease had continued for some time, four physicians wjere ap- pointed to the districts into which the town of Brooklin was. di- vided, to attend the poor at their houses, and to watch the pre- monitory symptoms, (iiaatNew York), and subsequently to this most of the cases received were in collapse, and consequently the greater part of them died. No well marked cas^s have been received for some days, and there are not morelhan a dozen patients in the hospital. Of these, two are consecutive- fever-^ they elre likely to do well. Amongst the patients, are four in whom the venous injection was used. 1 saw Ihe arms of all of them ; two had no recollection of the Injection having been used, being they said, quite unconscious at the time of its being done. Three of these are quite well, the fourth is one of the cases of consecutive fever. The injection was fully successful also in two others, who have left the hospital; but in several it failed, and at least one accident, with regard to the introduction of air, happened, which, though not immediately fatal, proved so in a short time, that is, it hastened death a little. On mentioning this number (sfx) <^f successful cases by in- jection at Brooklin to one of my New York medical friends, he seemed a little incredulous ; ut any rate he thought the cases could not have been in advanced collapse. The physician, how-- ever, with whom I conversed at Brooklin hospital, and who had injected them, assured me they were. He also ^old me that the quantity of injection used was very great, but to obviate the congestion that seemed to be produced by this, he almost always had a vein or the temporal artery opened at the time of injecting. In the general treatment of cholera, as described to me, there 19 nothing worthy of noting— nothing energetic. RIVINGTON-STREET HOSPITAL. August 28th.— To day 1 visited this establishment. ' It is a fine, spacious public building (a school house.) At present cholera patients are not received, as it is intended to shut it up. Here the camphor-water has been found even more efficacious than ice for stepping vomiting, but otherwise it availed little. In the incipient stage, where there appeared to be colluvies gastric, it was not an uncommon practice to givean emetic of Ipecacuanha or of common salt. In collapse, bleeding was abandoned after trial; the camphorated mercurial and capsicum Jii^isns^jvittlhe iiiternal n$Q»t calo m e l i a x or xxg rain do se s, becoming the settled practice, as being found to be most |le- pended on. When opium was conjoined v/\[h the calomel, it /> 30 JiivingtonStreet Hospital. '5^ was fomul to aggrnvnte the ^ub^equenl congis country hospital. I found- there only a few convalescents from fcholera, none even with consecutive fever ; indeed there had been no admissions for some^days, and it was consequently determined to shut it ap. There had been orie hundred-and torty casfes, and of these half had died. For further particulars of this hospital, I must wait for the forthcoming papers of the Medical Council. A fact mentioned by the senior physician of the]%o8pital, shows strikingly, the effects of the belief of con- tagion in the neglect and abandonment even of relations, from the hpprehension of personal danger. This hospital was pre- pared for the reception of cholera patients from a numerous population of labouring poor in the , neighbourhood. The physician was one night disturbed by the noise, as he supivsed. of a cart ; he went to the door, saw no cart, but found two patiQDts on the ground in extreme collapse. COKVALESCENT HOSPITAL. August illh.—l visited this hospital to-day, not expecting to 'seecaBcs of cholera, but to acquaint myself with^he condition of A With one or two exceptions, all the hospital physicians concmred in thifl ^ ojiinion, and had abandoned the use of opium in largo doses. Convaletcent Uuspilal. 31 ;o.t The !8, did not J become jfmptomsi ; promptest o day met nl (o the , who hud. y a VHcant m several be suffer- in ut 'the J, he sunk , mention- f Croshy- lonra he- eets quite ;ver, are ven with jmonitory d less at hsive yet ore than , I visited alescenfs Jed there sequently idred-nnd articalars rs of the rsician of f of con- ns, from was pre- lumerons I. The iippvsed, und two pcting to dition of tliose who have got over the actual di$!caHe. This is a fine building, In Orange street, being a Lying in Asyluoi, converted on the late emergency to its present purpose. ■ The patients are sent here from all the cholera hospitals, as soon as the symptoms of the disease are subdued, indeed sometimes, I find, before they can safely be removed, -so much so that tne physician told me two or threle (I think he said four or five) died shortly after being received. In one cholera hospital, there is to belief that if the patients are retained there they contract consecutive fever. There have been two hundred and thirty-seven adnm»t. V QUESTIONS RELATIVB TO IVIALI&xliAlVT CHOJLERA. Submkted to the Select Medical Councilof New Yoik ; WITH THK ANSWERS or THE COUNCIL. ai-«T,ONl._Wh«t is pciUvely known regarding the introduction of tholera into New York. Albany. Philadelphia and other Citie.. Town, and Villages of the United States, and of its subeequent propagation amongst he„ uihabitants; as well as of its introduction and spreading in public estab- Iwhments, <^ at Bellevue, Sing Sing prison &c.? inti.d.ti^^r^^r'^'''^""'^ '•"'"'' ^ ^''"' ^^"^' thatCholera we. .n^duced from abrdad mto either of the place. nan,ed in this question. . JtrZ V c ""^ ^"^"^ "^"^ '*' comm»nk:ation t6 be by contact. «U,er than by mfection. through vitiation of the air in houses, ward. and. districts, where there are Cholera subjects; or tlie reverse? l.^'^^" "" u? ^^ "'*"" ""^ knowledge, that go to p«>ve that Cho- lera „ comainnicable by contact. The disease doe. appearto be produce* cL^S^T' ^' "' ""r "P^" ^ •"' ^ '""^ concentration of influen^T capable of .producing the disease. «,metin,es confined to one hou«. and «)met,me. embracing a considerable neighbourhood. • ^f tr^'lf* "? '^'^ """^ remarkable facts recorded on- this point, a. lav- mg fallen under the observation of any medical practitioner, or othJr intelli- gent person, on whose discernment reliance may be placed' t« tT"^**"'' ^^been many bstances. in which the disease has appeared to be communwated fn,m one person to another, hut they have been chiefly m the country. »d for the most part among tho«, who were predispo««l by have come to o^ knowledge. In which healthy persons have contmcted the d^ease by spenduHj a day or a night, but especially the latter, in one of the situations alludedto in the lart reply. .«■«>«. um of Cholera m a house or famdy, has been followed by other case., often by .eizures of the majority of a family, or of the imnates of a house' A -Cases of Cholera liave often been single. But in many cases a l««e number have been taken m the same house; one or two or more cases con- tinuing to bo furnished daily for some time-^athe other hand, five or sU have^been taken with Jhe disease b the same house within twenty four ^^iifjrZ!"^ "'' '!!' l^r'^ "'■ N«w Ydrk had the^remoBiloijl^ •yroptonw of Cholera, or the fully formed diwaw? " A.— We are unable to My. 34 ^uettiotu relative to Malignant Cholera. Q,. 6.— How many hav« died of the diaeue? A.— Eight phytl«^ia]» have died «f Cholera in the City or its imihediate environa. Their diaesMt and death wen aachbed in almoat every inatahca to exceasive fatigue. Q. 7.-.Ia it knowiv if any of th«e had ncfiKted a diarrbtsa or other premonitory 8ymptoma,„or diaregarded the cautiona given to the public re- garding food and drink? A — It ia not l(iiOt«a. a: B^lUvo many of the medical attendanta, nurae^, labotfen and othera employed at the Cholera Hoapitak, in burying the dead, carrying the aick &c. bad Cholera or the p^monhory aytnptoma? A— »Iany of the nonaa haV« had Cholara in the , boapitak. But not any . of the other attendanta. The nuraea are for the moat part peraona of broken Mnatitotioaa, And ibtamperal* habita. Thia eireomstanoe, when united wiUr tfa* fatiguing aatore of their dutiea fairly entUIea them to Cholera. Q- 9.— How many of the petaona thus employe*} have died of the diaeaae at eaofa ho^utal? A — It ia not yet known. <4. lO.-^Ia U to be iafetred fitoa tfawe eaaea having tenniaated fatally, un- der cireumataacoa Where it may fairty belpreaomed the earliei>t adfiee would b* Bought, as woH fiw the premonitory a^jtoBfw, us for the actual attack of the diaeaae, that a portion of oaai^ are anco»troUable by medkmie. however timely attended to? ' A.— Ther«BBrk8Bnder4-«, are alimdanUy suffioieat to explain their dntha from Cholera. | O. 11.— Of Clwuymen how many hajre had the diMsaee, and how man* have died? - ' A.— None in town— one atHariaan, ejight mUea (h>ta New Vork a. 12.— How Hiany eaaea of Choleri to thia data (SOtb. Aogmi)? A. — 6811 caaea reported. O. 1«.— How many de«^, McordiL to the reporta of PhysteiaM, and aho aecovdiBgttt the report of the eity inipectoit haw (hero beea» A. — nsft deatha reported. have been reported in New York J(92 not reported. Q,. 14.— What ia the cause of the disjtrepancy oftheae report*? A.— auackado not report, but it is } well known that they kill. Many pliysicianBara diaaatiafied with the Boar^ of Health, and do not cfaooae to report. a 15.— How many oases have been admitted into all the hospitals es- tabliahed by the Board of Health, and into that at Bellevue, for Cholera. A.— 2014 Patienta have been treated ih our hospitals to this date— 055 at IQellevne. Q. le—Ofthese how many were in a state of collapse, either incipient or fully formed, at the time of admiasion, and hew many ia advanced cel- lajpse and jnonbund? =^A7-a.Notiaiowa oTprennf: ^etnnu y« ijqKictea:): « imihediat* y inataftce to Imba or other lie public re- bo#en and carrying Um J QiMfh'ont relative to Malignpnt Cho}em. 36 Q- 17.— -How many deaAa hsTa oeovred in all tka boaphaU and at M- levueh • A— IntheHospitaiaSSl. At Belleme 821. * Q. 18.— Of tboae ifl incipient coHap^^jihat proportion haye rocoTeivd? la folly formed coUapae what proportion? « "> A. — Not yet known. Q.. 19.— Are any cases satisfactorily established of the compranieation of the disease by ctotfaing or other articles iafcen from sitnationa where they might haira been impregnated with the seeds of the disease? A.-^None. Some accounts hava been received from the cdoatry which ' favour this supposition, but they raqnire ooaftnoation. '^ Q.-^O. — If 90, how long subsequently to the time of acquiring this dela- „ „ tenons propfttyj are snch articles known to have commnnicated the 4") disease? ,« ' i » A-— See last reply. Q. 81.— What are the gen«;||l, the st^ortest, and the longeat periods of . time satisfactorily known to have elapsed from the date at which the seed* of the disease migKt have "been imbibed by any individual, to the time of iUr symptoms manifestmg themselves? A. — (n most of th^^isea which have come to our- knowledge (see AttB#'. 4) the disaaae has shewn itself witliiin two day*— often in dn«. The longest period known is perftaps ten days. , Q. 28.*— From these and other facts, is there a coneiosion come to re- garding the number of day* an individual leaving an infected district, and! proceeding to a healthy one, should be secluded, or kept in quarantine? A — The almost unanimoas opinion in this city is, that quaranfmcs are Bsdess, for if the disease is Rfectioua or contagious, the oau8« is of so subtle a' nature, that it cannot be excluded— A fresh breem being often found to cQunteract all the wisest precautions. Q,. 23.->^Have any peculiarities been observed in the weather and atmos- phere, 9s r^arding vicissitudes', heat, moistare, as well since the prevalence of Cholera, as previously thereto? A. — There harbeen nothing peculiar in the weather of the season — the soi^on has been cold, wet and backward. ^ 24. — Has any disease of a similar, or analogous nature, affeeted cattle, dogs or other animals ? A. — None to our knowledge. .. ' Q,. 25. — Have any been observed to sicken from livmg in the atmosph«re of cholera, as at hospitals, with the sick, m from having taken any of th» discharges of th^e sick ? A. — See answers to 4 and 9.* ' > Q- 26, — ^Has immunity from cholera appeared to be connected with the circumstance of having formerly had any other disease; or, on the other hand« have previous attacks of other diseases, as common cholera, dysenteiy. ti ♦From not repeating the word aoimal in this queetion, there is an ambign- ity, and hence the answer. 36 Qu«f(tofM.r«/a(iv« to Malignant CholtYa diairhtia, guUie dtraugaiMnt. or Upalio diatoM. rawkrad individuals mor» ■uiceptible? * A.— Noticing hu appeared to afford immanity from Cholera, bat perloctlr regular habits, and strict temperanoo-nor doe. nay thing appear to creata •ufceptibihty to it but conduct and habits of an opposito character. a 27.— Have aecond attacka,"aAer complete recovery, beeii obwrved to occur often? . ' A.— There have been a number of persona attach a lOcond time; but it ..doubtful if tliey were in perfect hoalth-They t^ild probal5ly be regard- ad as relapsea, which have occurred very often. Q. 28 — Is there much -tendency to relapse/ A. — See lost reply. Q. 29.— Have any mental or constitutional qnalities been observ'ed lo di». pose to the disease.' " A. — None. ' ' , Q. 80.— Have any famUies or individuals who have rigidly-secluded them- selves been attacked by the disease, A.— We know of no instances— but if they occurred, they could prove nothing; for thMO would be the very persons that would equally avoid a// causes of the disease. Q,. 31.— What have Ijeen observed to be the usual exciting causes of the disease' ^ A.— Excess in eating and drmking-rinteraperate habits in particular— ninc- tenths of the cases being in intemperate persons. All kinds of indigestible food all kinds of green vegetables and fruit— watching with the sick— getting wet. Q. 82— Are the diarrlKBa and gastric derangements, usually termed tlia premonitory symptoms, successfully treated by the «ime means that are found efficacious in such complaints under ordinary circnmsUnces? A. — Q,uite so. - Q. 83— Are there any cases known wherein, notwitstanding proper and timely attention, and a duly regulated regimen, the premouotory symptoma have persisted, and terminated in spasmodic cholera? A. —None*. t Q. 34.— Have there been any cases of this disease unprepeded by pre- monitory, symptoms? ■" A.rt-Not many; and wheh they did occur, it was almost always from some act of great imprudence. Q. 35.— Do any facta show that such symptoms a|-e really precursors of spasmodic cholera, and, if neglected, would result in that disease? From the experience of the ward physicians in treating such casOs in families where there had been spasmodic cholera, information might be had on this point. A.— Precursory symptoms are universal— so much so that it ,has become the common opinion that diarrhoea is the mildest form o£, epidemic cholera, and that cholera commences by the bowels— for when this diarrhcea is neg- lected, cholera in a malignant form almost invariably succeeds. Q. 36.— For the forming disease, known by vomiti ng, p urging an d cramp, =tfi« errcnfatlon yet continuing good, what haa eirerionce taught to ba the -» C f r a « ri \ h ~ (liuiHoni rtlativt to MaUgnatat CA«/«Qi^^. 37 nwatafficaciona UeatiMDl, uid wlut has it taught to avoid aa haviog baaa ibutid detrimental.' A.— Pui^tivea*— calomel particukrly^and iaAon, veneaiectioo-rdllowed bj small do8«a of camphor or oropianl. Q. 87. — For ineipient ool|a.pae, or tliat stage in which with all or soma of the above aympttfms, especially apasms, there are a sinking circulation, a livid coontenance, shrivelling of the intignmento of the fingers, &c. what haa been foood to 1>e the moat efficacious treatment, and what of the many remw- dies recommended have proved iujurions? A. — External heat, hot injectiona, constant frictio^ over the whole body with an ointment of two parts mercuriul ointment, and one of c/ipaicnm and camphor, eoch, calomel in scruple doses, often repeated, aa every hour, cam- phor, ojther, and all forms of alcoholic stimulL — Opiqm has not been found of service, having a tendency to produce congestion.— The two first means are the most important - Q. SS.T-For fully formed rollapse, or the state of the disease in which the pulse can only be felt in the largest vessels, and even in them, is but feeble, marked characteristically by a cold tongue, sunken couutenance, whispering voice, corrugation and blueness of the skin of the liands and feet, &c. whot meons h\ive proved most successful? A. — None.t ' . Q,. 39 — In how many cases has the saline injection into the veina been practised? . . A.— In six or eight cases. Q,. 40.— Of these how many were restored from tlio stote of coll^>se? A. — Not certainly known. Q. 41. — How many have c^m^letely recovered and are now living? A. — It is beliexed, only one o^wo .t ^ , t. Q. 42j— Is this injection^lfpractised in New York, or is its use discon- tinued? - ' A.— Tlie saline injections are now little thought of as a remedy, their ope- ration Appearing to be only temporary.§ Q. 43.— Has the use of camphor in this stage, as recommended by Doctor Channiqg and others, had a fair trial by impartial observers, and vvith what result? A.— The camphor treatment has not been/ully tried in the Hospitals. W» have seen no detail of cases, that would justify ua in recommending it to bo tried alone. Some particular facts, and the general information in the Diary, would Icwl to the prohibition of purgatives (colomel excepted) properly so colled, substituting the mildest laxatives, especially Gregory's mixture. tSee the practice in Crosby-street, Greenwich, and Carler's Hook Hos- pitals. ■ ,*J' ^^} ^.^ f^^ ^y *l>e8e answers, even not considering Brooklin (as out of the jurisdiction of New York), that the Medical Council had not received all the information respecting venous injection that is contained in the Dia- jy, as noted at Crosby-street, and Greenwich hospitals, and from Dr. De Kaj^ fDr. Rhinefander and the physician who used it so frequently at Brooklin " hospital, arc stiH disposed to practise it on all convenient occasions. X X iU/t- ^ ( -;fe ■''S-^fi^.. 'S- it' >,, •.*»' Hi S8 (iutstioH, rtlatm to Malignant ChoHra. Q. 44.--.Wh« tnatmtat has provsd nuMt •accewfiil ttjfith* roHMMiM ud ^onaecutive fever of coUapBed Cholera? ^ ^OBgptatm ud A-^Salhration and veaeMotioD or topical bloedio^. - Q.45.-Igany mode of treatment of the preceding rtage. of Cbolein , more ft«,.enUy foUowedth^. «oth.,by thi- f,.S ^. of 1^'„"' Wt ui confidently believed tha. th. free use of calomel » abovThL a t«deocy^ p„^ent,.«l powerful i«#.r».i.timnlation to ca«e thi. eon- i^^ con^^ti^a f.v.,>^TW i. ,«^ ^ ,,^ „^. ,,^ ^^ w£;oiTS:ty":j:::.'^"''"^""-^«^^^ A,— There ie fint a p«|pag ordiairiwn, with etnoiiationa IMcentMl nr «ce.wa,er.forU.mo..p.n inodoren.. oft« eoloarie- 1 1". dty';^e" ~Th« 1. attended or folJqjjred by vomiting of the aame flnid-the p«I«, rinkfc li JZT" ft^-nt-^^m-scles of the leg,, thighs, abdom.n'^lt; ;^A M J!*" ^P^^ -Kn become, mottled or livid, and covered with clamtay .weat-^fte eye, become wnken and lifel*a., ;, have som^ -Alt thrpttghont the case, the mort marked and decided diagnortfc is. that rr ,""'Jr '^«" «^^--«" of bile-^ntil the oaloT ha. pr^n^ Upecuhar effects which is rarely the case nntil reaction occnr.-mre^ «ien . &»d*oa,d»cha,ge of thick, dark gr^en bil^Bnt thii never odcm, - previously to the exhibition and operation of calomel. i. .i,. jiA... i- i/ roagflMioa ud of Cfaolare, resngestion? «boTa, hu a M thia eoB- maitmy k >lera, and in like gnwl or diitjr waiter, palaef ainka, m and anna ind covered kave Bomri^ i and inoiit. ••tie is, that ■a prodoeed — ^T%ere i> tver oocurs ' ■nptom; the COMCLUDINQ REMARKS. HAriHo, on my rrtarn to Hatifat, forwarded to the Board of Health all the Note* and ObBcrrrftiont I hnd collected at New York, relative to Malignant Cholera, for their judgement of the Taliie of (he information obteinedi and thait- determination on the manner of communicating to the public what to the Board should be deemf^d of aafficient interest to merit difiiafiion i»Nova Scotia, I felt relieved that mj labours on the^ subject of Cholera were terminated. Not a day had elapsed, however, before I per- ceived, from the number and nature of the qnestiqns^proposed to me, that this subject, coniinuing still to be one of mocfa popular interest, and with some even of anxiety, was also one op which the most indeBnite and confused ideas were generally eptertain^ ed, though every person haii appeared to be seeking ioformatioti regarding it for the last twelve months. It occurred to me on observing this, that from the general im- pressions received during mv late practical Application to the in- vestigation of this disease, I might be able to make some of the chiefly interesting points raoregenernlly and clearly undersioo^.* TbepaMiemind, inXhIscoihmanity,i^ems to have fastened on the last scene, the extremity of this disease, to characterize It MB a whole. A spectrte with sunken eyes, of a livid or blue colour, with shrivelled fingers and toes, a skin and tongue nearly ice-eold, pulseless, even in the large blood vessels, either suffer- ing from severe cramps and insatiable thirst, and continually tossing about, or lying unconscious of all surrounding objects, is present to the imagination ; and he who has seen the original of this, is asked if any way has been discovered to resuscitate this almost lifeless being, and if answered np, it is concluded that it is a hopeless thing, and therefore to little purpose to under- take long joornies by sea and land, only to be satisfied of what wfcs known before. As well might the surgeon be depreciated because be cannot restore vitality tn a mortified or gangrened extremity^ the, consequence of preceding inflammation or of being frozen, though if called during the foregoing inflammation or fVost-bite, he knows in both cases bow to prevent the sqper- vention of mortification. With the exception, generally, of tbtt extent Jof sufibring believed to attend, the abofe symptoms ere truly those of the ahnost closing iccne (of the advanced itage cf collapse) of • The neesi^ of attemrt^ this, is graater tflaBltB^Mt«B«^^ater »i« a Ato ^U^-^iatMr nfHo al t h ,—.,»» »,wM i m—w w rr— mi iranrn um ti tranamitted to theiD, withoat a«Mnduw, at MadMOM any faneral diractiona tfr ezplanatioQs. Hw fiiaTf aMdodnr •flhe itlrit 40 'Concluding Remarks IT \ ?'"'".• "^"^ *''"^' '" '»°''* <=»"«. '*»"''' »-^er have developed Uiemselve., had the early stages of the disease been under the gn.dance of judicious. medical treatment. J he stnge .mmed.ateljr preceding this, the last or fourth stage, IS chMractenzed by an incipient sinking of the heat and pulse cLflv i„7h . "''"'^' ""^ countenance ^nd colour, with cramps chefly.n the lower extremities, and occasionally pain at the Ji ol the stomach, conjoined with the two promineit symptoms of the second stage to which this third has succeeded, viz purging and vprnuing. The ducafion ofthis third stage at New Y^rk was generally not more than from one to four hours ; and a most cr lical one a .8. The measured, the watched use of bleeding (the most effectual mean for relieving distressing cramps) ; in. cessant frictions with camphorated mercurial ointment, to which a proportion of Cayenne pepper is added ; the administration of live or ten grams of calomel, with a half or three fourths of a grainofopium; atthe same time that the patient lies on the ^n mattress filled with hot water, and has tins applied to other parts where the Miction, are not carrying on, their application o be persisted in or not as the beat of the body and slVength of the pulse indicate, adding also iSS*rther warmth should seem necessary, warm catmint or linseed tea, or warm water iniec- lons are the means by which four patients out of five will at tM time be saved, having twb- nurses for every such patient, and a physician fdr every ward or room, where there is, a patient. .s I h»«^^-5'"^t-'^!,"^u*'''' *": ^''^ '«*^**°^ »*"8«' cbarhcterized. crlno r?"'''''"*^^ ^y P"'*8'"8 ^°*^ vomiting, to which also cramps of less severity, may already have been added, but the circulation continuing goj)d and the temperature of the body un- diminished, may last from six to twenty four hours. It is so manageable that by a treatment less vigilant and vigorous than that pointed out for the third stage, or that of Jpproathing collapse,* by the treatment indeed usually efficacious in smart attacks ot common Cholera, nineteen out of twenty cases will be here arrested, and in them the disease will consequently never assume the (listinctive features of malignant Cholerar - • wc**"^ " r^ ,*°°'''*'' "*»8« (**•« "^"O of malignant Cholera. iDsigbificant indeed as to the then sum of disease, but all impor- tant ID the mauence it has upoo the consecutive stages, and con- sequently upon the final issue of this so dreaded malady In roost cases this first, uwally called premonitory, bat more properly prefatory or introductory 8tage,t is marked by a simiile looseness of the bowels, and that ordinarily without ' ;„ of any kind. In a email proporfion of cases, there is a dis- tention of the stomach (abdomen), an uneasiness or weight, either without or accompanying the looseness. These are the com- ^ c.lknl^m-l'lLT^j^i'T"*''**^!!?'^ extreme collap«; but thi, stSe of «d S^m J^i J '•'•^ mto approaohing.incipient. My formed, advanced. f°°.,?f^;;_ «''ff« ^.p;i'y '" the degree of JnteMity of the sam* cbaraol KntUc lymptoaae, tM d iff e r ei i cei h ffwevcf^ '^^wy o b * im ii . ""~^ — jl..' ,11 i.t .V .. ^ Concluding Remarks. 41 plaints from which few of ihe physicians, nurses and others em- ployed about Cholera patients, in the Hospitals of New York, have been two days together free ; but removed or arrested by a little paregoric, liiwlanum or opium, either alone or conjointly with a few drops of tincture of camphor ; with at times ten or fifteen grains of rheubarb and magnesia, and, should the attack be rather sharp, botdermg perhaps, oa the second stage, four or five graips of calomel, confinement to bed, the applicalion of a flannel roller on the abdomen, and of warmth to the stomach, these complaints have rarely incapacitated nt all the sojourners in a Cholera atmosphere, or at least not more than a mv hours, for the discharge of their duly. As it happens to the residents in Cholera Hospitals, so it does to the inhabitant of a city or town, fespecially in the most in- fected parts of that town, and to those who cannot avoid inter- course with the diseased, but particulijriy to the poor in the same streets, houses or families. The disease commences with them by this introductory diarrhoea, and does not advance farther be- fore from twelve hours to fourteen days, and in fewer than ooc CBse in a hundred never would advance further did it receive the timely check that experience and convenience are enabled to give it in Hospitals. After this statement, it is hardly necessary for me to say why epidemic Cholera has always proved^ so especially the scourge of the intemperate and the indigent. Every one who is in the habit oHllrlsiting the sick-poor, has constantly occasion to regret and complain of their self-neglect, in allowing serious and even painful diseases to proceed uninterruptedly for days before they seek medical advice. Knowing this, it is nothing more tban what we might expect and fear, that they should be entirely regard- less of so tHflingly inconvenient and little painful an ailment as is that which I have described, being gJlerally ignorant, and also difficaltly convinced, that this is a part of the so dreaded Cholera. That the intemperate should do this, is nothing sur- prising, seeing tl^y are heedless in all things, and overpowered by the force of biid habits. It might, howeVer, hare been expected that the educated, that tradesmen, mierchants, physicians, clergymen, &c. who are generally aware of the importance of early attention to diarrhsea, and who also koow\how freqently almost every green fruit and regetahle has, as at^ew York, excited the disease, would' at- tend to arrest the onte, and religiously abstain from the other. , Erery day's experience has hitherto disappointed this reasonable expectation. Even' the physician has been found to transgreM the bounds oftemperanoe, and also to disregard the first approaches of this insidious disease t anxious to assist others, he forgets hhn- siftlf, and when he should be at home,perhapi8in bed, he is hurry- ing through ihe-streetsi kid wurriud with iaztety~repmlli|^ Kuf t It is alM in deaoriptions, •d with tha i^woBd staga. 1 wpeeiaUy in aMVMsatioo, oftsn esiifoaod- t^:ij«S;'.', ■ 4? Concluding il^mark$. I.iU,ent., unUl reduced by care, want of sleep, nnd the anchecked TnhT'nh' "'•'''^"' r*^""'^ '"^ '""^ prevailing „„,ady"*' Ifthephy.s,c,an neglects himseltlbr the sake of other, the merchant does .t to attend to the calk of pressing business whch he w.II not postpone merely on accouni of a tr.vial aSd h\tTe n commod.ous looseness of ,he bowels.- The qonsequence of tbu s. that we beaf of the death of a merchant, 3 man of most tem perate hab.ts who was well enough in the rnirning. an?enoa1^d ^.a dajtodmew.th h.s friend, having dif before mSt Th,aappah„g account comes to us, perhapj from London o; horn Quebec, and rarely have we iti,, ou^ T^werTo get clr c'«m' »tant..d mlormauon of the preceding health of , he v.cfim when ever we have, .t wdl, with few exceptions, 1 foonT.Ehe had been suffer.ng tor a day or days belbre fromlhe symptoms of the tirst stage of malignant cholera. I ^ F >-"'«» oi ine The same, in substance, may be said of L other classei of soc.ety; and of most it may be afiirmed, ihJt they will not din/ themselves a present gralitkation .os{'of i^ Sn^i t It/ - wh.ch the.r theu actual high health flatters them they^vi I esZe ' Indian coi*, cucumbers, musk-o.elonsi waler-melon" Lc *r* have agamand again been shewn to be Ibe elci.rg caus^ wS^'„ other forbidden article. I found'Aumbera da ly makine the fr!p^ est use, even in New York. There also CLrtLT^ Uiefree- .n the da, of pestilence, iodu Jog atV i?i/irttf u"^:?/ ^^^ and spirits as they were ever used to do Things continuing thus, there is little^ mol-al probabilifv that a uujversally self-denying, but salutary regimenrwill er'ei i? any large community be fully combined w5h the'n"ce.sarat° eotion to the .ntroductory stage of this disease, so a. tTeZura ▼ thereby US extinction (if unfortunatdjr introduced) " the^LJ bud, ar .te subsecuent La\ eradication: The co^ie^aU«Ihol^ aTh'oJ^r'r^K*^' P"*-^! """'y '^'^ P0P.«l-tii%JbXauS.i?il* »nd boards of health, wiil very greatly miUoAte the ^Tu nr^ tract the sphere of the disease'.^ ba/soX4' Z^ ^ ^e" at New York; especially remarkable intbehappj coMeZSM of the daily, wdeed the morning,aiul.evei.i.gyUiUofphJ£n.JJ every mmate of an alms-hoase. a pri«,D. a JanUeaSafvf rel^J warL t'^IT.^*'' ^^ "••'^^y authoritie.; tothe^orStS' Wbl : • 'I '"'' *^? ''T fPP^*'^*^ ^y the MedicTcou^S* When It IS known that, of the many physiciana (eenerM^lL or our to each of ,te fourteen oTflnL STt S„S«i.^ a tSir r *^ '«t "eotioned dotjr. some haye indivS, S2 ,hf^«. ""'' ''\''**"'°""**^ of mortality by .eeingth iwS lo'u'try greaT" ^'^ -««a stage, wUl rLfly b.?antS5 .io!^^f'*J^^* exflanationa regarding tb^ character and propane tion of malHtnant choier;^ it. diferent ^^ ^ th, tL^ZK >v . ' ■"'*» Jr .r^ ■.r 1 •^ •>;^ :.M>-;' ^■^: it'- . Condudins Remarki. 49 -:A for eanli (more fuHy given in the Diary, nnd in the Abswefs of the Medical Council to my Questions), I conclude these ffeberal' remarks, only adding the most important measures or riiles, es-- pw^iallyas relate to diet, temperancfe, clothing, sleep, laboar. erercise^ and exposure, to be observed in order to prevent ao HttHck of Cholera when this disease has established itself iti a community This I do in the words of the select Medical council of New York, in flnsiver to a qaestioo of the Board of Health of that City on Ike subject, as being the result of aft e%- parience and observation td which my fullest concurrence in thg directions can give no weight. •viil regard to DiET.-Tbe diet should be simple, and should consist of food which is both nutritious and easy of digestion In qoanfity there should be no excess ; in quality, it should be that which gives the greatest strength, with the least fatigue to the digestive organs. It is also important to be remarked, that oo great abstinence is as dangerous as any foriii of exc^ : and that the diet should be better and not more sparing than usual. " The most nutritious and dlgesttble articles are beef, mut- ton or chickens, plainly cooked ; e^gs slightly cooked, bread made of wbeaton flour, mgaly potatoes and rice. We fear that this list could not be much extended, without introdocine arti- cles that would be found lestf wtioleMfae. " Among articles whol«some in anv commno season, but found • to predispose to attacks ofqhotera \^ ihh city, art «« ct >. 81, rapply after frictions, " with an onfaent." ,, 12, „ 16, -■ after diminiahed, " to him." »»40, „ ' 43, tfae t in thin lio« jyfant to thtti9«t aotc in page 4 J. • -.'* ( ^ 1 " ■ . , i 4 . « ' • 1 t « , " • .' ^ 't^ i - 1 « • ' ■ '.'3 ^1 1 ,^ ^ \ \ ri|ffl. * • '1 . '■■ f ' -M ■.■^■ .^■■w i* \ «» ^ ^ Oi^ "■1 *'>,'• »&. t i^