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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..5388899 --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #52859 (https://www.gutenberg.org/ebooks/52859) diff --git a/old/52859-0.txt b/old/52859-0.txt deleted file mode 100644 index 5ecd28a..0000000 --- a/old/52859-0.txt +++ /dev/null @@ -1,1443 +0,0 @@ -The Project Gutenberg EBook of The Cholera Gazette, Vol. I. No. 5. -Wednesday, August 8th, 1832., by Various - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The Cholera Gazette, Vol. I. No. 5. Wednesday, August 8th, 1832. - -Author: Various - -Release Date: August 20, 2016 [EBook #52859] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK CHOLERA GAZETTE, AUGUST 8, 1832 *** - - - - -Produced by The Online Distributed Proofreading Team at -http://www.pgdp.net (This file was produced from images -generously made available by The Internet Archive) - - - - - - - - - - - THE - CHOLERA GAZETTE. - - VOL. I. _WEDNESDAY, AUGUST 8th, 1832._ No. 5. - - - - -_M. Petit’s Treatment of Cholera._ - - -The principal indication which M. Petit, one of the physicians of the -Hôtel-Dieu de Paris, proposes to himself to fulfil, in the treatment -of cholera, is to keep up a constant impression upon the spinal -marrow, and to change the phenomena of innervation. To effect this -he places over the whole length of the spine a strip of flannel, wet -with a liniment composed of an ounce of the essence of turpentine -and a drachm of aqua ammonia, and passes slowly over it a very hot -flat-iron. An instantaneous evaporation of a great part of the liniment -results, which acts powerfully on the skin over the spine, and induces -very speedily vesication. The heat returns to the skin, the cramps -and vomitings disappear, the circulation is reëstablished, and the -patient feels much better. The effects of this remedy are assisted by -hot bricks to the limbs; by frictions to the body with a decoction of -mustard, to which some aq. ammonia is added, and the patient is also -made to drink copiously of balm and mint tea. A table-spoonful of the -following potion is likewise given every hour:--℞. Aq. distil. Tilleæ -Europeæ; aq. distil. melissæ, āā. ℥ij.; tinct. opii, gtt. xx.; syrup. -ether. ℥j. M. Finally, the patient is rubbed all over with a liniment -composed of camphorated oil of chamomile, ℥ij.; laudanum, ℨij.; liquid -ammonia, ℨj. - -M. Petit is said to have been more successful than most of his -colleagues in the treatment of cholera. In a communication to the -Academy of Medicine he states that under the above treatment two-thirds -of his patients have recovered. - - - - -_On Density of Population._ - - -Density of population in cities becomes a matter of extreme importance -connected with the visitations of pestilential diseases. A too crowded -population may of itself engender a pestilence, and must inevitably -aggravate one should it prevail from other causes. Hence the necessity -which occasionally arises of thinning the inhabitants of certain -districts--an exigency which, like that of war, often subverts civil -authority, and demands the exercise of the most arbitrary power. We -have recently seen our New York neighbours compelled to thin the -population in some parts of their city, and we may yet be forced to -have recourse to a similar measure. Upon this subject there are some -interesting calculations furnished in Hazzard’s Register, (Vol. VIII. -No. 5,) where may be found an interesting table, exhibiting the number -of square feet in each ward of our city, together with the population -at each census from 1790 to 1830, and the number of square feet to each -inhabitant. From this table it appears that the increase in density -of population throughout the city plot, has been in the following -proportion during the forty years embraced in the estimate. - - In 1790 there was 1 person to 1755 square feet. - 1800 ” 1 ” 1216 - 1810 ” 1 ” 933 - 1820 ” 1 ” 986 - 1830 ” 1 ” 623 - -Viewing the wards separately, we find that, in 1830, there was one -inhabitant to every 313 square feet of superficies in the eastern -division, and one to 979 of the western. - - Eastern Wards. - - New Market ward had 1 to 236 - Lower Delaware 1 243 - Pine 1 248 - Upper Delaware 1 318 - Chesnut 1 341 - Walnut 1 398 - High 1 402 - Dock 1 416 - --- - Average 313 - -In the western wards, where there is a large proportion of unoccupied -ground, the density varies from 840 to 1354 square feet to each -inhabitant--the average being 979. - -The propriety of legislative enactments limiting the maximum density of -population, and the space allowed to be occupied by buildings, so as to -ensure sufficient ventilation, &c. seems to us to be manifest. We shall -take a future opportunity of offering some further remarks on this -subject. - - - - -_Injection of Saline Solutions into the Veins._ - -(Continued from page 55.) - - -No. 4. - -_Letter from Dr. Lewins, to the Secretary of the Central Board of -Health._ - -_Results of the Injection Practice in the Drummond-street Cholera -Hospital, Edinburgh._ - - SIR,--You will receive from Dr. Latta, the details of two or - three cases treated by saline injections. We have both been so - much occupied to-day, that we have not had leisure to get our - communications ready to be sent in the same envelope. We steal - an hour from the time usually allotted for rest to write to - you. In case Dr. Latta should omit to mention the circumstance, - I beg to mention that his patient, Cousins, the woman who was - injected to the amount of three hundred and seventy-six ounces, - and who promised to do well, for a considerable time, was a - person of very dissipated habits. - - In the Drummond-street hospital six patients have been - injected, and three recovered, or are recovering. In the three - that died, extensive organic disease was found on dissection; - disease that had existed previously to the attack of cholera. - - I send herewith the report of two cases, treated by Dr. Craigie - of this place, which, at my request, he furnished me to-day for - the perusal of the Board. - - I intended to have sent an account of an interesting fatal - case, the only one in which the venous injection may be said to - have fairly failed where it was fairly used; that I shall do - to-morrow. - - I have the honour to be, sir, your most obedient servant. - - ROBERT LEWINS, M. D. - - _Leith, May 27th._ - - -No. 5. - -_Details of Two Cases of Malignant Cholera treated by Venous Injection, -by Dr. Craigie, of Leith._ - - _No. 1. Case successful. 15lbs. injected at intervals in nine - hours._--Martha Smith, aged thirty-eight, a noted drunkard, - thin and debilitated, in sixth month of pregnancy, admitted - into the hospital at 8 P. M. May 16th, 1832. - - It appears she had had vomiting and purging since Sunday - morning, 12th inst. Cramps came on about four hours ago in both - legs; great evacuations both upwards and downwards like dirty - water. The countenance is now collapsed; eyes sunk; tongue - cold; pulse imperceptible at wrists; very small in brachial - artery; 124. - - ℞. Muriat sodæ, ℨiij; Carbon sodæ, ℨi; Aq. calid. ℔vj. solve. - Ft. Enema statim injiciend. Sinapisms to spine and epigastrium; - let her be placed on heated tin mattress. - - Nine A. M. Has a good deal of vomiting; is getting warmer; - pulse now perceptible in right wrist; tongue warmer; she - allows the enema to come away without giving notice to nurse. - Saline enema as above, with the addition of white of eggs, to - be repeated every half hour. - - Ten. Vomiting and purging of watery fluid, with slimy matter in - it. - - Half-past ten. Cramps have returned severe in left leg; pulse - again imperceptible; urgent thirst, and constant vomiting. - _Rep. enema et pulveres effervescentes._ - - Half-past eleven. Breathing becoming much affected; extreme - restlessness; cramps severe in legs, and every symptom of - sinking. Let the following saline solution be injected into one - of the veins of the arm. - - ℞. Muriat sodæ, ℨi; Carbon sodæ, gr. x; Aq. calid. ℔iij, solve - temp. 105° Fahr. - - Noon. When about ℔i. had been thrown in, the pulse was - perceived to flutter at the wrist, and gradually strengthened - as the injection was proceeded with. By the same ℔iiiss. - had been injected, the countenance, which was before quite - death-like, now beamed with the appearance of health, and she - began to converse freely. Pulse 96, moderate. To have ℥i. gin - in warm water with sugar. - - Half-past one. The gin was immediately rejected. Pulse has - again gradually become imperceptible, and respiration quick and - laborious. - - Two. Let the venous injection be repeated to ℔vij. - - The effect of the injection, as formerly, was very striking. - To see an individual who seemed _in articulo mortis_ brought - back, as it were, in so short a space of time to an apparently - tolerable state of health, could not but astonish the beholder. - Before the injection was finished the pulse had returned to a - healthy fulness and firmness. Expresses herself much relieved; - no purging, but vomits much serous matter. - - ℞. Muriat sodæ, ℨij; Carbon sodæ, ℨi; Alcohol. dilut. ℥i; Aq. - calid. ℔iij. M. ft. enema statim injiciend. - - Four. Enema retained about an hour and a half; surface of body - now comfortably warm; she has not passed more fluid by stool - than was thrown into the rectum. - - Six. Has slept softly for an hour; the first sleep she has had - for many days. - - ℞. Subm. hydrarg. gr. v; Pulv. opii, gr. ss. M. sumat stat. et - rep. 3tia quaque hora. - - Nine. Complains much of vomiting and sense of weakness; - countenance rather collapsed; breathing rather difficult. - - Let ℥lxxx. be injected into the veins again gradually. - - After the first few ounces were thrown in she complained of an - acute pain at the epigastrium, and faintness, probably arising - from the fluid being thrown in too fast upon the heart, or - from the passing of a bubble or two of air, which may have got - in from the inaccuracy of the injecting apparatus used. Be - that as it may, the circulating system was so much affected, - that the pulse, from being distinct though feeble, became - quite imperceptible, but on stopping the injection for a few - minutes the pulse gradually returned, and the pain abated. She - expresses herself as always getting relief from the operation. - - Eleven. Vomiting continues urgent. - - App. emp. cantharid. epigast. Effervescing draughts - occasionally. - - May 17th. Has passed about ℔j. of urine, of natural appearance; - this is the first she has made since she was brought in. - - From this time she went on gradually to improve, but stomach - continued very irritable, and the matter vomited was bilious. - - 21st. Labour pains came on, and she was delivered of a - still-born female child. - - 22d. Symptoms of phlebitis in right arm came on, proceeding - from the wound upwards, but this yielded to the ordinary - treatment, and she may now be considered out of all danger, - though she is not yet reported cured. - - THOMAS CRAIGIE, M. D. - - _Leith, May 26th, 1832._ - - * * * * * - - _No. 2. Case fatal--appearances on dissection._--George - Cousins, aged ten, was brought into quarantine at nine, A. - M. 13th May, on account of his mother being ill of cholera. - About an hour after admission began to vomit and purge, and it - appears he has had diarrhœa severely all the morning. Pulse - 102, extremely weak; complains much of sickness; countenance - collapsed; areolæ rather dark under the eyes; voice very weak. - - He had hot air-bath immediately, and got the following dose:-- - - ℞. Ol. ricini, ℥ss; Tinct. opii, gtt. xv; Aq. menth. pip. ℥iss. - M. ft. haust. - - Half-past eleven, A. M. Draught retained; sickness has gone - off; complains of heat of bath; let it be removed. - - Noon. Has vomited some watery matter, with undigested potatoes - in it, and again a rice-watery fluid with flocculi. He has - now a considerable degree of jactitation; countenance more - sunk, and great desire for cold water. These symptoms went - on increasing in severity in spite of sinapisms to spine, - effervescing draughts, calomel, and Dover’s powder, warm - water, enemeta, &c., and head symptoms were now making their - appearance. - - Half-past two P. M. Pulse quite imperceptible, and has been so - for an hour and a half; he lies quiet and drowsy, with eyes - turned upwards; face bedewed with cold perspiration; hands and - feet cold and very blue. - - My colleagues, Drs. Combe and Lewins, saw him with me at this - time, and concurred with me in thinking him not only beyond all - hope of recovery, but likely to die _within an hour or two_. - - From what I had seen of the resuscitating powers of Dr. - Latta’s treatment on the boy’s mother this morning, by venous - injection, I determined on giving it a trial, though this was - a case rather likely to bring discredit on the remedy than - otherwise. The following solution, at temperature 102° F. was - slowly injected into the median basilic by means of a common - silver blow-pipe attached to Reid’s enema syringe:-- - - ℞. Muriat sodæ, ℨi; Carbon sodæ, gr. x; Aq. calid. ℔vj. solve. - T. 102. - - Three P. M. A few minutes after the injection was commenced - the pulse returned to the wrists, the blueness and coldness - of the extremities gradually wore off; the countenance was - much improved; and the whole fluid was injected within twenty - minutes. - - Half-past three P. M. He has now a healthy, blooming - appearance; is sitting up in bed, and looking about him as if - awoke out of a dream. Pulse 110, natural; extremities of good - colour and warm; voice much stronger. - - Half-past four P. M. Pulse has been gradually falling off since - last report; is getting listless, and dislikes to be troubled - with questions, breathing becoming laborious, and head symptoms - more marked, with squinting to a slight degree superadded. - - Seven P. M. Pulse again imperceptible; respiration quick and - laboured; countenance collapsed; tongue and breath cold; says - he is dying. - - Let the venous injection be repeated to ℔iij. - - Half-past seven P. M. Pulse immediately returned, of natural - strength and fulness, and continues so. - - Nine P. M. Lies very quiet; pulse good; breathing more natural; - surface of body covered with warm perspiration. - - Ten P. M. Large watery evacuations from the bowels came on soon - after last injection; the quantity cannot easily be guessed, - but must have been considerable, as it is running through the - mattress on the floor. Pulse scarcely perceptible; screams - loudly like a child in hydrocephalus. - - Eleven P. M. Pulse quite imperceptible; is sinking fast; venous - injections attempted a third time, but desisted from as it was - not productive of the first good effects. Both pupils much - dilated. Died at two A. M. 14th. - - _Dissection fifteen hours after death._--On exposing the - brain and spinal marrow, but before opening their investing - membranes, the least pressure with the fingers on the middle - of the hemispheres of the brain caused a remarkable undulating - down to the middle of the back, showing the existence of a - fluid beneath the membranes, and on opening them about two - drachms of pure serum flowed out. - - The surface of the brain was rather vascular, and the blood in - the most minute vessels particularly bright. A few ecchymosed - spots on its surface. All the other viscera were found healthy. - The urinary bladder contained about half an ounce of urine. - - THOMAS CRAIGIE, M. D. - - _Leith, 26th May, 1832._ - - -No. 6. - -_List of Queries addressed to Drs. Lewins and Latta, by the Central -Board of Health, London, relative to the preceding cases, &c._ - - QUERIES BY THE CENTRAL BOARD. - - 1. Were any of your patients bled previously to, or after the - saline injections into their veins? - - 2. Were the evacuations by purging, vomiting, or perspiration, - increased by the injections? - - 3. Did any of the patients submitted to the saline injection - plan die; and if examined after death, what were the - appearances? - - 4. Had the pulse at the wrist absolutely ceased, and for how - long; or had blueness of the surface taken place, and to what - extent, in any of your patients before the injection of the - saline fluids; and how many of such patients recovered under - that treatment? - - 5. Had suppression of urine been _perfectly_ established, and - for how long, in any of your cases previously to the saline - injection, and what effect did that practice appear to produce - on the urinary secretions? - - 6. What effect did the injections appear to have on the - temperature of the patient? - - 7. Were the blood and evacuations analysed before and after the - injections? - - 8. Did consecutive fever occur in any, and if so, in how many - of your cases, whether successful or otherwise? - - 9. Was the quantity of the evacuations noted before and after - the injections in any of your cases? - - 10. Please to give the details of two or three cases treated by - saline injections, with age, condition of life, temperament, - habits, &c., and particulars of such other treatment as may - have been adopted in addition to the saline injections. - - ANSWERS BY DR. LEWINS. - - 1. None before. One to the amount of twelve ounces immediately - after the first injection. - - 2. The evacuations by purging and vomiting, in most of the - cases continued. In some of them the purging, the discharge - from the bowels at least, was increased. Perspiration was - increased in all. - - 3. Yes; no less than ten of the fifteen that have been injected - up to the present day; but under such circumstances as do not - detract from the general merits of the practice: this will be - made evident by the history of the cases that will be sent by - to-morrow’s post. - - 4. Yes; even at the axilla in some of the cases, blueness of - the surface had taken place to a considerable extent. Five of - these patients recovered. - - 5. Complete suppression, I think, in all except two, and for - hours. In all the successful, and in some of the unsuccessful - cases, the effects of the injection in restoring the secretion - of urine were most evident. - - 6. The injections raised the temperature of the body; but in - all the successful cases, where the veins were injected, the - patients complained of cold soon after the injection. - - 7. Neither the blood nor the evacuations were analysed, but I - sent some of the blood of a patient that had been injected by - the veins, to Dr. Reed for analysis to-day. - - 8. The consecutive fever in all the patients who were injected, - has been slight. - - 9. No; but they were excessive in most of the cases. - - 10. Question ten shall be fully answered by to-morrow’s post. - - ROBERT LEWINS, M. D. - - _6 Quality Street, May 26th, 2 o’clock, A. M._ - - -No. 7. - -_Latest Communication from Dr. Lewins to the Secretary of the Central -Board of Health._ - - Sir,--The urgency of my present private and public duties - prevents me from communicating more to you to-night than the - following brief particulars of a case that occurred at the - Leith Cholera Hospital yesterday:-- - - A woman of about forty years of age, was admitted on Sunday - evening at 7 o’clock. She was _pulseless_, even at the axilla, - _sightlesss_, _cold_, and _blue_, over almost the whole body. - _Respiration_ very slow and irregular--in a word, she was - all but lifeless. It was feared she would be dead before the - operation of injecting could be commenced. Between 7 at night - and 2 o’clock next morning, there were thrown in two hundred - and eighty-four ounces, upwards of twenty-three pounds. The - report of her situation at 2 on Monday morning, in the hospital - book, is as follows:--“A change for the better, that appears - almost miraculous, has taken place. The action of the heart is - greatly improved; respiration not in the least laborious, but - quicker than natural; pulse 120, small, but distinct. She can - articulate distinctly; countenance natural; lips red; tongue - moist and warm; she perspires freely; heat over the whole body - natural.” - - A full report of this wonderful case shall be forwarded soon. - - I remain, Sir, &c. - - ROBERT LEWINS. - - P. S.--In one, the pulse had ceased at the wrist eight - hours before the injection. Dr. Alison had seen the patient - eight hours before the operation, and the pulse was then - imperceptible. - - _Quality Street, Leith, May 29th, 1832, 1 o’clock, A. M._ - - - - -_Origin of the Cholera at Quebec._ - - - _Board of Health, Quebec, June 25th, 1832._ - -The undersigned, appointed by the Board of Health to investigate and -report upon the introduction and treatment of the cholera, now existing -in this country, have agreed to the following Report, which they -respectfully submit. - -The disease, on its first appearance in this city, exhibited all the -characters of that commonly called the Asiatic or Spasmodic Cholera. -It commenced about the 8th instant, in boarding houses and taverns -in the Cul-de-Sac--a low, uncleanly, and ill-ventilated part of the -city--crowded with emigrants of the lowest description, with sailors -and other persons of irregular habits. - -About the fourth day of the disease, (the 12th,) it showed itself in -the more elevated parts of the city, among the wealthier classes of -society, and persons of sober and regular habits, who could have had -but little, if any, direct communication with the people among whom the -disease had first appeared. - -About the same date, (the 12th,) the disease was observed in various -parts of the city, and in several neighbouring parishes, some few miles -distant, having a constant intercourse with it. - -The cases continued to increase in number until about the 16th or 18th, -(being the 8th or 10th day of the disease,) when they began to subside, -both in number and in violence--the disease still prevailing more -extensively in the ill-ventilated parts of the city above mentioned. -About the period of its greatest prevalence, (the 8th or 10th day of -the disease,) the number of cases was estimated to be between 250 and -300, in the course of twenty-four hours. - -The undersigned have not as yet been able to discover that any case -of cholera has been landed from any vessel in the harbour, before nor -until several days after its first appearance in the city. - -They deem it necessary to add, that some parishes in the neighbourhood -of Quebec have continued free from the disease until lately, and that -no case appears to have yet occurred at Three Rivers, an intermediate -and populous town between Montreal and Quebec, where the steamboats -with emigrants from Quebec, generally arrive. - -Since the appearance of this malady, only two soldiers have been -attacked in Quebec, and those while on duty--the rest being closely -confined to their quarters. - -The symptoms were the most violent at the commencement, and continued -so until about the 16th or 18th, when they began to mitigate in -severity, as the cases diminished in number. - -In the treatment of this disease, recourse has been had to almost every -remedy favourably reported of by European practitioners, and they all -have had, for a time, their advocates--some preferring stimulants, -others opiates, while others satisfied themselves with an intermediate -plan of treatment--the whole of the medical practitioners with one -accord agreeing, however, in the application of external stimulants, -such as oil of turpentine, mustard, warm applications and frictions; -calomel and opium have been much relied on by many. Practitioners speak -with confidence of blood-letting at the onset of the disease, and -before an approach to collapse has been recognised. Sweating has been -much practised, and decidedly with advantage, when it is not allowed -to run into that state of collapse indicated by a pulseless wrist, -dejected countenance, blue extremities, tongue and breath cold, and a -sunken voice, feeling as if it passed through the ears. - -Some instances have been noticed, and also observed by our intelligent -clergy, as well as by ourselves, where, in some mild forms of the -disease, nature effected a cure by copious perspiration, encouraged by -warm drinks and extra clothing. - -The undersigned, with one accord, have found purgatives injurious, if -used before perspiration or blood-letting had been resorted to, to -allay the irritable state of the stomach and bowels; and then only the -milder purgatives should be employed, such as calomel or blue pills, -guarded with minute doses of opium, and carried off, after a few hours, -with rhubarb, combined with soda and carbonate of ammonia. - -Signed, Jos. Morrin, Health Commissioner; W. A. Hall, Resident -Physician; F. X. Tessier, Health Officer; Wm. Lyons, Superintendent of -the Emigrant Hospital. - - - - -_Origin of the Cholera at Sunderland._ By T. M. GREENHOW, Esq. of -Newcastle. - - -The assumed capability of Cholera being conveyed by shipping from one -country to another, on which our system of quarantine is founded, very -naturally gave rise to the suspicion, when it first appeared in the -port of Sunderland, of its having been imported from some place on the -Continent, where it was known to prevail; and several stories were -in circulation descriptive of the manner in which it had thus been -introduced. I shall not here repeat any of these tales, suffice it to -say that none of them have been in any degree authenticated. That the -ships which were blamed for having committed the mischief, were found -to have been from uninfected ports, their bills of health clean, and -their crews healthy; in point of fact they were fairly acquitted of -the charge; and I believe the conviction is now almost universally -entertained by the inhabitants of Sunderland, medical and non-medical, -that the disease did not reach that place from any foreign source -whatever. It may be further stated that the first case of cholera -which took place in this part of the country, was at a considerable -distance from Sunderland, having been at a small village called Team, -about two miles south-west of Newcastle. This case occurred to Dr. -Alexander, of Newcastle, on the 4th of August, 1831. The details are -given in the Appendix, No. I.; other cases occurred at Newcastle -simultaneously, if not before the regular appearance of the disease at -Sunderland; although want of experience of its true characteristics, -and unwillingness to believe in the fact, induced medical gentlemen to -endeavour to prove that these were not cases of the new disease; yet -subsequent observation has sufficiently proved their identity, and, I -believe, it is now generally admitted. Such were the cases of Oswald -Reay, which occurred in October, of William Armstrong in the beginning, -and of Robert Jordan towards the end of November. On the 7th December -the next case occurred, that of Maria Mills, with which commenced the -official reports of the Board of Health of this place. The strictest -inquiries respecting the origin of these cases have failed to obtain -the slightest evidence of their having arisen from any infected source, -and seem to prove, in the most satisfactory manner, that, however the -disease may have since extended itself, its commencement in the country -was spontaneous, upon whatever causes it may have depended. - - - - -_On Asiatic Cholera Morbus_. By PAUL M. EVE, M. D. of Augusta, -_Georgia_. - - -Believing it criminal to withhold from the medical profession anything -on the Cholera Morbus at this moment, and conceiving it a duty to -comply with the request of the editor of the American Journal of the -Medical Sciences, I send the following observations which were made -last summer while I was in Europe. I had felt a reluctance to make a -further communication to the public on this engrossing subject, which -was warranted and justified from my late situation in the Polish -army; my time and attention having been almost exclusively devoted -to surgical cases, and opportunities of investigating this disease -having been comparatively limited. If it is thought, however, that my -observations, imperfect as they are, and that my opinion, humble as it -is, can in any way serve my fellow-labourers in the treatment of this -modern plague, I most willingly and cheerfully present them my views on -the subject. - -As I have neither time nor inclination to write a long article, I will -briefly state the principal symptoms of the Asiatic Cholera Morbus, the -appearances on dissection, and then deduce from them the treatment. -An attack is usually preceded by diarrhœa or by uneasiness in the -stomach and bowels for some days, or is suddenly announced by vomiting -and purging, commencing about three o’clock in the morning, when the -temperature is lowest of the twenty-four hours; and is followed and -accompanied by cramps or spasmodic contractions of the abdomen. There -is great prostration of the animal powers; shrinking of the external -parts, particularly of the features, which assume in many places as -well as the fingers and toes, a leaden or purple appearance; a cold -and moist or even a wet skin, conveying when felt, the sensation of -touching a frog; great thirst; the tongue is blue and cold, or moist -and partly covered with a white fur; the pulse is either imperceptible -at the wrist or is quick, frequent, feeble and intermitting; -respiration is slow and very difficult; the voice is much altered, -questions and answers being made in a low whisper; the secretions, -particularly of the kidneys, are diminished, except into the alimentary -canal, where they are altered and augmented, without however any bile; -purging and vomiting, sometimes one only, but generally both; first -the contents of the stomach and intestines are discharged, and then a -peculiar whitish fluid resembling rice-gruel or sero-albuminous matter; -and lastly, cramps of the extremities, most frequently of the legs, and -which may be compared to a bayonet piercing the calf or most muscular -part. - -The appearances after death, were almost constantly the same. The -external parts were very much diminished in size; the extremities, the -nose, lips, eyelids, cheeks, &c. were of a bluish or livid colour, -and the skin was wrinkled upon the hands and feet. The vessels of the -brain in some subjects contained black blood, but generally there was -nothing peculiar in the contents of the cranium. There was more blood -in the spine, probably arising from position. The heart, lungs and -large vessels were filled with a fluid resembling tar in colour and -consistency. Two hours after death it was liquid and appeared like -venous blood; but at twenty-four hours it seemed deprived of serosity -and of the property of coagulation, and albuminous concretions were -found in the heart. The stomach and intestines were either empty or -contained matter similar to the vomitings and purgings; their coats -were contracted and paler than in a natural state, or as was most -frequently the case, presented all the varieties from congestion to -sub-inflammation. The liver and vena portæ were distended with black -blood, and the gall-bladder with tenacious, dark yellow, or green bile. -In almost every case the bladder was found empty and contracted. - -From the above symptoms and results of post mortem examinations, it -would seem that the pathology of the cholera morbus may be explained -by a want of oxegenation of the blood, which becoming surcharged with -carbon is unfit to stimulate the heart to contraction, and hence the -congestion upon the internal and vital organs at the expense of the -surface and extremities. With this pathological view of the disease, -and from the positive fact of there being a centripetal action of the -blood, is easily deduced the principle of conducting its treatment--the -equilibrium of the circulation must be restored or death will ensue. -Now, mechanically speaking, there are two ways of affecting this -object, either by introducing a power which will give the blood a -centrifugal direction, or calling it back to the surface, by direct -external applications. But the animal economy is governed by other -as well as mechanical laws; the vital properties of the heart are -oppressed, its energy is diminished, and its power of reäction impaired -by an accumulation of blood, and this is peculiarly the case when the -blood is black or not oxegenated; the stimuli or powers introduced -to rouse its action would therefore be worse than useless; besides, -we usually address the heart through the stomach, which is in such -an irritable state as to reject even the mildest article. Upon the -surface, on the contrary, there is a want of action, and stimuli are -called for to excite the skin; to restore its lost or increase its -feeble circulation, and thus draw the blood and heat from the internal -parts of the extremities. - -The plan of treatment which I have found most successful, consisted -in varying the following means according to circumstances. Within -the first four hours after an attack, bleeding will generally be -necessary; but when prostration has ensued and when the surface is -covered with cold sweat, leeches to the epigastric region, or cupping -followed by warm fomentations or mustard plaster or blister, together -with frictions and heat to the extremities, will afford the greatest -and most speedy relief. Notwithstanding the various and multiplied -articles of the materia medica which have been recommended, as opium, -calomel, oxide of bismuth, cajuput oil, spirits, &c. to allay vomiting -and purging and calm spasms, I must give my decided preference to -dermoid applications, which invite the blood from the heart, lungs, -liver, stomach, &c. the congestion of which produces these symptoms. -I do not deny that there are cases which can be, and are relieved by -medicines; but, since we possess no remedy which can drive the blood -from the centre to the surface--since all internal medicines are apt -to excite vomiting, one of the most painful, distressing and fatal -symptoms of cholera--and moreover, since we possess means which can -be easily managed and varied to suit circumstances, and whose action -is plain and evident to the senses--I cannot forsake them to launch -upon the sea of experiment and conjecture, in the treatment of this -rapid disease. The language of those who advocate the administration of -internal remedies, is to give so much of a mixture or so many pills, -and if they produce _vomiting_, repeat the dose; but if a cure is to -be effected by relieving the symptoms, why give those medicines which -excite or aggravate them? An infusion of peppermint, or the oil or -essence of this plant, with a few drops of laudanum, in a little warm -brandy and water, is what I have found best adapted for internal use; -and even this should be prohibited when it produces vomiting. This -symptom is often so distressing and so easily excited, that the stomach -will reject whatever is presented to it. In such cases, I rely upon -the horizontal position, perfect rest, and heat and frictions to the -abdomen and extremities, without administering any thing internally. -The warm bath I have known to be of great service, but the time -necessary to prepare it and the exposure of the body to the air, are -serious objections to its general employment. The same will not hold -good in relation to the vapour bath, where the patient can be kept -continually warm. Excessive thirst is best relieved by cold gum water, -or by a piece of ice dissolved in the mouth. - -Having enjoyed an opportunity of comparing the practice of the English, -French, German and Poles, while stationed at Warsaw, in the months of -May, June, July, and August, of the past year, and having experienced -personally the disease, I feel some confidence in recommending the -above treatment of the Cholera, to the American practitioner of -medicine: and in support of its correctness and superiority, I will -state that at Wisnia, a town of Gallacia, out of two hundred and forty -persons attacked with it who were subjected to cutaneous frictions, and -to the internal use of only an infusion of chamomile and peppermint -_two alone died_. - -To prevent an attack of cholera, cleanliness and sobriety ought to -be most rigidly observed. All sudden or great impressions upon the -system, as changes in the temperature of the air, cold and moisture, -or emotions of the mind, excessive joy, fear, and the depressing -passions, should be carefully avoided. The body to be kept moderately -warm, a belt of flannel is recommended to be worn; and the mind calm, -and confiding in a protecting Providence. The diet should be regular, -and without any material change in the accustomed repasts. Emetics and -purgatives are to be avoided, and certain articles of nourishment which -are known to predispose to colic, or cholera affections; these are bad -beer, sour-crout, cabbage, salad, beans or peas, spinage, cucumbers, -pickles, unripe sour fruit, musk and water melons, cold meats, sour -milk, &c. Good soups, beef, mutton, veal, fowls, eggs, Irish potatoes, -bread, and tea in preference to coffee, should constitute the principal -food of those who inhabit an infected district. - -After all that has happened to admonish us, we can still hope that -the cholera may not reach the Southern States. Its general course has -been north-westwardly; from Calcutta it reached the Russian Empire; -from Constantinople it passed to Great Britain. Although it existed in -Hungary and in Vienna, still Lombardy, Switzerland, and Italy, have -escaped; and the same thing is applicable to France and Paris, in -relation to Spain and Portugal. It has not even existed in cities of -the South of France, and Quebec and Montreal are nearly in the latitude -of Paris; besides, these two Canadian cities are remarkable as being -the most filthy and ill-ventilated of America. If it has progressed in -a north-westwardly direction, and if it has avoided a southern latitude -in Europe, why may we not escape its dreadful ravages? Let us, however, -be prepared to meet it, that if it ever does come, we may be ready -to cure the distressed, to relieve the afflicted, and to lessen the -sufferings of the dying victim. - -_Augusta, June 30th, 1832._ - - - - -_Non-Purgative Salts in Cholera._ - - -The following statement, relative to the treatment of cholera in the -prison at Cold Bath Fields, are interesting, and are said by the editor -of the London Medical Gazette, to be entitled to entire confidence as -to its accuracy. - - “The first twelve cases occurred in the vagrant’s ward, and - the patients were attacked soon after some prisoners had been - admitted from St. Giles’s, and other infected districts. The - first case that was reported as cholera, occurred on the 5th of - April. This man was suddenly attacked, and died after a very - short illness with all the symptoms of the prevailing epidemic. - - “When the first cases occurred, there were in all about twelve - hundred persons in the prison; but, up to the beginning of this - month, they were not afflicted with bowel complaints, nor, in - fact, with any other epidemic disease, being as healthy as they - generally are at that season of the year. - - “The first four cases were treated in the common way, with - brandy and opium, an ammoniated mixture, ginger, sinapisms to - the region of the stomach, the hot air-bath, &c. &c.; and all - of them died after a short illness. - - “Since the 4th of April, up to this date, (April 17,) forty - cases in all have been under treatment. Of this number, - nineteen were admitted into the Observation ward with the - premonitory symptoms of cholera. All of these had bowel - complaints and suspicious ejections; some of them complained - of severe pain in the abdomen, sickness of the stomach, and - in several cases these symptoms were attended with cramps, - chiefly in the lower extremities. The whole of them were - immediately treated by Mr. Wakefield with non-purgative saline - remedies, recommended by Dr. Stevens, and in general they were - convalescent in one, two, or three days, from the commencement - of this practice. From this we may infer, that where the - disease is attended to early, and _properly treated_, the state - of collapse may be prevented in nineteen cases out of twenty. - - “We must state, however, that as the numbers increased, it - became necessary to dismiss those that appeared to be least - ill, on purpose to make room for others. Of those that were - dismissed as convalescent, two were reädmitted soon after in a - state of collapse, and though every attempt was made to save - them, yet they both died after a very short illness, with - the symptoms of cholera in its most virulent form. With the - exception, however, of the two that died, none of the cases, - (seventeen in number,) were reported to the Central Board, - partly, we believe, from a wish to avoid spreading alarm with - respect to the prison, and partly because the disease was - checked in the beginning; consequently, the patients had not - _all_ the symptoms of cholera, such as occur in the worst - cases, or in the last stage. - - “In addition to the above seventeen which were not reported, - there were twenty-one cases where the symptoms of cholera were - very distinctly marked. Of this number, four of the early cases - were treated in the common way, with diffusible stimuli, &c. - &c., and all of them died after a short illness. These, with - the two cases of relapse from the Observation ward, make in all - six deaths. Mr. Wakefield, however, having lost all faith in - the common treatment, changed the practice:--at the request of - Dr. Stevens, the other fifteen cases were put under the saline - treatment, and all of them recovered. - - “When the patients were first admitted, the following powder - was immediately given, either in half a tumbler of tepid water, - or occasionally in a little thin, clear, beef-tea:-- - - “Supercarbonate of Soda, ℨss. Muriate of Soda, ℈j. Chlorate of - Potass, grs. vii. - - “The above was given every hour, and continued until the - patients were recovering from the state of collapse; after - which it was diminished in frequency, in proportion as the - reäction increased. - - “In all these cases, the outline of the practice was nearly - the same; but in several instances the treatment was varied - according to circumstances. When the stomach, for example, - was extremely irritable, it was found that the carbonate of - soda, given by itself, or the tartrate of soda, in a state of - effervescence, were the most effective remedies that could be - used on purpose to allay the irritation, so as to enable the - stomach to retain the stronger salts. - - “During the progress of the disease, an enema, with a large - table-spoonful of muriate of soda, dissolved in warm water, was - administered with or without sugar, starch, &c. every three - or four hours, at as high a temperature as the patients could - well bear it. Sinapisms were also applied as early as possible - to the region of the stomach, betwixt the shoulders, &c.; and - in the cold stage, frictions were also frequently used with - warm towels. Of the seventeen cases that were treated in this - way, two died, (namely, the two patients who were reädmitted - in a state of complete collapse,) making in seventeen cases, - two deaths, and fifteen recoveries. But including the whole - of those that were under the saline treatment, the total - amount is, in thirty-six cases, two deaths, and thirty-four - recoveries. - - “The cases in question were under the care of Mr. Wakefield, - the medical attendant of the establishment, and during his - absence they were attended to by Mr. J. Wm. Crooke, who kept - notes of the cases, and saw that the medicines were properly - administered. We may add, also, that Mr. Wakefield, with a - degree of fairness which does him great credit, invited Dr. - Stevens to attend along with him to witness the effect of the - saline treatment, which has here, we may say, for the first - time, been fairly tried in this disease. - - “We can also state, that the cholera made its appearance about - the same period amongst a small colony of Italians, who live - in a narrow lane within a few hundred yards of the prison. Of - these, eleven were attacked. The three first cases were treated - by bleeding, brandy, and opium, all used at the same time, - and they all died. The other eight cases were attended by Mr. - Whitmore, a surgeon in the neighbourhood, who, having witnessed - the effects of the saline treatment in the prison, adopted it. - All his patients speedily and completely recovered, except - one, who, on the 13th, was so ill that he was not expected - to live many hours; even he, however, is now in a state of - convalescence. _Thus there have been in all fifty-three cases, - seven of which were treated in the common way, with diffusible - stimuli; and out of this number seven died; while, of the - forty-six that were under the saline treatment, there were two - deaths and forty-four recoveries._” - - - - -_Cholera at New York._ - - -The decrease of cholera at New York during the past week has been -exceedingly slow; nevertheless, there can be no doubt that the disease -has passed its zenith in that city. - - August 1st, No. of cases, 92 deaths[1] 53 - 2d, 81 56 - 3d, 90 38 - 4th, 88 54 - 5th, 96 39 - 6th, 101 51 - 7th, 89 28 - --- --- - Totals, 637 319 - - [1] These are taken from the city inspector’s reports of - burials. - -Whole number of deaths in New York during the week ending 4th August, -according to the city inspector’s report, 580, of which 383 were from -malignant cholera, 1 cholera morbus, 5 diarrhœa, 8 dysentery, 30 -cholera infantum, 2 inflammation of the bowels, and 10 unknown. - -The whole number of cases of malignant cholera from the 1st July to -7th August inclusive, reported by the Board of Health, 4497; number of -deaths as reported by the same, 1799. The report of the City Inspector, -which is manifestly the more accurate, gives the number as 2295. - - - - -_Health of Philadelphia._ - - -The epidemic whose approach we confidently announced a month since, is -now prevailing among us, and appears as yet scarcely to have attained -its maximum. The public mind having been prepared to expect its -visitation, and quieted, to a considerable extent, by the preparations -made for its reception, there has been little excitement, and certainly -none of that panic which has elsewhere been so favourable to its -ravages. - - Number of cases reported August 2d, 40 - 3d, 35 - 4th, 45 - 5th, 105[2] - 6th, 136 - 7th, 136 - 8th, 114 - --- - Total for the week, 611 - - [2] Forty of these cases were in the Arch St. Prison, and not - being reported until the next day, the number of cases appears - from the report of the Board of Health to be, August 5th, 65, - and on the 6th of August, 176. - -We hope in our next No. to be able to present a tabular view of the -cases, showing the number each day from the commencement of the -epidemic, the situations in which they have occurred, &c. - -The following table exhibits the whole mortality, and also that from -bowel complaints for the 1st week in August for five successive years. - - 1828.--1st week, ending August 2d. Whole mortality, 129; of - which, the deaths from cholera morbus were, adults, - 3; children, 32; Total, 35.--Diarrhœa, adults, 2; - children, 1; Total, 3.--Dysentery, adults, 0; children, - 5; Total, 5.--Total from bowel complaints, 43. - - 1829.--1st week, ending August 8th. Whole mortality, 89; of - which, the deaths from cholera morbus were, adults, 2; - children, 18; Total, 20.--Diarrhœa, adults, 2; children, - 2; Total, 4.--Dysentery, adults, 1; children, 2; Total, - 3.--Total from bowel complaints, 27. - - 1830.--1st week, ending August 7th. Whole mortality, 80; of - which, the deaths from cholera morbus were, adults, 0; - children, 21; Total, 21.--Diarrhœa, adults, 1; children, - 0; Total, 1.--Dysentery, adults, 1; children, 1; Total, - 2.--Total from bowel complaints, 24. - - 1831.--1st week, ending August 6th. Whole mortality, 111; of - which, the deaths from cholera morbus were, adults, 0; - children, 23; Total, 23.--Diarrhœa, adults, 1; children, - 5; Total, 6.--Dysentery, adults, 1; children, 3; Total, - 4.--Total from bowel complaints, 33. - - 1832.--1st week, ending August 4th. Total mortality, 243; of - which, the deaths from cholera morbus were, adults, 1; - children, 30; Total, 31.--Malignant cholera, adults, 81; - children, 3; Total, 84.--Diarrhœa, adults, 5; children, - 4; Total, 9.--Dysentery, adults, 3; children, 2; Total, - 5.--Total from bowel complaints, 129. - - -PHILADELPHIA--CAREY & LEA--CHESNUT STREET. - - - - - -End of the Project Gutenberg EBook of The Cholera Gazette, Vol. I. No. 5. -Wednesday, August 8th, 1832., by Various - -*** END OF THIS PROJECT GUTENBERG EBOOK CHOLERA GAZETTE, AUGUST 8, 1832 *** - -***** This file should be named 52859-0.txt or 52859-0.zip ***** -This and all associated files of various formats will be found in: - http://www.gutenberg.org/5/2/8/5/52859/ - -Produced by The Online Distributed Proofreading Team at -http://www.pgdp.net (This file was produced from images -generously made available by The Internet Archive) - -Updated editions will replace the previous one--the old editions will -be renamed. - -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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No. 5, by Various. - </title> - - <link rel="coverpage" href="images/cover.jpg" /> - -<style type="text/css"> - -a { - text-decoration: none; -} - -body { - margin-left: 10%; - margin-right: 10%; - font-size: 100%; -} - -h1,h2,h3 { - text-align: center; - clear: both; -} - -hr { - width: 65%; - margin-left: 17.5%; - margin-right: 17.5%; - margin-top: 2em; - margin-bottom: 2em; - clear: both; -} - -hr.r15 { - width: 15%; - margin-left: 42.5%; - margin-right: 42.5%; -} - -p { - margin-top: 0.5em; - text-align: justify; - margin-bottom: 0.5em; - text-indent: 1em; -} - -table { - margin: 1em auto 1em auto; - max-width: 40em; -} - -td { - padding: 0 0.25em 0 0.25em; - vertical-align: top; - text-align: justify; -} - -.blockquote { - margin-left: 10%; - margin-right: 10%; - font-size: smaller; -} - -.borders { - border-top: double; - border-bottom: double; -} - -.center { - text-align: center; - text-indent: 0em; -} - -.footnotes { - border: dashed 1px; -} - -.footnote { - margin-left: 10%; - margin-right: 10%; - font-size: 0.9em; -} - -.footnote .label { - position: absolute; - right: 84%; - text-align: right; -} - -.fnanchor { - position: relative; - top: -0.4em; - font-size: .8em; - text-decoration: none; -} - -.fnspacer { - padding-right: 1em; -} - -.pagenum { - position: absolute; - right: 4%; - font-size: 0.9em; - text-align: right; - font-style: normal; -} - -.right { - text-align: right; -} - -.shift-up { - margin-top: -1.7em; -} - -.smaller { - font-size: 80%; -} - -.smcap { - font-variant: small-caps; - font-style: normal; -} - -.tdc { - text-align: center; -} - -.tdr { - text-align: right; -} - -.tdtotal { - text-align: right; - border-top: thin solid black; -} - -.titlepage { - text-align: center; - margin-top: 3em; - text-indent: 0em; -} - -@media handheld { - -.blockquote { - margin-left: 5%; - margin-right: 5%; -} -} - </style> - </head> -<body> - - -<pre> - -The Project Gutenberg EBook of The Cholera Gazette, Vol. I. No. 5. -Wednesday, August 8th, 1832., by Various - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The Cholera Gazette, Vol. I. No. 5. Wednesday, August 8th, 1832. - -Author: Various - -Release Date: August 20, 2016 [EBook #52859] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK CHOLERA GAZETTE, AUGUST 8, 1832 *** - - - - -Produced by The Online Distributed Proofreading Team at -http://www.pgdp.net (This file was produced from images -generously made available by The Internet Archive) - - - - - - -</pre> - - -<p><span class="pagenum"><a name="Page_65" id="Page_65">[65]</a></span></p> - -<h1><span class="smaller">THE</span><br /> -CHOLERA GAZETTE.</h1> - -<div class="borders"> - -<p><span class="smcap">Vol. I.</span></p> - -<p class="center shift-up"><i>WEDNESDAY, AUGUST 8th, 1832.</i></p> - -<p class="right shift-up">No. 5.</p> - -</div> - -<h2><i>M. Petit’s Treatment of Cholera.</i></h2> - -<p>The principal indication which M. Petit, one of the physicians of -the Hôtel-Dieu de Paris, proposes to himself to fulfil, in the treatment -of cholera, is to keep up a constant impression upon the -spinal marrow, and to change the phenomena of innervation. To -effect this he places over the whole length of the spine a strip -of flannel, wet with a liniment composed of an ounce of the essence -of turpentine and a drachm of aqua ammonia, and passes -slowly over it a very hot flat-iron. An instantaneous evaporation of -a great part of the liniment results, which acts powerfully on the -skin over the spine, and induces very speedily vesication. The heat -returns to the skin, the cramps and vomitings disappear, the circulation -is reëstablished, and the patient feels much better. The effects -of this remedy are assisted by hot bricks to the limbs; by frictions to -the body with a decoction of mustard, to which some aq. ammonia -is added, and the patient is also made to drink copiously of balm -and mint tea. A table-spoonful of the following potion is likewise -given every hour:—℞. Aq. distil. Tilleæ Europeæ; aq. distil. melissæ, -āā. ℥ij.; tinct. opii, gtt. xx.; syrup. ether. ℥j. M. Finally, -the patient is rubbed all over with a liniment composed of camphorated -oil of chamomile, ℥ij.; laudanum, ℨij.; liquid ammonia, ℨj.</p> - -<p>M. Petit is said to have been more successful than most of his colleagues -in the treatment of cholera. In a communication to the Academy -of Medicine he states that under the above treatment two-thirds -of his patients have recovered.</p> - -<hr /> - -<h2><i>On Density of Population.</i></h2> - -<p>Density of population in cities becomes a matter of extreme importance -connected with the visitations of pestilential diseases. A<span class="pagenum"><a name="Page_66" id="Page_66">[66]</a></span> -too crowded population may of itself engender a pestilence, and -must inevitably aggravate one should it prevail from other causes. -Hence the necessity which occasionally arises of thinning the inhabitants -of certain districts—an exigency which, like that of war, often -subverts civil authority, and demands the exercise of the most arbitrary -power. We have recently seen our New York neighbours compelled -to thin the population in some parts of their city, and we may -yet be forced to have recourse to a similar measure. Upon this subject -there are some interesting calculations furnished in Hazzard’s -Register, (Vol. VIII. No. 5,) where may be found an interesting table, -exhibiting the number of square feet in each ward of our city, -together with the population at each census from 1790 to 1830, and -the number of square feet to each inhabitant. From this table it appears -that the increase in density of population throughout the city -plot, has been in the following proportion during the forty years embraced -in the estimate.</p> - -<table summary="Population density"> - <tr> - <td>In</td><td>1790</td><td>there was</td><td class="tdr">1</td><td>person to</td><td class="tdr">1755</td><td>square feet.</td> - </tr> - <tr> - <td></td><td>1800</td><td class="tdc">”</td><td class="tdr">1</td><td class="tdc">”</td><td class="tdr">1216</td><td></td> - </tr> - <tr> - <td></td><td>1810</td><td class="tdc">”</td><td class="tdr">1</td><td class="tdc">”</td><td class="tdr">933</td><td></td> - </tr> - <tr> - <td></td><td>1820</td><td class="tdc">”</td><td class="tdr">1</td><td class="tdc">”</td><td class="tdr">986</td><td></td> - </tr> - <tr> - <td></td><td>1830</td><td class="tdc">”</td><td class="tdr">1</td><td class="tdc">”</td><td class="tdr">623</td><td></td> - </tr> -</table> - -<p>Viewing the wards separately, we find that, in 1830, there was -one inhabitant to every 313 square feet of superficies in the eastern -division, and one to 979 of the western.</p> - -<table summary="Population density by ward"> - <tr> - <td>Eastern Wards.</td> - </tr> - <tr> - <td>New Market ward had</td><td class="tdr">1</td><td>to</td><td class="tdr">236</td> - </tr> - <tr> - <td>Lower Delaware</td><td class="tdr">1</td><td></td><td class="tdr">243</td> - </tr> - <tr> - <td>Pine</td><td class="tdr">1</td><td></td><td class="tdr">248</td> - </tr> - <tr> - <td>Upper Delaware</td><td class="tdr">1</td><td></td><td class="tdr">318</td> - </tr> - <tr> - <td>Chesnut</td><td class="tdr">1</td><td></td><td class="tdr">341</td> - </tr> - <tr> - <td>Walnut</td><td class="tdr">1</td><td></td><td class="tdr">398</td> - </tr> - <tr> - <td>High</td><td class="tdr">1</td><td></td><td class="tdr">402</td> - </tr> - <tr> - <td>Dock</td><td class="tdr">1</td><td></td><td class="tdr">416</td> - </tr> - <tr> - <td class="tdr">Average</td><td></td><td></td><td class="tdtotal">313</td> - </tr> -</table> - -<p>In the western wards, where there is a large proportion of unoccupied -ground, the density varies from 840 to 1354 square feet to each -inhabitant—the average being 979.</p> - -<p>The propriety of legislative enactments limiting the maximum density -of population, and the space allowed to be occupied by buildings, -so as to ensure sufficient ventilation, &c. seems to us to be manifest. -We shall take a future opportunity of offering some further remarks -on this subject.</p> - -<hr /> - -<p><span class="pagenum"><a name="Page_67" id="Page_67">[67]</a></span></p> - -<h2><i>Injection of Saline Solutions into the Veins.</i></h2> - -<p class="center">(Continued from page 55.)</p> - -<div class="blockquote"> - -<h3>No. 4.</h3> - -<p class="center"><i>Letter from Dr. Lewins, to the Secretary of the Central Board of Health.</i></p> - -<p class="center"><i>Results of the Injection Practice in the Drummond-street Cholera Hospital, -Edinburgh.</i></p> - -<p><span class="smcap">Sir</span>,—You will receive from Dr. Latta, the details of two or three cases -treated by saline injections. We have both been so much occupied to-day, that -we have not had leisure to get our communications ready to be sent in the -same envelope. We steal an hour from the time usually allotted for rest to -write to you. In case Dr. Latta should omit to mention the circumstance, I beg -to mention that his patient, Cousins, the woman who was injected to the amount -of three hundred and seventy-six ounces, and who promised to do well, for a -considerable time, was a person of very dissipated habits.</p> - -<p>In the Drummond-street hospital six patients have been injected, and three -recovered, or are recovering. In the three that died, extensive organic disease -was found on dissection; disease that had existed previously to the attack of -cholera.</p> - -<p>I send herewith the report of two cases, treated by Dr. Craigie of this place, -which, at my request, he furnished me to-day for the perusal of the Board.</p> - -<p>I intended to have sent an account of an interesting fatal case, the only one -in which the venous injection may be said to have fairly failed where it was -fairly used; that I shall do to-morrow.</p> - -<p class="center">I have the honour to be, sir, your most obedient servant.</p> - -<p class="right">ROBERT LEWINS, M. D.</p> - -<p><i>Leith, May 27th.</i></p> - -<h3>No. 5.</h3> - -<p class="center"><i>Details of Two Cases of Malignant Cholera treated by Venous Injection, by Dr. -Craigie, of Leith.</i></p> - -<p><i>No. 1. Case successful. 15lbs. injected at intervals in nine hours.</i>—Martha -Smith, aged thirty-eight, a noted drunkard, thin and debilitated, in sixth month -of pregnancy, admitted into the hospital at 8 P. M. May 16th, 1832.</p> - -<p>It appears she had had vomiting and purging since Sunday morning, 12th -inst. Cramps came on about four hours ago in both legs; great evacuations -both upwards and downwards like dirty water. The countenance is now collapsed; -eyes sunk; tongue cold; pulse imperceptible at wrists; very small in -brachial artery; 124.</p> - -<p>℞. Muriat sodæ, ℨiij; Carbon sodæ, ℨi; Aq. calid. ℔vj. solve. Ft. Enema -statim injiciend. Sinapisms to spine and epigastrium; let her be placed on -heated tin mattress.</p> - -<p>Nine A. M. Has a good deal of vomiting; is getting warmer; pulse now<span class="pagenum"><a name="Page_68" id="Page_68">[68]</a></span> -perceptible in right wrist; tongue warmer; she allows the enema to come away -without giving notice to nurse. Saline enema as above, with the addition of -white of eggs, to be repeated every half hour.</p> - -<p>Ten. Vomiting and purging of watery fluid, with slimy matter in it.</p> - -<p>Half-past ten. Cramps have returned severe in left leg; pulse again imperceptible; -urgent thirst, and constant vomiting. <i>Rep. enema et pulveres effervescentes.</i></p> - -<p>Half-past eleven. Breathing becoming much affected; extreme restlessness; -cramps severe in legs, and every symptom of sinking. Let the following saline -solution be injected into one of the veins of the arm.</p> - -<p>℞. Muriat sodæ, ℨi; Carbon sodæ, gr. x; Aq. calid. ℔iij, solve temp. 105° -Fahr.</p> - -<p>Noon. When about ℔i. had been thrown in, the pulse was perceived to flutter -at the wrist, and gradually strengthened as the injection was proceeded -with. By the same ℔iiiss. had been injected, the countenance, which was before -quite death-like, now beamed with the appearance of health, and she began -to converse freely. Pulse 96, moderate. To have ℥i. gin in warm water -with sugar.</p> - -<p>Half-past one. The gin was immediately rejected. Pulse has again gradually -become imperceptible, and respiration quick and laborious.</p> - -<p>Two. Let the venous injection be repeated to ℔vij.</p> - -<p>The effect of the injection, as formerly, was very striking. To see an individual -who seemed <i>in articulo mortis</i> brought back, as it were, in so short a -space of time to an apparently tolerable state of health, could not but astonish -the beholder. Before the injection was finished the pulse had returned to a -healthy fulness and firmness. Expresses herself much relieved; no purging, -but vomits much serous matter.</p> - -<p>℞. Muriat sodæ, ℨij; Carbon sodæ, ℨi; Alcohol. dilut. ℥i; Aq. calid. ℔iij. -M. ft. enema statim injiciend.</p> - -<p>Four. Enema retained about an hour and a half; surface of body now comfortably -warm; she has not passed more fluid by stool than was thrown into the -rectum.</p> - -<p>Six. Has slept softly for an hour; the first sleep she has had for many days.</p> - -<p>℞. Subm. hydrarg. gr. v; Pulv. opii, gr. ss. M. sumat stat. et rep. 3tia quaque -hora.</p> - -<p>Nine. Complains much of vomiting and sense of weakness; countenance -rather collapsed; breathing rather difficult.</p> - -<p>Let ℥lxxx. be injected into the veins again gradually.</p> - -<p>After the first few ounces were thrown in she complained of an acute pain -at the epigastrium, and faintness, probably arising from the fluid being thrown -in too fast upon the heart, or from the passing of a bubble or two of air, which -may have got in from the inaccuracy of the injecting apparatus used. Be that -as it may, the circulating system was so much affected, that the pulse, from -being distinct though feeble, became quite imperceptible, but on stopping the -injection for a few minutes the pulse gradually returned, and the pain abated. -She expresses herself as always getting relief from the operation.</p> - -<p>Eleven. Vomiting continues urgent.</p> - -<p>App. emp. cantharid. epigast. Effervescing draughts occasionally.</p> - -<p><span class="pagenum"><a name="Page_69" id="Page_69">[69]</a></span></p> - -<p>May 17th. Has passed about ℔j. of urine, of natural appearance; this is the -first she has made since she was brought in.</p> - -<p>From this time she went on gradually to improve, but stomach continued very -irritable, and the matter vomited was bilious.</p> - -<p>21st. Labour pains came on, and she was delivered of a still-born female -child.</p> - -<p>22d. Symptoms of phlebitis in right arm came on, proceeding from the -wound upwards, but this yielded to the ordinary treatment, and she may now -be considered out of all danger, though she is not yet reported cured.</p> - -<p class="right">THOMAS CRAIGIE, M. D.</p> - -<p><i>Leith, May 26th, 1832.</i></p> - -<hr class="r15" /> - -<p><i>No. 2. Case fatal—appearances on dissection.</i>—George Cousins, aged ten, was -brought into quarantine at nine, A. M. 13th May, on account of his mother being -ill of cholera. About an hour after admission began to vomit and purge, and -it appears he has had diarrhœa severely all the morning. Pulse 102, extremely -weak; complains much of sickness; countenance collapsed; areolæ rather dark -under the eyes; voice very weak.</p> - -<p>He had hot air-bath immediately, and got the following dose:—</p> - -<p>℞. Ol. ricini, ℥ss; Tinct. opii, gtt. xv; Aq. menth. pip. ℥iss. M. ft. haust.</p> - -<p>Half-past eleven, A. M. Draught retained; sickness has gone off; complains -of heat of bath; let it be removed.</p> - -<p>Noon. Has vomited some watery matter, with undigested potatoes in it, and -again a rice-watery fluid with flocculi. He has now a considerable degree of -jactitation; countenance more sunk, and great desire for cold water. These -symptoms went on increasing in severity in spite of sinapisms to spine, effervescing -draughts, calomel, and Dover’s powder, warm water, enemeta, &c., and -head symptoms were now making their appearance.</p> - -<p>Half-past two P. M. Pulse quite imperceptible, and has been so for an hour -and a half; he lies quiet and drowsy, with eyes turned upwards; face bedewed -with cold perspiration; hands and feet cold and very blue.</p> - -<p>My colleagues, Drs. Combe and Lewins, saw him with me at this time, and -concurred with me in thinking him not only beyond all hope of recovery, but -likely to die <i>within an hour or two</i>.</p> - -<p>From what I had seen of the resuscitating powers of Dr. Latta’s treatment -on the boy’s mother this morning, by venous injection, I determined on giving -it a trial, though this was a case rather likely to bring discredit on the remedy -than otherwise. The following solution, at temperature 102° F. was slowly -injected into the median basilic by means of a common silver blow-pipe attached -to Reid’s enema syringe:—</p> - -<p>℞. Muriat sodæ, ℨi; Carbon sodæ, gr. x; Aq. calid. ℔vj. solve. T. 102.</p> - -<p>Three P. M. A few minutes after the injection was commenced the pulse -returned to the wrists, the blueness and coldness of the extremities gradually -wore off; the countenance was much improved; and the whole fluid was injected -within twenty minutes.</p> - -<p>Half-past three P. M. He has now a healthy, blooming appearance; is sitting -up in bed, and looking about him as if awoke out of a dream. Pulse 110, natural; -extremities of good colour and warm; voice much stronger.</p> - -<p><span class="pagenum"><a name="Page_70" id="Page_70">[70]</a></span></p> - -<p>Half-past four P. M. Pulse has been gradually falling off since last report; -is getting listless, and dislikes to be troubled with questions, breathing becoming -laborious, and head symptoms more marked, with squinting to a slight degree -superadded.</p> - -<p>Seven P. M. Pulse again imperceptible; respiration quick and laboured; -countenance collapsed; tongue and breath cold; says he is dying.</p> - -<p>Let the venous injection be repeated to ℔iij.</p> - -<p>Half-past seven P. M. Pulse immediately returned, of natural strength and -fulness, and continues so.</p> - -<p>Nine P. M. Lies very quiet; pulse good; breathing more natural; surface of -body covered with warm perspiration.</p> - -<p>Ten P. M. Large watery evacuations from the bowels came on soon after -last injection; the quantity cannot easily be guessed, but must have been considerable, -as it is running through the mattress on the floor. Pulse scarcely -perceptible; screams loudly like a child in hydrocephalus.</p> - -<p>Eleven P. M. Pulse quite imperceptible; is sinking fast; venous injections -attempted a third time, but desisted from as it was not productive of the first -good effects. Both pupils much dilated. Died at two A. M. 14th.</p> - -<p><i>Dissection fifteen hours after death.</i>—On exposing the brain and spinal marrow, -but before opening their investing membranes, the least pressure with the fingers -on the middle of the hemispheres of the brain caused a remarkable undulating -down to the middle of the back, showing the existence of a fluid beneath -the membranes, and on opening them about two drachms of pure serum flowed -out.</p> - -<p>The surface of the brain was rather vascular, and the blood in the most minute -vessels particularly bright. A few ecchymosed spots on its surface. All -the other viscera were found healthy. The urinary bladder contained about -half an ounce of urine.</p> - -<p class="right">THOMAS CRAIGIE, M. D.</p> - -<p><i>Leith, 26th May, 1832.</i></p> - -<h3>No. 6.</h3> - -<p class="center"><i>List of Queries addressed to Drs. Lewins and Latta, by the Central Board of -Health, London, relative to the preceding cases, &c.</i></p> - -<p class="center">QUERIES BY THE CENTRAL BOARD.</p> - -<p>1. Were any of your patients bled previously to, or after the saline injections -into their veins?</p> - -<p>2. Were the evacuations by purging, vomiting, or perspiration, increased by -the injections?</p> - -<p>3. Did any of the patients submitted to the saline injection plan die; and if -examined after death, what were the appearances?</p> - -<p>4. Had the pulse at the wrist absolutely ceased, and for how long; or had -blueness of the surface taken place, and to what extent, in any of your patients -before the injection of the saline fluids; and how many of such patients recovered -under that treatment?</p> - -<p>5. Had suppression of urine been <i>perfectly</i> established, and for how long, in<span class="pagenum"><a name="Page_71" id="Page_71">[71]</a></span> -any of your cases previously to the saline injection, and what effect did that -practice appear to produce on the urinary secretions?</p> - -<p>6. What effect did the injections appear to have on the temperature of the -patient?</p> - -<p>7. Were the blood and evacuations analysed before and after the injections?</p> - -<p>8. Did consecutive fever occur in any, and if so, in how many of your cases, -whether successful or otherwise?</p> - -<p>9. Was the quantity of the evacuations noted before and after the injections -in any of your cases?</p> - -<p>10. Please to give the details of two or three cases treated by saline injections, -with age, condition of life, temperament, habits, &c., and particulars of -such other treatment as may have been adopted in addition to the saline injections.</p> - -<p class="center">ANSWERS BY DR. LEWINS.</p> - -<p>1. None before. One to the amount of twelve ounces immediately after the -first injection.</p> - -<p>2. The evacuations by purging and vomiting, in most of the cases continued. -In some of them the purging, the discharge from the bowels at least, was increased. -Perspiration was increased in all.</p> - -<p>3. Yes; no less than ten of the fifteen that have been injected up to the present -day; but under such circumstances as do not detract from the general -merits of the practice: this will be made evident by the history of the cases -that will be sent by to-morrow’s post.</p> - -<p>4. Yes; even at the axilla in some of the cases, blueness of the surface had -taken place to a considerable extent. Five of these patients recovered.</p> - -<p>5. Complete suppression, I think, in all except two, and for hours. In all -the successful, and in some of the unsuccessful cases, the effects of the injection -in restoring the secretion of urine were most evident.</p> - -<p>6. The injections raised the temperature of the body; but in all the successful -cases, where the veins were injected, the patients complained of cold soon -after the injection.</p> - -<p>7. Neither the blood nor the evacuations were analysed, but I sent some of -the blood of a patient that had been injected by the veins, to Dr. Reed for -analysis to-day.</p> - -<p>8. The consecutive fever in all the patients who were injected, has been -slight.</p> - -<p>9. No; but they were excessive in most of the cases.</p> - -<p>10. Question ten shall be fully answered by to-morrow’s post.</p> - -<p class="right">ROBERT LEWINS, M. D.</p> - -<p><i>6 Quality Street, May 26th, 2 o’clock, A. M.</i></p> - -<h3>No. 7.</h3> - -<p class="center"><i>Latest Communication from Dr. Lewins to the Secretary of the Central Board of -Health.</i></p> - -<p>Sir,—The urgency of my present private and public duties prevents me from<span class="pagenum"><a name="Page_72" id="Page_72">[72]</a></span> -communicating more to you to-night than the following brief particulars of a -case that occurred at the Leith Cholera Hospital yesterday:—</p> - -<p>A woman of about forty years of age, was admitted on Sunday evening at -7 o’clock. She was <i>pulseless</i>, even at the axilla, <i>sightlesss</i>, <i>cold</i>, and <i>blue</i>, over -almost the whole body. <i>Respiration</i> very slow and irregular—in a word, she -was all but lifeless. It was feared she would be dead before the operation of -injecting could be commenced. Between 7 at night and 2 o’clock next morning, -there were thrown in two hundred and eighty-four ounces, upwards of -twenty-three pounds. The report of her situation at 2 on Monday morning, in -the hospital book, is as follows:—“A change for the better, that appears almost -miraculous, has taken place. The action of the heart is greatly improved; -respiration not in the least laborious, but quicker than natural; pulse 120, small, -but distinct. She can articulate distinctly; countenance natural; lips red; tongue -moist and warm; she perspires freely; heat over the whole body natural.”</p> - -<p>A full report of this wonderful case shall be forwarded soon.</p> - -<p class="center">I remain, Sir, &c.</p> - -<p class="right">ROBERT LEWINS.</p> - -<p>P. S.—In one, the pulse had ceased at the wrist eight hours before the injection. -Dr. Alison had seen the patient eight hours before the operation, and -the pulse was then imperceptible.</p> - -<p><i>Quality Street, Leith, May 29th, 1832, 1 o’clock, A. M.</i></p> - -</div> - -<hr /> - -<h2><i>Origin of the Cholera at Quebec.</i></h2> - -<p class="right"><i>Board of Health, Quebec, June 25th, 1832.</i></p> - -<p>The undersigned, appointed by the Board of Health to investigate and report -upon the introduction and treatment of the cholera, now existing in this country, -have agreed to the following Report, which they respectfully submit.</p> - -<p>The disease, on its first appearance in this city, exhibited all the characters of -that commonly called the Asiatic or Spasmodic Cholera. It commenced about the -8th instant, in boarding houses and taverns in the Cul-de-Sac—a low, uncleanly, -and ill-ventilated part of the city—crowded with emigrants of the lowest description, -with sailors and other persons of irregular habits.</p> - -<p>About the fourth day of the disease, (the 12th,) it showed itself in the more -elevated parts of the city, among the wealthier classes of society, and persons -of sober and regular habits, who could have had but little, if any, direct communication -with the people among whom the disease had first appeared.</p> - -<p>About the same date, (the 12th,) the disease was observed in various parts -of the city, and in several neighbouring parishes, some few miles distant, having -a constant intercourse with it.</p> - -<p>The cases continued to increase in number until about the 16th or 18th, -(being the 8th or 10th day of the disease,) when they began to subside, both -in number and in violence—the disease still prevailing more extensively in the -ill-ventilated parts of the city above mentioned. About the period of its greatest -prevalence, (the 8th or 10th day of the disease,) the number of cases was -estimated to be between 250 and 300, in the course of twenty-four hours.</p> - -<p><span class="pagenum"><a name="Page_73" id="Page_73">[73]</a></span></p> - -<p>The undersigned have not as yet been able to discover that any case of cholera -has been landed from any vessel in the harbour, before nor until several -days after its first appearance in the city.</p> - -<p>They deem it necessary to add, that some parishes in the neighbourhood of -Quebec have continued free from the disease until lately, and that no case appears -to have yet occurred at Three Rivers, an intermediate and populous town -between Montreal and Quebec, where the steamboats with emigrants from -Quebec, generally arrive.</p> - -<p>Since the appearance of this malady, only two soldiers have been attacked -in Quebec, and those while on duty—the rest being closely confined to their -quarters.</p> - -<p>The symptoms were the most violent at the commencement, and continued -so until about the 16th or 18th, when they began to mitigate in severity, as the -cases diminished in number.</p> - -<p>In the treatment of this disease, recourse has been had to almost every remedy -favourably reported of by European practitioners, and they all have had, -for a time, their advocates—some preferring stimulants, others opiates, while -others satisfied themselves with an intermediate plan of treatment—the whole -of the medical practitioners with one accord agreeing, however, in the application -of external stimulants, such as oil of turpentine, mustard, warm applications -and frictions; calomel and opium have been much relied on by many. -Practitioners speak with confidence of blood-letting at the onset of the disease, -and before an approach to collapse has been recognised. Sweating has been -much practised, and decidedly with advantage, when it is not allowed to run -into that state of collapse indicated by a pulseless wrist, dejected countenance, -blue extremities, tongue and breath cold, and a sunken voice, feeling as if it -passed through the ears.</p> - -<p>Some instances have been noticed, and also observed by our intelligent -clergy, as well as by ourselves, where, in some mild forms of the disease, nature -effected a cure by copious perspiration, encouraged by warm drinks and extra -clothing.</p> - -<p>The undersigned, with one accord, have found purgatives injurious, if used -before perspiration or blood-letting had been resorted to, to allay the irritable -state of the stomach and bowels; and then only the milder purgatives should -be employed, such as calomel or blue pills, guarded with minute doses of opium, -and carried off, after a few hours, with rhubarb, combined with soda and carbonate -of ammonia.</p> - -<p>Signed, Jos. Morrin, Health Commissioner; W. A. Hall, Resident Physician; -F. X. Tessier, Health Officer; Wm. Lyons, Superintendent of the Emigrant -Hospital.</p> - -<hr /> - -<h2><i>Origin of the Cholera at Sunderland.</i> By <span class="smcap">T. M. Greenhow</span>, Esq. -of Newcastle.</h2> - -<p>The assumed capability of Cholera being conveyed by shipping from one -country to another, on which our system of quarantine is founded, very naturally -gave rise to the suspicion, when it first appeared in the port of Sunderland, -of its having been imported from some place on the Continent, where it -was known to prevail; and several stories were in circulation descriptive of the<span class="pagenum"><a name="Page_74" id="Page_74">[74]</a></span> -manner in which it had thus been introduced. I shall not here repeat any of -these tales, suffice it to say that none of them have been in any degree authenticated. -That the ships which were blamed for having committed the mischief, -were found to have been from uninfected ports, their bills of health clean, and -their crews healthy; in point of fact they were fairly acquitted of the charge; -and I believe the conviction is now almost universally entertained by the inhabitants -of Sunderland, medical and non-medical, that the disease did not reach -that place from any foreign source whatever. It may be further stated that the -first case of cholera which took place in this part of the country, was at a considerable -distance from Sunderland, having been at a small village called Team, -about two miles south-west of Newcastle. This case occurred to Dr. Alexander, -of Newcastle, on the 4th of August, 1831. The details are given in the Appendix, -No. I.; other cases occurred at Newcastle simultaneously, if not before -the regular appearance of the disease at Sunderland; although want of experience -of its true characteristics, and unwillingness to believe in the fact, induced -medical gentlemen to endeavour to prove that these were not cases of the new -disease; yet subsequent observation has sufficiently proved their identity, and, -I believe, it is now generally admitted. Such were the cases of Oswald Reay, -which occurred in October, of William Armstrong in the beginning, and of -Robert Jordan towards the end of November. On the 7th December the next -case occurred, that of Maria Mills, with which commenced the official reports -of the Board of Health of this place. The strictest inquiries respecting the -origin of these cases have failed to obtain the slightest evidence of their having -arisen from any infected source, and seem to prove, in the most satisfactory -manner, that, however the disease may have since extended itself, its commencement -in the country was spontaneous, upon whatever causes it may have -depended.</p> - -<hr /> - -<h2><i>On Asiatic Cholera Morbus</i>. By <span class="smcap">Paul M. Eve</span>, M. D. of Augusta, -<i>Georgia</i>.</h2> - -<p>Believing it criminal to withhold from the medical profession anything on the -Cholera Morbus at this moment, and conceiving it a duty to comply with the -request of the editor of the American Journal of the Medical Sciences, I send -the following observations which were made last summer while I was in Europe. -I had felt a reluctance to make a further communication to the public on this -engrossing subject, which was warranted and justified from my late situation -in the Polish army; my time and attention having been almost exclusively devoted -to surgical cases, and opportunities of investigating this disease having -been comparatively limited. If it is thought, however, that my observations, -imperfect as they are, and that my opinion, humble as it is, can in any way -serve my fellow-labourers in the treatment of this modern plague, I most willingly -and cheerfully present them my views on the subject.</p> - -<p>As I have neither time nor inclination to write a long article, I will briefly -state the principal symptoms of the Asiatic Cholera Morbus, the appearances -on dissection, and then deduce from them the treatment. An attack is usually -preceded by diarrhœa or by uneasiness in the stomach and bowels for some -days, or is suddenly announced by vomiting and purging, commencing about -three o’clock in the morning, when the temperature is lowest of the twenty-four -hours; and is followed and accompanied by cramps or spasmodic contractions<span class="pagenum"><a name="Page_75" id="Page_75">[75]</a></span> -of the abdomen. There is great prostration of the animal powers; shrinking -of the external parts, particularly of the features, which assume in many -places as well as the fingers and toes, a leaden or purple appearance; a cold and -moist or even a wet skin, conveying when felt, the sensation of touching a frog; -great thirst; the tongue is blue and cold, or moist and partly covered with a -white fur; the pulse is either imperceptible at the wrist or is quick, frequent, -feeble and intermitting; respiration is slow and very difficult; the voice is much -altered, questions and answers being made in a low whisper; the secretions, -particularly of the kidneys, are diminished, except into the alimentary canal, -where they are altered and augmented, without however any bile; purging and -vomiting, sometimes one only, but generally both; first the contents of the stomach -and intestines are discharged, and then a peculiar whitish fluid resembling -rice-gruel or sero-albuminous matter; and lastly, cramps of the extremities, -most frequently of the legs, and which may be compared to a bayonet piercing -the calf or most muscular part.</p> - -<p>The appearances after death, were almost constantly the same. The external -parts were very much diminished in size; the extremities, the nose, lips, eyelids, -cheeks, &c. were of a bluish or livid colour, and the skin was wrinkled -upon the hands and feet. The vessels of the brain in some subjects contained -black blood, but generally there was nothing peculiar in the contents of the -cranium. There was more blood in the spine, probably arising from position. -The heart, lungs and large vessels were filled with a fluid resembling tar in colour -and consistency. Two hours after death it was liquid and appeared like -venous blood; but at twenty-four hours it seemed deprived of serosity and of -the property of coagulation, and albuminous concretions were found in the -heart. The stomach and intestines were either empty or contained matter similar -to the vomitings and purgings; their coats were contracted and paler than -in a natural state, or as was most frequently the case, presented all the varieties -from congestion to sub-inflammation. The liver and vena portæ were distended -with black blood, and the gall-bladder with tenacious, dark yellow, or green -bile. In almost every case the bladder was found empty and contracted.</p> - -<p>From the above symptoms and results of post mortem examinations, it would -seem that the pathology of the cholera morbus may be explained by a want of -oxegenation of the blood, which becoming surcharged with carbon is unfit to -stimulate the heart to contraction, and hence the congestion upon the internal -and vital organs at the expense of the surface and extremities. With this pathological -view of the disease, and from the positive fact of there being a centripetal -action of the blood, is easily deduced the principle of conducting its -treatment—the equilibrium of the circulation must be restored or death will -ensue. Now, mechanically speaking, there are two ways of affecting this object, -either by introducing a power which will give the blood a centrifugal -direction, or calling it back to the surface, by direct external applications. But -the animal economy is governed by other as well as mechanical laws; the vital -properties of the heart are oppressed, its energy is diminished, and its power -of reäction impaired by an accumulation of blood, and this is peculiarly the -case when the blood is black or not oxegenated; the stimuli or powers introduced -to rouse its action would therefore be worse than useless; besides, we -usually address the heart through the stomach, which is in such an irritable -state as to reject even the mildest article. Upon the surface, on the contrary, -there is a want of action, and stimuli are called for to excite the skin; to restore<span class="pagenum"><a name="Page_76" id="Page_76">[76]</a></span> -its lost or increase its feeble circulation, and thus draw the blood and heat from -the internal parts of the extremities.</p> - -<p>The plan of treatment which I have found most successful, consisted in varying -the following means according to circumstances. Within the first four hours -after an attack, bleeding will generally be necessary; but when prostration has -ensued and when the surface is covered with cold sweat, leeches to the epigastric -region, or cupping followed by warm fomentations or mustard plaster or -blister, together with frictions and heat to the extremities, will afford the -greatest and most speedy relief. Notwithstanding the various and multiplied -articles of the materia medica which have been recommended, as opium, calomel, -oxide of bismuth, cajuput oil, spirits, &c. to allay vomiting and purging -and calm spasms, I must give my decided preference to dermoid applications, -which invite the blood from the heart, lungs, liver, stomach, &c. the congestion -of which produces these symptoms. I do not deny that there are cases which -can be, and are relieved by medicines; but, since we possess no remedy which -can drive the blood from the centre to the surface—since all internal medicines -are apt to excite vomiting, one of the most painful, distressing and fatal symptoms -of cholera—and moreover, since we possess means which can be easily -managed and varied to suit circumstances, and whose action is plain and evident -to the senses—I cannot forsake them to launch upon the sea of experiment -and conjecture, in the treatment of this rapid disease. The language of those -who advocate the administration of internal remedies, is to give so much of a -mixture or so many pills, and if they produce <i>vomiting</i>, repeat the dose; but if -a cure is to be effected by relieving the symptoms, why give those medicines -which excite or aggravate them? An infusion of peppermint, or the oil or essence -of this plant, with a few drops of laudanum, in a little warm brandy and -water, is what I have found best adapted for internal use; and even this should -be prohibited when it produces vomiting. This symptom is often so distressing -and so easily excited, that the stomach will reject whatever is presented to it. -In such cases, I rely upon the horizontal position, perfect rest, and heat and -frictions to the abdomen and extremities, without administering any thing internally. -The warm bath I have known to be of great service, but the time -necessary to prepare it and the exposure of the body to the air, are serious objections -to its general employment. The same will not hold good in relation to the -vapour bath, where the patient can be kept continually warm. Excessive thirst -is best relieved by cold gum water, or by a piece of ice dissolved in the mouth.</p> - -<p>Having enjoyed an opportunity of comparing the practice of the English, -French, German and Poles, while stationed at Warsaw, in the months of May, -June, July, and August, of the past year, and having experienced personally -the disease, I feel some confidence in recommending the above treatment of -the Cholera, to the American practitioner of medicine: and in support of its -correctness and superiority, I will state that at Wisnia, a town of Gallacia, out -of two hundred and forty persons attacked with it who were subjected to cutaneous -frictions, and to the internal use of only an infusion of chamomile and -peppermint <i>two alone died</i>.</p> - -<p>To prevent an attack of cholera, cleanliness and sobriety ought to be most -rigidly observed. All sudden or great impressions upon the system, as changes -in the temperature of the air, cold and moisture, or emotions of the mind, excessive -joy, fear, and the depressing passions, should be carefully avoided. The -body to be kept moderately warm, a belt of flannel is recommended to be<span class="pagenum"><a name="Page_77" id="Page_77">[77]</a></span> -worn; and the mind calm, and confiding in a protecting Providence. The diet -should be regular, and without any material change in the accustomed repasts. -Emetics and purgatives are to be avoided, and certain articles of nourishment -which are known to predispose to colic, or cholera affections; these are bad -beer, sour-crout, cabbage, salad, beans or peas, spinage, cucumbers, pickles, -unripe sour fruit, musk and water melons, cold meats, sour milk, &c. Good -soups, beef, mutton, veal, fowls, eggs, Irish potatoes, bread, and tea in preference -to coffee, should constitute the principal food of those who inhabit an infected -district.</p> - -<p>After all that has happened to admonish us, we can still hope that the cholera -may not reach the Southern States. Its general course has been north-westwardly; -from Calcutta it reached the Russian Empire; from Constantinople -it passed to Great Britain. Although it existed in Hungary and in Vienna, still -Lombardy, Switzerland, and Italy, have escaped; and the same thing is applicable -to France and Paris, in relation to Spain and Portugal. It has not even -existed in cities of the South of France, and Quebec and Montreal are nearly -in the latitude of Paris; besides, these two Canadian cities are remarkable as -being the most filthy and ill-ventilated of America. If it has progressed in a -north-westwardly direction, and if it has avoided a southern latitude in Europe, -why may we not escape its dreadful ravages? Let us, however, be prepared -to meet it, that if it ever does come, we may be ready to cure the distressed, -to relieve the afflicted, and to lessen the sufferings of the dying victim.</p> - -<p><i>Augusta, June 30th, 1832.</i></p> - -<hr /> - -<h2><i>Non-Purgative Salts in Cholera.</i></h2> - -<p>The following statement, relative to the treatment of cholera in -the prison at Cold Bath Fields, are interesting, and are said by the -editor of the London Medical Gazette, to be entitled to entire confidence -as to its accuracy.</p> - -<div class="blockquote"> - -<p>“The first twelve cases occurred in the vagrant’s ward, and the patients were -attacked soon after some prisoners had been admitted from St. Giles’s, and other -infected districts. The first case that was reported as cholera, occurred on the -5th of April. This man was suddenly attacked, and died after a very short illness -with all the symptoms of the prevailing epidemic.</p> - -<p>“When the first cases occurred, there were in all about twelve hundred -persons in the prison; but, up to the beginning of this month, they were not -afflicted with bowel complaints, nor, in fact, with any other epidemic disease, -being as healthy as they generally are at that season of the year.</p> - -<p>“The first four cases were treated in the common way, with brandy and -opium, an ammoniated mixture, ginger, sinapisms to the region of the stomach, -the hot air-bath, &c. &c.; and all of them died after a short illness.</p> - -<p>“Since the 4th of April, up to this date, (April 17,) forty cases in all have -been under treatment. Of this number, nineteen were admitted into the Observation -ward with the premonitory symptoms of cholera. All of these had -bowel complaints and suspicious ejections; some of them complained of severe -pain in the abdomen, sickness of the stomach, and in several cases these symptoms<span class="pagenum"><a name="Page_78" id="Page_78">[78]</a></span> -were attended with cramps, chiefly in the lower extremities. The whole -of them were immediately treated by Mr. Wakefield with non-purgative saline -remedies, recommended by Dr. Stevens, and in general they were convalescent -in one, two, or three days, from the commencement of this practice. From -this we may infer, that where the disease is attended to early, and <i>properly -treated</i>, the state of collapse may be prevented in nineteen cases out of twenty.</p> - -<p>“We must state, however, that as the numbers increased, it became necessary -to dismiss those that appeared to be least ill, on purpose to make room for -others. Of those that were dismissed as convalescent, two were reädmitted -soon after in a state of collapse, and though every attempt was made to save -them, yet they both died after a very short illness, with the symptoms of cholera -in its most virulent form. With the exception, however, of the two that -died, none of the cases, (seventeen in number,) were reported to the Central -Board, partly, we believe, from a wish to avoid spreading alarm with respect -to the prison, and partly because the disease was checked in the beginning; -consequently, the patients had not <i>all</i> the symptoms of cholera, such as occur -in the worst cases, or in the last stage.</p> - -<p>“In addition to the above seventeen which were not reported, there were -twenty-one cases where the symptoms of cholera were very distinctly marked. -Of this number, four of the early cases were treated in the common way, with -diffusible stimuli, &c. &c., and all of them died after a short illness. These, -with the two cases of relapse from the Observation ward, make in all six deaths. -Mr. Wakefield, however, having lost all faith in the common treatment, changed -the practice:—at the request of Dr. Stevens, the other fifteen cases were put -under the saline treatment, and all of them recovered.</p> - -<p>“When the patients were first admitted, the following powder was immediately -given, either in half a tumbler of tepid water, or occasionally in a little -thin, clear, beef-tea:—</p> - -<p>“Supercarbonate of Soda, ℨss. Muriate of Soda, ℈j. Chlorate of Potass, grs. -vii.</p> - -<p>“The above was given every hour, and continued until the patients were -recovering from the state of collapse; after which it was diminished in frequency, -in proportion as the reäction increased.</p> - -<p>“In all these cases, the outline of the practice was nearly the same; but in -several instances the treatment was varied according to circumstances. When -the stomach, for example, was extremely irritable, it was found that the carbonate -of soda, given by itself, or the tartrate of soda, in a state of effervescence, -were the most effective remedies that could be used on purpose to allay the -irritation, so as to enable the stomach to retain the stronger salts.</p> - -<p>“During the progress of the disease, an enema, with a large table-spoonful -of muriate of soda, dissolved in warm water, was administered with or without -sugar, starch, &c. every three or four hours, at as high a temperature as the -patients could well bear it. Sinapisms were also applied as early as possible to -the region of the stomach, betwixt the shoulders, &c.; and in the cold stage, -frictions were also frequently used with warm towels. Of the seventeen cases -that were treated in this way, two died, (namely, the two patients who were -reädmitted in a state of complete collapse,) making in seventeen cases, two -deaths, and fifteen recoveries. But including the whole of those that were -under the saline treatment, the total amount is, in thirty-six cases, two deaths, -and thirty-four recoveries.</p> - -<p><span class="pagenum"><a name="Page_79" id="Page_79">[79]</a></span></p> - -<p>“The cases in question were under the care of Mr. Wakefield, the medical -attendant of the establishment, and during his absence they were attended to -by Mr. J. Wm. Crooke, who kept notes of the cases, and saw that the medicines -were properly administered. We may add, also, that Mr. Wakefield, with -a degree of fairness which does him great credit, invited Dr. Stevens to attend -along with him to witness the effect of the saline treatment, which has here, we -may say, for the first time, been fairly tried in this disease.</p> - -<p>“We can also state, that the cholera made its appearance about the same -period amongst a small colony of Italians, who live in a narrow lane within a -few hundred yards of the prison. Of these, eleven were attacked. The three -first cases were treated by bleeding, brandy, and opium, all used at the same -time, and they all died. The other eight cases were attended by Mr. Whitmore, -a surgeon in the neighbourhood, who, having witnessed the effects of -the saline treatment in the prison, adopted it. All his patients speedily and -completely recovered, except one, who, on the 13th, was so ill that he was not -expected to live many hours; even he, however, is now in a state of convalescence. -<i>Thus there have been in all fifty-three cases, seven of which were treated -in the common way, with diffusible stimuli; and out of this number seven died; -while, of the forty-six that were under the saline treatment, there were two deaths -and forty-four recoveries.</i>”</p> - -</div> - -<hr /> - -<h2><i>Cholera at New York.</i></h2> - -<p>The decrease of cholera at New York during the past week has -been exceedingly slow; nevertheless, there can be no doubt that the -disease has passed its zenith in that city.</p> - -<table summary="New York cholera report"> - <tr> - <td>August</td><td>1st,</td><td>No. of cases,</td><td class="tdr">92</td><td>deaths<a name="FNanchor_1" id="FNanchor_1"></a><a href="#Footnote_1" class="fnanchor">[1]</a></td><td class="tdr">53</td> - </tr> - <tr> - <td></td><td>2d,</td><td></td><td class="tdr">81</td><td></td><td class="tdr">56</td> - </tr> - <tr> - <td></td><td>3d,</td><td></td><td class="tdr">90</td><td></td><td class="tdr">38</td> - </tr> - <tr> - <td></td><td>4th,</td><td></td><td class="tdr">88</td><td></td><td class="tdr">54</td> - </tr> - <tr> - <td></td><td>5th,</td><td></td><td class="tdr">96</td><td></td><td class="tdr">39</td> - </tr> - <tr> - <td></td><td>6th,</td><td></td><td class="tdr">101</td><td></td><td class="tdr">51</td> - </tr> - <tr> - <td></td><td>7th,</td><td></td><td class="tdr">89</td><td></td><td class="tdr">28</td> - </tr> - <tr> - <td></td><td></td><td>Totals,</td><td class="tdtotal">637</td><td></td><td class="tdtotal">319</td> - </tr> -</table> - -<div class="footnotes"> - <div class="footnote"> - <p><a name="Footnote_1" id="Footnote_1"></a><a href="#FNanchor_1"> - <span class="label">[1]</span></a> These are taken from the city - inspector’s reports of burials.</p> - </div> -</div> - -<p>Whole number of deaths in New York during the week ending 4th -August, according to the city inspector’s report, 580, of which 383 -were from malignant cholera, 1 cholera morbus, 5 diarrhœa, 8 dysentery, -30 cholera infantum, 2 inflammation of the bowels, and 10 unknown.</p> - -<p>The whole number of cases of malignant cholera from the 1st July -to 7th August inclusive, reported by the Board of Health, 4497; -number of deaths as reported by the same, 1799. The report of the -City Inspector, which is manifestly the more accurate, gives the -number as 2295.</p> - -<hr /> - -<p><span class="pagenum"><a name="Page_80" id="Page_80">[80]</a></span></p> - -<h2><i>Health of Philadelphia.</i></h2> - -<p>The epidemic whose approach we confidently announced a month -since, is now prevailing among us, and appears as yet scarcely to -have attained its maximum. The public mind having been prepared -to expect its visitation, and quieted, to a considerable extent, by the -preparations made for its reception, there has been little excitement, -and certainly none of that panic which has elsewhere been so favourable -to its ravages.</p> - -<table summary="Philadelphia cholera report"> - <tr> - <td>Number of cases reported August</td><td>2d,</td><td class="tdr"><span class="fnspacer">40</span></td> - </tr> - <tr> - <td></td><td>3d,</td><td class="tdr"><span class="fnspacer">35</span></td> - </tr> - <tr> - <td></td><td>4th,</td><td class="tdr"><span class="fnspacer">45</span></td> - </tr> - <tr> - <td></td><td>5th,</td><td class="tdr">105<a name="FNanchor_2" id="FNanchor_2"></a><a href="#Footnote_2" class="fnanchor">[2]</a></td> - </tr> - <tr> - <td></td><td>6th,</td><td class="tdr"><span class="fnspacer">136</span></td> - </tr> - <tr> - <td></td><td>7th,</td><td class="tdr"><span class="fnspacer">136</span></td> - </tr> - <tr> - <td></td><td>8th,</td><td class="tdr"><span class="fnspacer">114</span></td> - </tr> - <tr> - <td colspan="2">Total for the week,</td><td class="tdtotal"><span class="fnspacer">611</span></td> - </tr> -</table> - -<div class="footnotes"> - <div class="footnote"> - <p><a name="Footnote_2" id="Footnote_2"></a><a href="#FNanchor_2"> - <span class="label">[2]</span></a> Forty of these cases were in the - Arch St. Prison, and not being reported until the next day, the number - of cases appears from the report of the Board of Health to be, August - 5th, 65, and on the 6th of August, 176.</p> - </div> -</div> - -<p>We hope in our next No. to be able to present a tabular view of -the cases, showing the number each day from the commencement of -the epidemic, the situations in which they have occurred, &c.</p> - -<p>The following table exhibits the whole mortality, and also that -from bowel complaints for the 1st week in August for five successive -years.</p> - -<table summary="Mortality for the 1st week in August, five successive years"> - <tr> - <td class="tdr">1828.—</td><td>1st week, ending - August 2d. Whole mortality, 129; of which, the deaths - from cholera morbus were, adults, 3; children, 32; Total, - 35.—Diarrhœa, adults, 2; children, 1; Total, - 3.—Dysentery, adults, 0; children, 5; Total, - 5.—Total from bowel complaints, 43.</td> - </tr> - <tr> - <td class="tdr">1829.—</td><td>1st week, ending - August 8th. Whole mortality, 89; of which, the deaths - from cholera morbus were, adults, 2; children, 18; Total, - 20.—Diarrhœa, adults, 2; children, 2; Total, - 4.—Dysentery, adults, 1; children, 2; Total, - 3.—Total from bowel complaints, 27.</td> - </tr> - <tr> - <td class="tdr">1830.—</td><td>1st week, ending - August 7th. Whole mortality, 80; of which, the deaths - from cholera morbus were, adults, 0; children, 21; Total, - 21.—Diarrhœa, adults, 1; children, 0; Total, - 1.—Dysentery, adults, 1; children, 1; Total, - 2.—Total from bowel complaints, 24.</td> - </tr> - <tr> - <td class="tdr">1831.—</td><td>1st week, ending - August 6th. Whole mortality, 111; of which, the deaths - from cholera morbus were, adults, 0; children, 23; Total, - 23.—Diarrhœa, adults, 1; children, 5; Total, - 6.—Dysentery, adults, 1; children, 3; Total, - 4.—Total from bowel complaints, 33.</td> - </tr> - <tr> - <td class="tdr">1832.—</td><td>1st week, ending - August 4th. Total mortality, 243; of which, the deaths - from cholera morbus were, adults, 1; children, 30; Total, - 31.—Malignant cholera, adults, 81; children, 3; - Total, 84.—Diarrhœa, adults, 5; children, 4; Total, - 9.—Dysentery, adults, 3; children, 2; Total, - 5.—Total from bowel complaints, 129.</td> - </tr> -</table> - -<p class="titlepage">PHILADELPHIA—CAREY & LEA—CHESNUT STREET.</p> - - - - - - - - -<pre> - - - - - -End of the Project Gutenberg EBook of The Cholera Gazette, Vol. I. 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