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+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.
+
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+Project Gutenberg (https://www.gutenberg.org) public repository for
+eBook #52859 (https://www.gutenberg.org/ebooks/52859)
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-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
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-<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:&mdash;℞. 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&mdash;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&mdash;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, &amp;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>,&mdash;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>&mdash;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&mdash;appearances on dissection.</i>&mdash;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:&mdash;</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, &amp;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:&mdash;</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>&mdash;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, &amp;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, &amp;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,&mdash;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:&mdash;</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&mdash;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:&mdash;“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, &amp;c.</p>
-
-<p class="right">ROBERT LEWINS.</p>
-
-<p>P. S.&mdash;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&mdash;a low, uncleanly,
-and ill-ventilated part of the city&mdash;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&mdash;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&mdash;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&mdash;some preferring stimulants, others opiates, while
-others satisfied themselves with an intermediate plan of treatment&mdash;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, &amp;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&mdash;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, &amp;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, &amp;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&mdash;since all internal medicines
-are apt to excite vomiting, one of the most painful, distressing and fatal symptoms
-of cholera&mdash;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&mdash;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, &amp;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, &amp;c. &amp;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, &amp;c. &amp;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:&mdash;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:&mdash;</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, &amp;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, &amp;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, &amp;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.&mdash;</td><td>1st week, ending
- August 2d. Whole mortality, 129; of which, the deaths
- from cholera morbus were, adults, 3; children, 32; Total,
- 35.&mdash;Diarrhœa, adults, 2; children, 1; Total,
- 3.&mdash;Dysentery, adults, 0; children, 5; Total,
- 5.&mdash;Total from bowel complaints, 43.</td>
- </tr>
- <tr>
- <td class="tdr">1829.&mdash;</td><td>1st week, ending
- August 8th. Whole mortality, 89; of which, the deaths
- from cholera morbus were, adults, 2; children, 18; Total,
- 20.&mdash;Diarrhœa, adults, 2; children, 2; Total,
- 4.&mdash;Dysentery, adults, 1; children, 2; Total,
- 3.&mdash;Total from bowel complaints, 27.</td>
- </tr>
- <tr>
- <td class="tdr">1830.&mdash;</td><td>1st week, ending
- August 7th. Whole mortality, 80; of which, the deaths
- from cholera morbus were, adults, 0; children, 21; Total,
- 21.&mdash;Diarrhœa, adults, 1; children, 0; Total,
- 1.&mdash;Dysentery, adults, 1; children, 1; Total,
- 2.&mdash;Total from bowel complaints, 24.</td>
- </tr>
- <tr>
- <td class="tdr">1831.&mdash;</td><td>1st week, ending
- August 6th. Whole mortality, 111; of which, the deaths
- from cholera morbus were, adults, 0; children, 23; Total,
- 23.&mdash;Diarrhœa, adults, 1; children, 5; Total,
- 6.&mdash;Dysentery, adults, 1; children, 3; Total,
- 4.&mdash;Total from bowel complaints, 33.</td>
- </tr>
- <tr>
- <td class="tdr">1832.&mdash;</td><td>1st week, ending
- August 4th. Total mortality, 243; of which, the deaths
- from cholera morbus were, adults, 1; children, 30; Total,
- 31.&mdash;Malignant cholera, adults, 81; children, 3;
- Total, 84.&mdash;Diarrhœa, adults, 5; children, 4; Total,
- 9.&mdash;Dysentery, adults, 3; children, 2; Total,
- 5.&mdash;Total from bowel complaints, 129.</td>
- </tr>
-</table>
-
-<p class="titlepage">PHILADELPHIA&mdash;CAREY &amp; LEA&mdash;CHESNUT STREET.</p>
-
-
-
-
-
-
-
-
-<pre>
-
-
-
-
-
-End of the Project Gutenberg EBook of The Cholera Gazette, Vol. I. No. 5.
-Wednesday, August 8th, 1832., by Various
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