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