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.