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.

August1st,No. of cases,92deaths[1]53
2d,8156
3d,9038
4th,8854
5th,9639
6th,10151
7th,8928
Totals,637319

[ [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 August2d,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.