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THE
CHOLERA GAZETTE.

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[66] 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.

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.

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.

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Injection of Saline Solutions into the Veins.

(Continued from page 55.)

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.

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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[74] 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[75] 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[76] 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[77] 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.

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.

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.

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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.

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.

PHILADELPHIA—CAREY & LEA—CHESNUT STREET.