A practical treatise on the history, prevention, and treatment of epidemic cholera, designed both for the profession and the people

Preface

The object of the Author of this little volume has been, to present the physicians and reading public of the valley of the Mississippi with an authentic digest of the most important facts relative to the Causes, Symptoms, and Treatment of the Epidemic which is now impending.

Most of the chapters will be found sufficiently divested of technical terms, to be intelligible to the general reader; while no part, the author natters himself, will be thought beneath the dignity of the profession.

As the work has been most hastily compiled, in the midst of pressing engagements, and under continued ill healih, it will be found greatly deficient in gravity and polish of style; but not, the Author hopes, in the general accuracy of its statements.

It has been his aim throughout, to adapt it, as much as possible, to the condition and constitutions of the people, among whom it is designed to circulate, and to whom, he trusts it will be of some value; not merely in the approaching crisis, but annually, when cholera morbus and cholera infantum are reproduced upon us, by the heat of summer. Indeed, all that is said on the Prevention, and much of what relates to the Treatment of the Epidemic, is as applicable to our indigenous, as to the dreaded variety of foreign Cholera.

Cincinnati, Ohio, July 20, 1832.

Prevention and Mitigation of the Disease, - 166

EPIDEMIC CHOLERA.

Chapter I. Geography And Chronology Of The Disease

The word Cholera, a term introduced into every modern language, is formed from two Greek words, and signifies, a flow of bile. Joined, as it has long been, with a Latin word, Morbus or disease, a phrase is formed, the meaning of which is generally understood. It literally imports a disorder in which bile flows off" by vomiting and purging; but is also applied to attacks attended with the latter symptoms, although no bile may be discharged.

Such a malady may arise at any season of the year, in persons who accidentally swallow certain poisons, as tartar emetic, or corrosive sublimate; or eat, by mistake, deleterious mushrooms; indulge themselves in the use of indigestible articles of food or drink; or ingurgitate excessive quantities of healthy aliment. This is called, Occasional or Sporadic Cholera.

In hot countries, and in the temperate zone about the period of greatest heat, which, in the valleys of the Western States, is generally from the twentieth of May to the first of August, cholera morbus, as the disease is named in adults, and the cholera infantum, or the same malady in children, is a common complaint. This is Endemic Cholera, and arises directly from heat, or from some cause that is annually reproduced by heat and moisture acting on decomposable substances, or from something connected, in some unknown manner, with a summer temperature; being alwaysmost intense and general, in the hottest weather. This malady, as we all know, is often fatal; and when it kills promptly, the symptoms do not differ widely from those of the epidemic, which is the object of this volume.

Epidemic Cholera, unlike the last variety, in not constantly arising and disappearing with the hot season, has spread from country to country; and prevailed, though not with equal violence, throughout the whole year, and in the most opposite topographical circumstances. This is the pestilence which now alarms the civilized world, and threatens shortly to visit us.

Origin and Progress of Epidemic Cholera.

The term Asiatic, so generaNy applied to this variety, indicates its origin. From time immemorial, it has occasionally ravaged India, being in fact an endemic of that country, as the cholera morbus is of this. It has not often happened, however, that the disease has travelled beyond the limits of the hot region, in which it was generated.

The present Epidemic seems to have commenced in the year 1817, in the delta of the Ganges. The first accounts of it were from the city of Jessore, eighty or one hundred miles northeast of Calcutta, in the month of August; but it was afterwards ascertained that it prevailed in some parts of Nuddeca as early as the month of May. Before winter, it laid waste a great number of towns, along the Ganges, and in various parts of the peninsula of Hindoostan, including Calcutta, where it manifested itself early in August. Thus, the Epidemic, during the same unpropitious summer, broke out almost simultaneously in different and distant places.

It does not comport with the plan of this work, to trace its progress, from year to year, over Asia, till it entered Europe, in 1829; but I may remark, that for a period of twelve years, it prevailed constantly in some part of Asia. Extending eastwardly, it invaded Siam, Cochin China, China proper, and reached Pekin in 1825. Leaving the continent, it visited Java, the Philippine and many other islands, — extending even to Banda, nearly in the Pacific ocean, in longitude 128° east. To the south of the Indian peninsula, it assailed the island of Ceylon, and even reached Bourbon, in the southern hemisphere. To the west, it passed the Indus, meandered the northern shore of the Persian gulf, ascended the Tigris and Euphrates, and arrived at Antioch, Aleppo, and other places, near the eastern extremity of the Mediterranean. Arabia seems to have resisted its progress to the south ; but to the north, different parts of the Persian empire were signally scourged, and the pestilence spread quite to the sources of the Ganges and Indus. The Himmalah mountains alone seemed to stay its progress.

Before proceeding to trace the course of the Epidemic in Europe, let us enumerate some of the facts connected with its Asiatic history.

1. As already stated, it appeared in various places nearly at the same time.

2. After visiting a town or city, it frequently, within a few months, or in some subsequent year, returned upon it with equal or greater violence.

3. It often left towns and narrow slips of country unaffected, prevailing quite around them; and sometimes attacked them subsequently, when adjoining places were healthy.

4. It affected both town and country; but most of the reports concerning it are drawn from the former.

5. In towns, it has generally raged with the greatest virulence where the population was most dense. It has sometimes confined itself to one side of a street, and often left considerable portions of a city untouched, although free intercommunication existed.

6. In several instances, it has seemed to be introduced into towns by ships, or caravans of travellers ; at least, has commenced soon after their arrival, and spread rapidly, when it did not exist there before.

7. It has frequently arisen in towns, which had not had any known intercourse with places in which the disease prevailed. It has appeared in ships at sea, which, for a long time before, had not been exposed to it on land.

8. It has constantly been disposed to assail large assemblages of people.

9. The armies of Asia have been peculiarly obnoxious to it. When marching, they have been suddenly and mortally assailed. Whenever the army has dispersed in small bands, the disease has ceased. One wing of an army has sometimes been affected, while the other continued healthy. A detachment of troops has, sometimes, while afflicted with the disease, rejoined the main army, without communicating the malady. A marching army has been suddenly attacked, and as suddenly relieved, by changing its place of encampment. In marching, the disease has appeared and disappeared in an army, two or three times, according as it prevailed or did not prevail, in the districts over which the march was directed.

10. All over Asia it has prevailed most on the margins of rivers, near their mouths, and in other damp and vaporous localities.

b2

11. It has often prevailed on one side of a river, for some time, and then crossed to the other.

12. Sometimes it has attacked the inhabitants of dry and elevated places. It has even ascended to the height of five or six thousand feet.

13. It has often traversed countries in the direction of their great roads; but to this there are many exceptions.

14. It has equally affected the Hindoos, the Europeans resident in India, and the natives of that country, descended from European parents.

. 15. Every where in Asia it has fallen most heavily upon the alarmed; the poor; the aged, and those enfeebled by previous disease or great exertion; those who lodged in confined, damp, and dirty places; the intemperate; the half famished ; and those who exposed themselves to the night air.

16. In India it has generally affected adults much more than children, and men more than women; in some places, however, the reverse of the latter has occurred.

17. Cholera patients have often been received into the general hospitals, without communicating the disease to the other patients; on the other hand, the disease has sometimes seemed to spread in this manner.

18. Physicians and nurses have been observed to be less subject to attacks than other people; but they have occasionally been affected; and in a few instances have appeared to contract the disease from such exposure.

19. The disease has sometimes prevailed throughout all seasons of the year, but has generally been suspended or much mitigated in winter.

20. In most instances, its invasion has been sudden; and, like -other epidemics, it has been most fatal at the onset. The subsequent cases have become milder and more manageable. At length it has disappeared, leaving, in many places, a large number untouched. The proportion of those affected by it, has varied exceedingly in different towns. Its duration has sometimes not exceeded a fortnight; but in other, cases, it has continued for two or three months. In general, the more dreadful the energy of the invasion, the shorter has been its duration.

21. In various parts of India and Persia, earthquakes have occurred several times since the epidemic first arose. In one instance it appeared with great mortality in a body of troops, immediately subsequent to a violent tornado. At other times it has ceased after thunder storms.

22. The winds have not seemed either to hasten or retard the march of the epidemic.

23. It has commonly made its attacks in the latter

part of the night.

24. In many places, mortal diseases in the domestic animals, both birds and quadrupeds, have been observed to precede or accompany its visitations upon the inhabitants.

25. It has not ceased in Asia since its introduction •into Europe.

Such are the principal and the most important results of the observations made in Asia. Let us now turn our attention to Europe.

For twelve years the epidemic ravaged India, Persia, and Syria, without passing the borders of the Caspian sea, and the summits of the Ural mountains. In the month of August, 1829, it entered Russia. The town of Orenburg, situated on the right bank of the river Ural, in latitude 51° N., and longitude 72° E., has generally been regarded as the place first affected. I shall transcribe from the elaborate report of a committee of the Fjrench Academy of Medicine, made to the government in July, 1831, what seems to be an impartial digest of the facts in this case.

' Behold then the Cholera primarily established in a city which scarcely presented any general cause of insalubrity. It is true, that the season immediately preceding that in which the Epidemic appeared, had been irregular, inconstant, and marked by great atmospheric vicissitudes; the humidity, especially, had been great and sudden, succeeding prolonged heats and extreme drought.

' It is also true, that a considerable quantity of fruits of an indifferent or bad quality had been gathered in this year, and the inhabitants had freelyeaten of unripe water-melons and cucumbers. ' It is also true, that the koumiss, a species of drink made from fermented mare's milk, had failed, and still more the knout, an analogous but better drink, made from the milk of the sheep and the cow.

' But already, in antecedent years, had all these anti-hygienic conditions been frequently presented, in the same degree, and in similar combinations, yet without the least appearance of Epidemic Cholera.

'Let us further add with respect to fruits, that subsequently to their absolute interdiction, and notwithstanding the rigid measures adopted by the public authorities to effect their total exclusion from the city, the disease increased with greater activity and counted a greater number of victims.

' The Cholera having appeared then at Orenburg, notwithstanding the salubrity of this city, it became necessary to seek elsewhere for its origin ; the epidemic reason not being as yet presented to meditative minds, or rather this reason alone was not deemed satisfactory.

'It is in this state of the question, that the origin of the disease has been attributed to an importation imputed, by some, to the caravans arrived from Boukaria and Khiva, and by others, to the commercial relations established with the neighboring hordes of Kirguis-Cossacks.

' The Kirguis, a wandering and half-savage people, encamped in the immense steppes, beyond the Ural mountains, being in constant commercial intercourse with Turkestan, Boukaria, and Khiva, have long been in the habit of furnishing Orenburg with sheep, felt, camlets, &c. Now, when the Cholera appeared at Orenburg, we know that the epidemic was extending its ravages in Chorazan, in Asia, and Persia.

'Let us, however, examine both assertions, that is to say, the importation of the Cholera by caravans, and by the Kirguis. 'On the 26th of August, 1829, at nine in the morning, surgeon-major Smirnorff detected the Cholera Morbus in Andre Yvanhoff, a soldier of the 3d battalion of the line, then in garrison at Orenburg, who was carried to the military hospital at Orenburg, where he died at about the expiration of twelve hours from the commencement of the disease.

'From the 26th of August to the 9th of September, no other person in Orenburg was attacked with the Cholera.

'On the 9th of September, at 11 o'clock in the night, another soldier, of the same battalion of the line, likewise attacked with this malady, was brought to the military hospital. He died towards 5 o'clock in the evening of the following day.

'The day after, September 10th, two other patients were sent to the hospital, one of whom died, the other was cured. In both these cases, the disease had progressed with less rapidity than in the two preceding.

'On the 11th, a soldier of the same battalion was attacked and carried to the hospital; then on the

14th, a soldier of the battalion of invalids; again, on the 16th, two other soldiers of the same battalion ; and, finally, on the 17th, two non-commissioned officers.

'During the whole of this time, and until the 18th of September, only two individuals among the citizens of Orenburg had been seized with the malady; both of whom died. One was an excise officer, the other a tradesman.

'The commerce of Orenburg, a city altogether commercial, has for a long time been maintained in frequent, extensive, and important relations with Asia, India, and Persia; it is at least since 1813, that the city of Orenburg has been in the habit of admitting annually the caravans coming from Kiachta and Boukaria: now, the Cholera reigned epidemically in these countries during the month of August, 1817; and it was not until August, 1829, that it first made its appearance at Orenburg.

' The caravans from Boukaria and Khiva arrived in July, (the 20th at the latest,) at Orenburg, were admitted into the Court for Strangers, after sanitary visits and inspection, but the Cholera was not manifested until the 26th of August.

' Convoys making a part of these caravans, had entered about the same time into the fortresses of Orstia and Troitzka, yet the Cholera did not appear in these two fortresses.

'The guards and camel-drivers, hired by these caravans, in one place and in another throughout their route, have entirely escaped the disease.

'It must also be noted, that these Asiatic traders loaded and unloaded their camels during their journey; that whenever they arrived at an aoula, or encampment of Kirguis, they made numerous exchanges of merchandize for provisions of every sort, which consequently rendered it necessary to unpack the bales in which they were contained ; yet, notwithstanding these different operations, there has not been a single instance in which Cholera was communicated.

'From the 26th of August, the day in which the first patient, the soldier Yvanhoff, was attacked by the disease, and who died with it on the same day, until the 9th of September, there was not a single individual seized with the Cholera at Orenburg.

'The Cholera suddenly makes its appearance among the poorer class of people, in individuals worn down by hard labor and debilitated by extreme want. It was not first observed among customhouse officers in continual communication with the suspected Kirguis, and in constant contact with the suspected articles of merchandize. It has not attacked the merchants who purchased camlets, felts, and furs; it has respected easy or rich people who carried them. The traffic-market of Orenburg, situated at a distance of three versts* from the city, on the right bank of the Ural, where, during the whole summer and one-half of the autumn, the Russian and Asiatic merchants reside and exchange their

.About two miles; a tent being nearly two-thirds of an English mile.

merchandize with that of the Kirguis, it would seem ought to have been the first theatre on which the disease appeared; yet, notwithstanding, it was in a lesser proportion and at a later period, that these quarters were attacked.

' The Cholera had existed a long time in the city of Orenburg, when it broke out in the badly constructed fauxbourgs which constitute the boundaries of it.

'Now it was not until the 28th of September that information was received of the first appearance of the Cholera in the environs of Orenburg; and, surprising circumstance ! whilst the villages nearest to the city, having intimate relations and constant communication with it, were altogether exempt from the Cholera; whilst the fortresses adjacent to Orenburg, and situated in the line of the two principal roads which terminate at this place, preserved their habitual salubrity, — during this time, the Cholera exhibited its accustomed ravages in villages at some distance from Orenburg, and also in a fortress situated at more than a hundred versts from the city, which had maintained but very little communication with it.

' The villages lying east from Orenburg, between the Ural mountains and the city, but beyond the latter, in the line of communication of Asia with Orenburg; these villages, Nieginka and Kaminoe for instance, although built along the upper Ural, and having free intercourse every hour, as well as c every day, with the city, have not been invaded by the malady.

'In the military hospital of Orenburg, the Cholera began on the 26th of August, and did not cease its reign until the 20th of November; the number of persons attacked with the disease was two hundred and ninety-nine, of which number two hundred and twenty were cured, and seventy-nine died. We have stated above, that the garrison consisted of six thousand men.

'In the city of Orenburg, the disease did not commence until the 15th of September; and on the 20th of November there was not, either in the city, or its suburbs, a single patient with the Cholera. Of the entire population of the city and its fauxbourgs. which is estimated at seven thousand, there were eight hundred and one patients, out of which number six hundred and eighty were cured, and one hundred and one died.

'Immediately after the city of Orenburg, the first two villages attacked by the epidemic were the burgh of Rassipnoe and the village of Bicoulovoy, placed at a great distance from one another, upon two diverging routes, having intermediate to them a great number of other towns and villages which were not attacked at all or not until a later period, and also having much less communication with one another than each of them had with certain other places until then remaining unmolested by the disease.'

In making this long extract, from a work to which I am indebted for many of the foregoing facts, I do not propose, in this place, to enter on the difficult question of the mode in which Epidemic Cholera extends itself. I presumed that some discussion of the circumstances of its entrance into Europe, would not be without interest. Let us now inquire, whether, in its extension over that continent, it observed the same laws as in Asia.

However, the first appearance of Epidemic Cholera in Europe, was in reality six years before, at Astrachan, in the delta of the river Volga, not far from the Caspian sea. It is remarkable, that after prevailing for a time in that city, it ceased, without extending beyond its limits.

In 1830, about the 1st of July, it reappeared, and soon began to show itself to the east, the north, and the west. In the second week of October, it commenced in Moscow, where it prevailed till January. In the ensuing spring, 1831, it broke out in Archangel on the White sea, in lat. 65°, and on the 12th of June commenced in St Petersburg; where it raged for a time, ceased,and then recurred. A month before, it had manifested itself in Riga, at the mouth of the Dwina, in the southwest cornerof Russia proper; and at Danzig, another town of the Baltic sea, in Prussia; having already affected most of the vast country, between that sea and the Caspian.

Meanwhile extending along the shores of the sea of Azof, and the northern side of the Black sea, it ravaged the southern provinces of Russia; and, overspreading Hungary and Poland, extended beyond them into Prussia and Austria, quite to Hamburg, on the Elbe. Dipping down the Dardanelles, it affected Constantinople, and recrossing into Asia Minor, fell with violence upon Smyrna, in lat. 38°, below which it did not occur.

As yet, it had not extended west of the 10th degree of east longitude; but in the Autumn of the same year, 1831, in which it ravaged the countries lying south of the Baltic, it appeared in England. Its onset was at Sunderland, a coal town, at the mouth of the river Wear, in the northeastern part of the kingdom. Well authenticated cases occurred in August, but no alarm was sounded, till the month of October. It prevailed till February, extending to the towns and villages on the Wear and Tyne, including New Castle, Gateshead, and other places, in the great coal district; and, extending into Scotland, raged with considerable mortality in the villages and country, quite to Edinburg and Glasgow, inclusive. In the month of March, it appeared in London, where, however, it affected comparatively but a small number. About the same time, without invading the centre and west of England, including the great commercial and manufacturing towns of Liverpool, Birmingham, and Manchester, it opened on ill-fated Ireland, and overran most of the island ; being attended in many places with great mortality. In May, it broke out in Paris, and raged for two or three weeks, with deadly violence. What may have been its spread in that kingdom, is not, at this time, known with any certainty.

Thus, the parts of Europe which remain unvisited, are Holland and Belgium to the north, and the states which border on the Mediterranean sea — Greece, Italy, Naples, Switzerland, the southern part of France, Spain, and Portugal — to the south.

Having briefly sketched the progress of the Epidemic in Europe, let us inquire, for a moment, whether its character has undergone a change on that continent. Many of the facts necessary to this inquiry are still wanting in this country. From what I have seen, I would say:

1, That the laws of its propagation seem to be the same in Europe, as in Asia. It has, as in its native country, extended itself along navigable rivers, and highways; sought out maritime towns; fallen heavily upon the great armies engaged in advancing and resisting the plans of despotism; passed by villages and districts of country, affecting places on both sides and beyond them; sought out the poor, the terrified, the afflicted, the badly lodged, clothed, and fed; the intemperate; the exposed; and the dwellers in damp and unventilated places. But it has, also, stricken many in the opposite of all these circumstances.

2. It has penetrated further north in Europe than in Asia; and, as we have just seen, has spared many southern countries, lying nearly in latitudes which it has repeatedly ravaged in Asia. It will doubtless

reach them also.

c2

3. It has prevailed more severely, in the winter season, in the high latitudes of Europe, than in the mild winters of India and Persia.

4. In many instances, it has appeared to be communicated from man to man; while, as in Asia, the atmosphere of the sick has generally seemed to be harmless ; and it has broken out in several places where no suspicion of extraneous introduction could be raised.

5. Quarantines and military cordons, neglected, generally, in Asia, have been instituted and enforced in Europe, without resisting its progress.

6. The governments, and the medical men of Europe, both contagionists and non-contagionists, have satisfied themselves, that the disease cannot be propagated by inanimate objects of any kind.

7. The character of the Epidemic in Europe, has varied a little in two respects from its Asiatic type. First, it has been much more commonly preceded by diarrhoea, or some kind of intestinal irritation; and secondly, much oftener followed by a fever of the typhus form.

8. Its mortality, in proportion to the number attacked, has been greater in Europe than Asia. In the former it has sometimes been as high as one out two, and frequently two out of five; while in Asia, the average mortality has not exceeded one out of six or seven.

9. It is worthy of remark, that in London, a small number, proportionally, were affected, and the deaths exceedingly few, compared with many villages of the kingdom, allowing for the difference of population. In Paris, on the other hand, it attacked multitudes; ascended, in many instances, into the higher ranks of society, and proved extensively fatal; events well calculated to humble the pride of science, as that city is the great emporium of medical learning; the whole of which had been put into requisition, and such deliberate preparations made for the reception of the pestilence, as led many of its physicians to predict, that it would prove but a small calamity to the people of France !

10. The cause or causes which have produced such striking differences in its mortality, in different towns, have not yet been discovered.

Leaving the Old World, we come to contemplate Epidemic Cholera in the New.

From the gazettes, it appears that on the 9th of June, of the present year, a malignant cholera morbus suddenly broke out at Quebec, among the Canadian French, and wretched emigrants, chiefly from Ireland, who had, during the spring, been thrown in thousands upon the banks of the St Lawrence. It quickly spread over the city, and affected many of the natives in comfortable circumstances. In a few days it was at its height, and before two weeks, had sensibly declined; indeed, nearly ceased. On the 11th or 12th, the same malady manifested itself in Montreal, 129 miles further up the St Lawrence, where it raged with great mortality ; but on the 24th of June was nearly extinct. Meantime it made its appearance in many of the villages surrounding those two cities; and affected the Canadian French still more, it is said, than the emigrants, multitudes of whom had ascended the river as far as Montreal, and even above.

The question has been started, whether this be any thing else, than the ordinary endemic of the country, in an aggravated form? It is impossible, from the data, which have, as yet, reached Cincinnati, to resolve this question; but from the suddenness of the invasion, and its short duration, the multitudes taken down, its great prevalence among the poor and exposed, its alarming mortality, and the concourse of symptoms, I am compelled, till other facts shall be made public, to regard it as an extension of the Asiatic Epidemic. The question whether it will extend into the United States, from Canada, will probably be answered in the affirmative, before these pages see the light. For, whether propagated by contagion or atmospheric influence of any kind, its entrance into our country is not likely to be prevented, unless the laws of its diffusion should be different in America from those of Europe and Asia. Moreover, we had, last autumn, a wide-spreading influenza, so often the precursor of more violent epidemics, and a visitant of Europe the year before the Cholera; and, at the present time, July 4th, there is in this city, and no doubt other parts of the United States, a great deal of diarrhoea, and many mild cases of endemic cholera morbus, both of which were harbingers of the Epidemic Cholera in England. The pestilence may not, however, overspread the United States during the present summer, for it has often lingered a year on the confines of a country without entering, and then made a sudden and mortal irruption.

Chapter II. Causes Of The Disease

A disease so wide-spreading and mortal as Epidemic Cholera, must of course have a powerful and pervading remote cause, but what it is, has not yet been discovered. The ingenuity of the profession has suggested several, but strong objections lie against the whole. Let us review them.

1. Sol-lunar Hypothesis.

Epidemic Cholera has been ascribed to the influence of the sun and moon. But, as the disease has been progressive through various latitudes and longitudes, and persons have been taken down at every hour, from the new to the full moon, and from the latter to the former, the hypothesis of sol-lunar influence, would seem to be altogether visionary.