Epidemic cholera: its history, causes, pathology, and treatment ..

Front matter

PROF. C. B. GOTENTET

YALE MEDICAL LIBRARY

HISTORICAL LIBRARY

Preface

The numerous applications which have been made to the author for copies of his Report on Epidemic Cholera — which he was unable to furnish — and the absence of any publication containing a concise history of the origin and progress of the epidemic, have induced him to present the following pages to the public. In the summer of 1831, when the cholera made its appearance at Montreal, the writer was appointed by the Board of Health of the city of Utica, to prepare and present to the Medical Society of the county of Oneida an address on the subject. Much of the early history of the disease, together with the symptoms and post-mortem appearances, are taken from that address, as it is believed that subsequent experience has only served to prove the correctness of the very graphic and accurate description of the disease given by Annesley and other medical officers in India.

When the disease appeared in Albany and New York, the writer was appointed by the Common Council of the city of Utica to visit those places to investigate its nature. In his report which was published, he urged upon the Council the importance of removing those who had not sickened, from the houses and locality where the disease appeared — not from

VI PREFACE.

fear of contagion, but lest some local cause might exist which contributed to produce the disease. This practice has, since that time, been adopted in both London and Edinburgh with the most decided advantage. The author was in the city of New York whilst the disease was at its height, and both there, and subsequently at Utica, had ample opportunity of becoming familiar with its character.

In the winter of 1847 and '48 pur country seemed again threatened with this scourge, and the author visited Europe with instructions from the Medical Faculties of Geneva College and the University of Buffalo, to examine into its Pathology, Causes and Treatment; but the destroyer had been temporarily arrested in its course in Russia. The political disturbances in Europe rendered traveling both difficult and dangerous, so that, after making such investigations as were within his reach, he returned without having met the disease. The results of these investigations were presented to the respective Faculties in the form of a report, which was published in the Buffalo Medical Journal, in 1848.

For the views presented in this work the writer is alone responsible ; they are the results of much examination and reflection, with considerable experience in the treatment of the disease. He will not undertake to say that the treatment recommended is the best that could be adopted ; he can only say, that in his own hands it was so satisfactory that he was unwilling to hazard the welfare of his patients by tryinoother modes. The author is fully satisfied that the want of success in the treatment of cholera, does not arise so much

PREFACE. Vll

from want of skill in the practitioner, or the inefficiency of means, as in some cases, from the suddenness of the attack, when the patient is at once beyond the reach . of medicine — the absence of pain in the first stage of the disease, and the patient consequently thinking there is no danger, and neglecting treatment until too late — and as another, and, alas, too frequent cause of death a reliance upon some nostrum as a preventive, until too late to remove the disease. If there is one fact which should be more strongly urged upon community than another, it is the necessity of attending to the first premonition of the disease ; at that lime it is cured with almost certainty ; but if permitted to go on until the vital powers are paralized, medicine has no effect, and is useless.

EPIDEMIC CHOLERA.

HISTORY.

Cholera is a disease indigenous to India, and has prevailed to a greater or less extent since the first settlement of the country hy Europeans. Mr. Scott, who was Surgeon and Secretary to the Medical Board of the Presidency of St. George, has even attempted to trace accounts of the disease to the mythological writers of antiquity, but with what success, I cannot say. It is however described by Bontius, as prevailing in 1629, and by Paislesy, in 1774. Somerset, who traveled the Coromandel coast in 1774 and 1781, speaks of a disease resembling cholera, prevailing as an epidemic, and states that in one visitation of the disease, above 00,000 people from Cherigan to Pondicherry, perished. Jameson, in the Bengal Reports, mentions it as prevailing in 1781, and in 1782. Curtis gave the best description of the disease which had then been published. Cholera has also prevailed as an epidemic in Europe ; thus,

Sydenham describes it as prevailing in London in 1669, and Huxham in 1741, and it is said to have prevailed extensively in Paris in 1730 and 1738. In all these accounts, the description seems to correspond with the cholera morbus, so frequently seen as a sporadic and endemic disease — in the autumnal months — in our own country, viz., profuse discharges of bile. In 1813, the late Dr. James Johnson published liis valuable work on the diseases of tropical climates, in which he denies the bilious character of the disease, and gives a description corresponding with that of the malignant or epidemic cholera. From this period, little notice is taken of it untd 1817, when the disease broke* out with great violenoe — and from which period Annesley insists we should date its true history. The Bombay Reports state that "the cholera" first appeared in August of 1817, in Zila- Jepore, situated about 100 miles north-east of Calcutta. "There had been no previous marked peculiarity in the weather. The preceding hot and cold months were nowise different from those of former years ; and the rainy season was proceeding with ' its wonted regularity. To the authorities on the spot, the disorder seemed at first to be of a purely local description, and attributable to the intemperate use of rank fish and bad rice. They were soon undeceived ; after nearly depopulating the town of Jepore, it spread rapidly through the adjoining villages, and ran from district to district, until it brought nearly the whole Province of Bengal under its influence.

It next extended to Behar, and having visited the principal cities west and east of the Ganges, reached the- upper provinces. There its course was more irregular." Benares, Allahabad, Gornckpore, Lucknow, Cawnpore, and the more populous towns in their vicinity, were affected nearly in the regular course of time. But it was otherwise in the ' more thinly populated parts of the country. The disease would sometimes make a complete circle round a village, and, leaving it untouched, pass on as if it was about to depart from the district. Then, after a lapse of weeks, or even months, it would suddenly return, and scarcely reappearing in the parts which it had already visited, would nearly depopulate the spot that had so recently congratulated itself on its escape. Sometimes, after running a long course on one side of the Ganges, it would, as if arrested by some unknown agent, at once stop, and taking a rapid sweep across the river, lay all waste on the opposite bank. It rarely failed to -return, however, to the same track which it had left. After leaving a district or town, it sometimes re-visited it, but in such cases, the second attacks were milder and more readily subdued by medicine than in the primary visitation. The disorder showed itself in Calcutta the first week of September. Few were seized in the beginning, but of those few, scarce one survived. From January to May it was at its height, and during the whole of that period, the deaths in the city seldom fell short of two hundred a week. It in turn attacked every division, and almost every corps in the army. Its greatest fatality was in the middle division. There it commenced its attack on the 18th or 19 th of November, was at its utmost violence for four or five days, and finally withdrew in the first days of December. The division consisted of less than twelve thousand fighting men, and the deaths, at the lowest estimate, were three thousand, some say five, and even eight thousand. It seemed for a time to be arrested by the Bundlekinnd and Rewa lulls. It was at Jubbulepore on the 10 th of April, prevailed there, and at other subordinate stations, until the 21st, and nearly disappeared before the end o£ the month. Here its influence was singularly irregular. In the same camp, and under circumstances precisely similar, some corps of the army were entirely exempt; others had a few mild cases, and others again, suffered very severely. The same irregularity held in different descriptions and classes of troops. — {Bengal Reports.)

Tracing the disease from Bengal, we find it at Madras in October, and at the Island of Ceylon in December. By January 1819, it had reached the southernmost extremity of the Peninsula, and the Isle of Bourbon in January, 1820.

Following the route of the Ganges, it extended north and west, reaching Bombay in September of 1818. The Report of the French Commissioners say it first appeared in Bombay on the 11th of August, 1820, and carried off, previous to the mouth of February following, eleven hundred and thirty victims. Again it returned in September of 1821, accompanied by excessive heat, and destroyed, from the 23d to the 28th, two hundred and thirty-five persons. — {Report of the French Commissioners.)

In its eastern route, we find it at Arracan in 1818, at Sumatra and Java in 1819, Manilla, Canton, &c, in 1820, entering Pekin in 1821, where it prevailed during 1821, '22, and '23. By the end of the last year it had traversed the Molucca and Spice Islands, including the Isle of Timor, which seems to have been its southeastern boundary.

Returning to its northwestern course, we find it had reached Muscat, at the southern extremity of the Persian Gulf, in June of 1821. Passing up the Gulf, and ravaging the towns on each side, it extended inland, spreading from Busheen through Persia, and from Bassora through Asiatic Turkey. It reached Bagdad in 1821 ; Mosul and Taurus in 1822, and before the Autumn of 1823 had reached Antioch, where it appeared to pause in its course, proceeding no further in that direction. Dining this time it- had continued its ravages in Persia, appearing at Shiraa in September, 1821. For a time its further progress seemed stopped by the cold, but with the return of spring is revived its ravages, and by the close of 1822 5 almost every place of note in Persia had been visited by the pestilence. In August of 1823, the province of Shiroon was invaded, and after visiting Bakon and other ports on the Caspian, it reached Astrakan in September ; threatening Europe from that quarter, but after the severe winter weather commenced, it died away, relieving Russia from the threatened danger. As the disease did not return in the spring, Europe began congratulating herself on her escape. The disease occasionally appeared in a mild form in the places it had passed over, but pursued no regular route. In 1825, we find medical writers speaking of it as an epidemic which is past, and expressing the hope that it may never return.

Before proceeding to the history of the disease as it appeared in Europe, let us notice some of the conditions of its extension in India. In many instances we find the disease following the main route and avenues of communication from one city to another, particularly the course of the main streams. The congregation of large bodies of men — the fatigue, exposure, and intemperance inseparable from an army — seem particularly calculated to produce the disease. We find in India, that the cholera appeared almost simultaneously at different places in the same district, but in places remote from each other, and where there had been no intercommunication ; whilst other places in constant intercourse with the sick escaped entirely. Even in the midst of vast regions suffering from the disease, we find considerable tracts where it never penetrated. Annesley says " the hill forts in Kandiest remained exempt from cholera, while the disease inflicted the greatest ravages on the surrounding country. The individual attacks were so sudden and simultaneous in different parts of a city, that it is impossible to account for them on any other principle than by an epidemic cause. The great number attacked at the same instant — its fierce and rapid march — and its prompt disappearance in many instances after a continuance of only a few days, seems to preclude all idea of its communication by contagion. In almost every part of India, persons attending upon the sick have been attacked in less numbers than others. Cholera patients in large, well ventilated, and clean appartments, did not communicate the disease to patients in the same wards, laboring under other diseases." Dr. Johnson, who was Recording Secretary of the Medical Council of Calcutta, says, " Out of two hundred and fifty-three physicians who have attended to the disease throughout its whole course, three only were attacked with the disease, of whom one died. The medical authorities visited the hospitals both night and day, remaining there for a considerable time, yet none of the members were seized with the cholera." Dr. Annesley — for five years physician to the Madras Medical Establishment — had under his care a continued succession of patients, the average number being from one hundred and seventy to two hundred per day. The hospital was kept in a state of perfect cleanliness and free ventilation ; all the wards were opened and communicated constantly with one another. A great number of persons attacked with cholera were brought to it daily, and, notwithstanding these persons were intliscriminately dispersed among the other patients in the hospital, Mr. A. has never seen more than from six to seven cases developed in the house, and that during the space of five years.

The disease generally attacked those who were debilitated by forced marches, and by excesses of every kind : the poor — uncomfortably lodged, badly clothed, and imperfectly nourished — in a word, those who were suffering from the effects of fear or sorrow ; from exhaustion consequent on bodily fatigue or dissipation ; from filth, and from the privations of extreme poverty.

Annesley shows that in the first periods of cholera, the disease is usually rapid and most generally fatal ; in the second, more protracted, and more successfully treated ; and at a still later period, comparatively mild, of short duration, and rarely mortal. The disease usually ran a regular course of accession, increase, and decline. Thus in the centad division of the English Army, the cholera appeared on the 7th of November ; from the 16th to the 22d it was at its height ; towards its close it diminished considerably, and about the 2d and 3d of December had entirely disappeared. In the division of the left it appeared on the 10th of April; was at its vigor in the middle of the month, and after the commencement of the month of May there was not a case to be seen. It was similar in the other divisions. When considerable military detachments encamped in the midst of these epidemic jungles, (Foyers,) or when they merely traversed thein, the soldiers almost always contracted the cholera, and that in an intensity proportioned to the general predisposing causes, as fatigue, unwholesome food, &c. In many instances bodies of troops having the disease, formed junctions with other bodies, without the latter becoming affected. It was found that when the main body of troops were attacked with the disease, they were soon relieved by separating into small detachments. Annesley mentions several cases where detachments, quitting a station where the cholera prevailed, and losing several men on the route, when they reached the new station, we're free from the disease, neither did it make its appearance in the detachments which they joined. In one instance, it reigned with violence among the troops on the right of the line, whilst the 17th Regiment, occupying the left, were entirely free from it, though the intercourse between the two detachments was constant and uninterrupted. The Physico-Medical Society of Calcutta, in their Memoirs, exhibit numerous instances of local insalubrity, pervading almost every part of India, and also the great extent to which bilious intermittent and remittent fevers, colics, dysenteries,

&c., prevail, whilst on the other hand they mention places that remained entirely free from the disease. It seems that the winds neither hastened nor retarded the march of the cholera, neither did streams, rivers, lakes, nor arms of the sea, present any obstacle to its march. On the contrary, moisture seemed to favor its propagation. Although it is said to have appeared on high ground, yet it is certain that elevated positions were more exempt than the low grounds, and the inhabitants often fled to the hills to escape its ravages. In India the cholera has been observed at all seasons, but in northern regions it was certainly checked during the cold weather. Men were more frequently attacked than women and children. It was noticed on several occasions that the disease ceased suddenly after a severe storm accompanied with thunder. We shall see that the same circumstance occurred in this country. The invasion of the disease was most frequent in the night, or towards morning. In several instances, in India, it was noticed that a short time before, and at the time of invasion of the cholera, domestic animals, and particularly dogs, have been seized with severe and fatal diseases. In one instance a malignant intermittent fever prevailed at the same time with the cholera. Annesley, Johnson, Seakl, and others, observe that relapses were not unfrequent, and it has been noticed that those who recover from an attack of cholera are often for a long time troubled -with derangements of the bowels. An important fact, noticed by almost all the writers in India, was, that most of those persons who escaped an attack of cholera, had more or less derangement of the bowels.

PROGRESS OF THE CHOLERA IN EUROPE.

In 1829 the cholera reappeared in some of the Provinces of Persia, and in August it reached Orenburg, the capital of the province of the same name. The first authenticated case appeared on the 2Gth of August; on the 9th and 10th of September four cases occurred, and from this period the disease rapidly increased ; but by the 20th of November, it had entirely ceased ; of a population of eleven thousand, one thousand had the disease, but only two hundred of them died. There has been much speculation as to the cause of the disease at Orenburg. It is true, the season immediately preceding the cholera had been marked by sudden and extreme vicissitudes ; the humidity, particularly, had been very great, succeeding long droughts, a considerable quantity of fruits of an indifferent or bad quality had been used ; a species of fermented drink, which the people were accustomed to use, had failed, but ah these causes had frequently existed in previous years without producing cholera. By the advocates for contagion, it is said to have been brought by the caravans from Boukaria and Kliva, and by others, to the commercial relations with the neighboring hordes of Cossacks ; but caravans in previous years had arrived from cholera districts without bringing the disease. But what are the facts connected with its appearance ? On the 26th of August, 1829, at 9 o'clock in the morning, the surgeon detected the cholera in a soldier of the third battalion of the line, then in garrison at Orenburg. From the 26th of August to the 9th of September, no other person was attacked with the disease ; on the 9th of September, at 11 o'clock at night, another soldier of the same battalion was seized, and died about 5 o'clock the next evening. On the 10th two other patients were sent to the hospital, one of whom died ; the other recovered. On the 11th, a soldier of the same battalion was attacked ; on the 14th, a soldier of the battalion of Invalids ; on the 16th, two others of the same battalion, and on the 17 th, two non-commissioned officers. During the whole of this time, until the 18th, but two of the citizens had the disease, both of whom died. If the disease had really been brought by the caravans, the citizens in immediate intercourse with them shoidd have been first affected. On the 23d of September, it appeared at a fortress sixty miles west, and on the 30th, at a place twelve miles north, passing several villages in its course, leaving them untouched. By the middle of November, it had spread over an extent of two hundred miles. It seemed again checked by the cold, and by the middle of February, Russia was once more free from the disease.

In 1830 the cholera again appeared in some of the Persian Provinces on the Georgian frontier, on the Caspian Sea, visiting Bakin and Tiflis, the capital of Georgia, and on the 19th of July, had again reached Astrakan at the mouth of the Volga. In ten days, twelve hundred and ninety persons were seized, of whom four hundred and thirtythree died. From Astrakan it extended up the Volga, and on the 4th of August had extended two hundred and twenty miles, and on the 6th, two hundred miles further north, spreading in almost every direction. It reached Moscow about the middle of September, having traveled a distance of at least fifteen hundred miles in three months and a half. Extending south, and south-west, the following spring, it reached Warsaw about the middle of April, and the different ports on the

Baltic, in May of 1831. In June, of the same year, it had reached St. Petersburg. Shortly afterwards, it appeared at Archangel. Extending south, it was at Berlin in August, Vienna the following month, and on the 11th of October, at Hamburg.

The cholera made its appearance at Sunderland, in England, in October, 1831. On the 28th of November, there had been two hundred and ninety-four cases, of which sixty-eight had proved fatal, and thirty-two remained under treatment at the time of the report. It soon after appeared in London, and on the 18th of April, there had been twenty-four hundred and seventy-seven cases, of which, twelve hundred and one were fatal. In Dublin, ninety-four cases, and fifty-eight deaths. In Cork, eighty-five cases, and thirty-eight deaths. On the 19th, there had been, at Glasgow and the vicinity, eight hundred and ninety cases ; at Edinburgh, one hundred and seventy-one cases. On the 28th of March, it was publicly announced that the cholera was in Paris. It is unnecessary to trace the spread of the disease in the provincial towns of France, or describe the ravages which it committed in the metropolis. Before following it across the Atlantic, let us pause to examine, briefly, the character of its progress in Europe. From the first appearance of the disease at Orenburg, the district of Caen adopted the most severe, and particular precautions against its propagation ; even the punishment of death was pronounced against any infraction of the sanatary laws. Yet this district was ravaged by the disease. The strictest medical pohce was established throughout Russia, extending even to Moscow, without the least apparent effect in checking the progress of the disease. St. Petersburg, though eighty leagues distant from the nearest point where the cholera had appeared, was subjected to the most rigid preventive measures : the city was surrounded by a triple cordon of guards ; the citizens were directed to lay in a year's store of provision, in order to prevent the necessity of communication with the surrounding country ; yet St. Petersburg was twice visited with the disease. On the contrary, at Thorn, though in constant communication by boats with Warsaw, the cholera did not appear, or if it did, not until a much later period. In England, too, the strictest sanatary regulations were established, but, as we have seen, without avail. It is true that, in some instances, places where these regulations were established, escaped the disease ; but it is equally true that numerous villages, and other places where there was a constant intercourse with the sick, also escaped, whilst in most instances where they were adopted, they had no effect.

Let us turn now to our own continent. On the 11th of June it was publicly announced, that the malignant or Asiatic Cholera had appeared at Quebec. On the 12th of the same month, the Board of Health of Montreal state that there was no case of malignant cholera, though several patients had died of the common cholera of the country. On the 18th, only six days later, we find reported two thousand five hundred and sixteen cases and four hundred and thirty-seven deaths, but even this was thought at the time to be below the true estimate; the panic was so great that it was impossible to keep any accurate account of the numbers that sickened or died. On the 21st of June it was stated that the cholera was abating in Quebec. We have no account of the whole number of cases in that city. In the Hospital, the number of cases from the commencement to that date, was six hundred and ninety-nine, number of deaths, three hundred and sixty-one. On the 22d, it was said to be rapidly subsiding hi Montreal, and on the 24th, Doct. Bronson, who was sent out by the authorities of Albany, writes from Lapraira: — "I have come over to this place on account of the cessation of cholera at Montreal. On the 22d day of June, 1832, an act was passed, establishing quarantine regulations between the state of New York and 'Upper and Lower B

2G EPIDEMIC CHOLEHA

Canada,' on account of the supposed existence of the Asiatic or malignant Cholera in those Provinces." At the same time, the officers of the different towns, villages and cities were authorized to form Boards of Health, and to adopt such measures as they should deem necessary to avert the threatened pestilence. Notwithstanding the precautions which had been adopted, on the 21st of June, the cholera appeared in New York. All the intermediate places on the sea-board, as New Brunswick, Nova Scotia, Maine, Massachusetts, remaining free from it. Supposing the disease communicated, how did all these intermediate places, which were in constant intercourse with Montreal and Quebec, escape? Doct. M'Naughton says two fatal cases occurred in Albany on the 3d day of July. "It originated in the city: we have no reason to attribute its commencement to intercourse with Canada. During the latter part of June, diarrhoea and common cholera became frequent." From New York it extended south, appeared in Philadelphia on the 4th of July, and Baltimore in the course of the same month, and reached Charleston in November. In February, 1833, it was in Havana, Cuba, and the same year reached Mexico. Let us retrace our steps. From Montreal it extended west, up the St. Lawrence and along the great lakes. Whilst extending from Albany, in a

ITS HISTORW 27

similar direction, along the course of the Canal, visiting in its course Utica, Syracuse, Rochester and Buffalo, it subsequently appeared in Detroit. A detachment of troops, who left Buffalo hi health, stopped a short time at Detroit, where the disease was not then raging, were attacked on their route to. Chicago, and suffered severely. About the 1st of October, it appeared almost simultaneously at Madison, Louisville and St. Louis, and by the latter end of the month had reached New Orleans. In its passage it extended to Tennessee, Illinois, Indiana and Kentucky, visiting Lexington, Maysville and some other places severely. The disease lingered in different parts of the country for two years; in 1834 it reappeared in several places where it had formerly been, and visited some that had escaped in 1832. Its general course was the same as it had been in Europe, following the course of navigable waters and principal highways, passing by many places without affecting them. In the city of Utica, where the author resided, there had been one case with all the symptoms of the epidemic cholera, the latter part of July, but the patient recovering, it was not reported by the Board of Health as a case of cholera. About the same time, another patient, a man of dissipated habits, died in the third stage of measles, with all the most malignant symptoms of the disease. On the 12th of August the citizens were startled by the annunciation that four cases of cholera had appeared. In less than twenty-four hours all were dead, and these among the most respectable citizens of the place.

All were distinct from each other in different parts of the- city. Two were females, who, from the nature of the case, could hardly have been exposed to any contagion. From the 12th to the 27th there were 172 cases and 51 deaths; from the 12th to the 3d of September, 192 cases and 61 deaths. In the city of New York, the number of cases reported up to the 29th of August, when the Board resolved to cease to report, was 7118, the number of deaths reported by the Board, 2250. The number of interments reported by the sextons, give 3967 as from cholera. In Albany the Board of Health ceased to report on the 31st of August; number of cases reported, 1142, severe, 587, deaths, 410. In Philadelphia, up to September 1st, 2156 cases and 716 deaths. In Rochester, from the 20th to 27th, 372 cases, 103 deaths. In Buffalo it was announced on the 28th of August that the Cholera Hospital was closed, but it again broke out with increased severity. The whole number of cases up to the 28th, was 184, and 80 deaths. In addition to the places mentioned, it appeared in the state of New York at Ogdensburg, Poughkeepsie, Troy, Brooklyn, Flat Bush, Sing Sing, Whitehall, Peekskill and some other minor places. On the other hand, the city of Hudson, the villages of Auburn, Geneva and Canandaigua, (all of which are on the great thoroughfares,) either escaped entirely, or only had those cases that came from other places. In the neighborhood of Utica, the villages of Whitestown, New Hartford, Clinton and Trenton, were thronged by those who had fled from the city, yet the disease never spread to the residents of those villages. How are these facts to be reconciled with the idea that the disease is contagious.