A lecture on epidemic diseases generally, and particularly the spasmodic cholera, delivered in the city of New York, March 1832, and repeated june 1832, and in Albany, July 4, 1832, and in New York, june 1833. With an appendix containing, several testimonials, and a review of Beaumont's experiments on the gastric juice

Front matter

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.GrISL

Introduction To The Second Edition

I iting to the public a reprint of the following treatise on Epidiseases the editor is actuated by several considerations, to which he re? r-ectfully invokes the attention of the reader. In the first place, the former edition is entirely exhausted. Not a single copy is to be had, notwithstanding frequent inquiry is made for the work. Jnthe second place, it is believed that the intrinsic value of the work, as a scientific and practical treatise, is such as not only to warrant, but actually to demand the republication of it. For it is valuable not merely as a treatise on epidemic diseases, but as a condensed system of physiological and pathological science ; abounding in the most important practical precepts and rules for the guidance of persons afflicted with every form of disease, as well as of those who are in the enjoyment of good health, and desire to preserve it. In the third place, the republication of this work, at this time, affords a very desirable opportunity to present the strongest evidence of that cautious scrutiny and scientific accuracy with which Mr. Graham has pursued all his investigations and arrived at all his conclusions. And this is believed to be important, not merely as being laudatory to the man, but as justifying that confidence which has been placed in his doctrines by those who have listened to his public instructions, and as warranting the fullest confidence of the public in him as a teacher of the Science of Human Life.

The first edition of this work was published some months before Dr. Beaumont's « € Experiments and Observations On the Gastric Juice and the Physiology of Digestion," were given to the world, and contained many views which at that time were considered not only as contrary to the well established doctrines of the schools, but as wholly at variance with the universal experience and common sense of mankind ; yet the reader of the following pages, by comparing Mr. Graham's treatise with the review of Dr. Beaumont's work in the Appendix will be astonished to find that Dr, Beaumont has so fully demonstrated, by actual experiment on the human stomach, the truth of what Mr. Graham had before published as the result of his scientific investigations. Indeed, with the exception of the question of flesh eating, which Dr. Beaumont does not attempt to decide, there is scarcely a doctrine advanced by Mr. Graham in this treatise which is not confirmed by Dr. Beaumont.

The following treatise, as will be perceived by a reference to Mr. Graham's advertisement to the first edition, was prepared and first publicly delivered in New York, in March, 1832 ; full three months before the cholera appeared in this country; a«d again delivered in the same city, in June following, and published in the summer of 1833.

At the time it was prepared, therefore, Mr. Graham had seen nothing of the epidemic cholera, and had, as he informs us, no other knowledge of it than such as was derived from the accounts of its symptoms and ravages in Asia and Europe — published in the newspapers and explained by his own physiological and pathological views. He had never seen nor heard of a post mortem examination of a cholera subject, and the modes of practice adopted abroad were as various and contradictory as they well could be. He was, therefore, under the necessity of forming his own theory of the nature and cause of the disease, according to what he considered the true principles of physiological and pathological science.

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The conclusions to which he arrived in regard to the nature — the remote and immediate causes, and the prevention and remedy of the disease, were almost totally different from the opinions held by foreign physicians and entertained by the faculty in this country. Yet it is now well known that the experiment in the city of New York in the summer of 1832, powerfully confirmed the truth of Mr. Graham's views, in regard to the best means of preventing and remedying the cholera, and so far as any just inference can be drawn from the history of the disease throughout our country, it is fully corroborative of the results of the experiment in New York.

Guided solely by the physiological and pathological views which governed his reasonings in relation to the epidemic cholera, Mr. Graham was led to give it as his opinion that the disease which followed the eating of the quails, by the Jews in the wilderness, was a form of cholera. [See Lecture, page 17, fourth paragraph.] Several months after the publication of the first edition of this work Dr. DeKay's " Sketches of Turkey " issued from the New York press and from that work the following extract is taken.

" Traces of the cholera may be found among the Jews, three thousand years ago. It is stated in the Old Testament that the Lord, after promising the Jews abundance, (Num. xi. 20,) declares that they shall be fed upon this food until it comes out at their nostrils ; and until, as the Septuagint expresses it, they have the cholera (^oxsva.) which in fact afterwards appeared. In our English version it is translated loathsomeness, but we are informed by an intelligent Hebrew that the original Hebrew word ('zorah') means nausea, which is one of the most constant symptoms of cholera."

Whether Dr. DeKay when he wrote this, had seen Mr. Graham'sLecture on the Cholera, which had been on sale in New York some months before his work was published, we do not know ; but at any rate the coincidence is worthy of remark.

It has already been stated that Mr. Graham had never seen nor heard of sl post mortem examination of a cholera subject when he wrote the following treatise, and therefore, what he said concerning the seat, pathological physiology, and the morbid anatomy of Cholera (see Lecture, pp. 23, 24, 25 and 35,) was wholly predicated on what, according to his views, was clearly indicated by the general symptoms of the disease.

The 32d number of the " American Journal of the Medical Sciences," published in Philadelphia, August, 1835, (more than three years after the following treatise was first delivered, and two years after it was published) contains an article " On the Anatomical Characters of Asiatic Cholera, with Remarks on the Structure of the Mucous Coat of the Alimentary Canal. By W. E. Horner, M. D., Professor of Anatomy in the University of Pennsylvania," from which the following extracts are taken.

" In admitting the central point of cholera to be the abdomen, there are three leading theories which profess to explain the character of the lesion. " One of them is the nervous theory : the second, that of passive vascular congestion, and the third, that of acute inflammation."

Having made these statements, Dr. Horner briefly presents his reasons for rejecting the first and second of these theories, and then proceeds to advance his facts and reasons in favor of the third, or that of acute inflammation.

In reply to the reasonings of Magendie, in support of the theory of congestion, or "suspension of the circulation, arising principally from a debilitated contraction of the ventricles of the heart." Dr. Horner remarks, " The general capillaries unquestionably execute languidly in cholera, their office of forwarding the blood, and we may hence naturally infer that they are affected with atony ; but does it not appear more probable that the latter is a sympathetic condition produced by the extreme pathological actions of the mucous membrane of the alimentary canal ; the sympathies being conveyed, either by the great sympathetic nerve, or by that more refined innervation of parts, of which anatomy knows so little but which unquestionably exists." ■ .." Dr. DeGravier, the chief French Physician at Pondicherry, saw the inflammation of the stomach and intestines so well marked that he considered it to give rise to all the other symptoms by means of irritation, and went so far as to call the disease gastro-enteritis. Mr. Corbyn details such appearances of inflammation in the stomach and bowels as should leave no doubt of the fact."

" For my own part, considering the rapid secretion from the alimentary canal of serum and of fibrin, and knowing that this act itself is calculated, as in pleuritis, to relieve the inflammatory congestion of the vessels, I have but little difficulty in viewing cholera as a decided inflammation from the beginning.

M The precise state of the venous system of the digestive canal is among all the traits of cholera, that which will most fully account for its destructiveness to human life. The minute anatomy of this system has already been explained, and we now resume the general fact that the mucous membrane is formed by an intertexture of these veins, resembling a net, or more exactly, a plate of metal pierced with holes ; these holes being the follicles whose aggregate number is forty-six millions at least, and probably much more.

" It is to be borne in mind that it is the whole of this vaseular and follicular structure, endowed with vital actions the most important to life, and presenting in the aggregate an area of about thirteen square feet — the size of a small breakfast table, whose morbid derangements constitute the essential features of cholera.

" The most undeniable fact of cholera, is a rapid fluxion of the blood to the whole digestive mucous membrane, with a diminishing of its own volume by large losses at the part, as the immense serous discharges prove ; but here is an action extending over an area of at least two thousand square inches — I say the size of a small breakfast-table.

" Under such overwhelming circumstances of disease, can we wonder if the exterior symptoms of inflammation do not exist, that the inflammation instead of acting as a stimulus, as in common diseases, so as to diffuse the blood more rapidly towards the periphery of the body, increasing the heat of the skin and the volume of the arteries in the limbs, &c. should, on the contrary, prostrate every action of the system, except on the surface where itself prevails ?

" The majority of the cases of cholera probably suffer extreme violence only upon particular sections of the digestive mucous membrane. Some have it in the stomach chiefly ; others in the colon also, — others may have it chiefly in the small intestines. But in all cases, some de* gree of irritation extends along the whole canal ; the resistance of an individual to the disease will therefore depend mainly upon the quantity of surface vehemently attacked."

Let any intelligent person compare these extracts from the American Journal, w\\\i pag§s 23, 24, 25, and 35, of the following Lecture,

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and it will seem almost impossible to him that the writer of the one should not have been acquainted with the views of the author of the other. And yet Mr. Graham's Lecture was written and published years before Dr. Horner's article was, but, probably, never seen nor heard of by him. We see one man, therefore, reasoning purely from the symptoms of the living subject, according to his own physiological and pathological views, and another man reasoning from the demonstrations of morbid anatomy in the dead subject, and both arriving at the same conclusions, and without any knowledge of each other.

Compare also Note A, page 82, with the fourth paragraph of the 43d page of the Lecture.

Now then, the honest question is, did Mr. Graham arrive at his conclusions by mere conjecture, and guessing, and without any accurate knowledge of physiological and pathological science, or did he arrive at them by sound philosophical and scientific investigation and induction ? The former cannot for a moment be supposed, and if the latter be admitted then is it most evident that he is no tyro in the science which he professes to teach.

The man who, breaking away from the trammels of education and the shackles of popular opinion, 13 able to stand alone in the strength of his own philosophy, and with the clear vision of scientific truth, perceive and announce those deep principles, which others cannot discern and will not believe till severe experience and sensible demonstration compel them to, may indeed — nay, will be certain to be reviled by multitudes whose confidence and respect he deserves. Yet they who are willing to open their eyes to the light of truth, and are capable of appreciating the merits of such a teacher, will feel their confidence in him increased rather than diminished by the reviling of a blinded and misguided world.

It is no small tribute of respect to the author of the following treatise, however, that one of the most eminent and distinguished professional gentlemen of this country, procured a copy of it as soon as it was published and sent it to his son, who was completing his professional studies in Paris; and another professional gentleman, no less eminent and distinguished, has declared that, " it ought to be printed in large type and fastened to the wall of every parlor, and posted over every kitchen fireplace, in every community."

It is believed, therefore, that in republishing this valuable treatise, a decided good is done to soeiety, and it is hoped that every one into whose hands it may fall, will not only read it with attention but care-* fully study it.

BosTox 3 May, 18S8,

ADVERTISEMENT TO THE FIRST EDITION.

The following Lecture on the Cholera, was first delivere at the close of my course of Lectures on the Science of Human Life, in the Baptist Meeting-house, in Mulberry Street, New York, in March, 1832, in the presence of more than two thousand people. The effect produced was very considerable, and the Lecture became the topic of conversation and remark somewhat extensively in the city.

Soon after this, an editorial article appeared in the Courier and Enquirer under the head of 4 ' Facts, not Theory, in regard to Asiatic Cholera." In thi3 article it was attempted to be shown, that " the Cholera originated and raged most fatally among the Hindoos who subsisted on rice, and

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were the most temperate people in the world ; M and therefore, it wag better for the people of this country to eat atleast their usual proportion of flesh and other things to which they were accustomed, than to abstain from flesh entirely, with a view to avoid or mitigate the Cholera. I immediately replied to this article, in the most respectful manner, but the Editor did not find it convenient to publish my reply.

Not long after this article appeared in the Courier and Enquirer, a letter o considerable length, from Dr. De Kay, appeared in the Evening Post, in which it was stated that the et occasional use of stimuli in the form of generous wine or brandy, or gin and water, was found decidedly beneficial during the prevalence of the Cholera at Constantinople — that this epidemic broke out and raged with great violence among the Jews at Smyrna, during one of their religious fasts , and had proved peculiarly fatal among that class of people generally, in Asia and Europe, whose diet was particularly meagre and abstemious."

Whatever might have been the design- of the writers of these articles, the citizens of New York universally received them as specially intended to bear against the dietetic doctrines which I had taught in my Lecture on the Cholera, and immediately, throughout the city, the clamor was raised, " If the Cholera comes here, all the Grahamites will certainly die with it."— I am sorry to say, that too many physicians, who were ignorant of what I had really taught, gave countenance to this hue and cry.

When the news reached New York that the Cholera had appeared in Canada, the panic in the city exceeded all bounds. I had closed my Lectures for the season, and according to arrangements, made several months before, was about to proceed with my family to Rhode Island, where I had engaged to be as early as the fourth of July ; but such wa3 now the panic in the city, and so much was I urged to repeat my Lecture ori the Cholera, that I consented to defer my departure, and comply with the wishes of my friends. In announcing the Lecture through the newspapers, I particularly invited the Corporation, and the medical gentlemen of the city, to attend. I also sent a special invitation to the Board of Aldermen, by whom it was formally accepted, and put a quantity of tickets into the hands of Dr. Lee, who engaged to see that at least a considerable portion of the physicians were furnished.

In the mean time the clamor and excitement were increasing, and I was respectably informed that some physicians at least, were visiting families in which they practised, and advising them to subsist principally on animal food, and always to take a little brandy or wine with their water. On the evening of the 21st of June I repeated my Lecture in the Chatham Street Chapel, without any other alteration than the addition of such important facts and matter as circumstances presented. That is, the doctrine of the causes, nature, prevention, and remedy, of the Cholera, as it now stands in the text of the following Lecture, is precisely the same that 1 delivered in March preceding. The additional matter is principally in reference to the articles which appeared in the Courier and Enquirer and the Evening Post.

I again began to prepare to leave the city for Rhode Island, when I received a letter from Dr. Beck of Albany, as the Secretary of the City Temperance Society, requesting me to come to that city, and deliver a lecture, on the 4th of July. It was impossible for me to comply with this request without putting myself and family, and some of my friends in the city, to very great inconvenience, and disappointing my friends in Rhode Island ; nevertheless it seemed to be my duty to go to Albany, and I concluded to go. - via

On the 2d of July, 9 cases of the Cholera were reported in New York : on the 3d I went to Albany: on the evening of the 4th, delivered my Lecture on the Cholera there, and on the 5th returned to New York, and found that Mrs. G. had engaged our passage to Newport for the 6th. I found also that the cry was up, in which even some respectable physicians had a voice, that I had fled from the city in such a panic, on account of the eholera, lhat I had left my family behind. I endeavored to persuade my family to proceed to Rhode Island without me, but not being able to succeed, I left the city for Newport on the 6th of July ; and then the cry became louder and more general, that Graham had fled from the city in a panic, and all his followers were dead or dying with the Cholera. This. cry was kept up through the whole season of sickness, in order to destroy all the confidence of the people in my doctrines, and drive them to flesh-eating, and brandy and wine-drinking. But not every one was shaken. Some were steadfast, and they fully realized all the benefits I had promised. [See the Appendix.] Immediately after my arrival in Rhode Island, X sat down and prepared the following lecture for the press, just as the text is now published, with an intention of sending it back to the city for publication ; but all communication being cut off, I was disappointed, and the manuscript remained on hand.

Some days after I had delivered my lecture the second time, the two Clinical Lectures on the nature, treatment, and symptoms of Spasmodic Cholera, by Broussais, appeared in an English dress in New York. I read these Lectures, and was not a little surprised to find a very striking resemblance, in many respects, between them and mine — especially as I had read no other medical treatise on the cholera whatever — my own lecture being written from the information I had gathered, as to facts, from the public papers, and from my own physiological and pathological views. And whatever may be thought of my opinion as to the epidemic cause of the cholera throughout the world, — let it be remembered that even if this opinion were shown to be incorrect, all my other reasoning would be none the less true.

On the evenings of June 7th and 13tb, 1833, I repeated this Lecture again at Clinton Hall : and now I present it to the public in print for several reasons. In the first place, the doctrines of this Lecture have been so entirely confirmed by the whole history of the cholera in this country up to the present moment, that I feel it the more important that it should be published as extensively as possible. In the second place, as it is not exclusively applicable to the epidemic cholera, but summarily embraces all epidemic, chronic, and acute diseases, so it will at all times and in all places be useful instruction to the people. In the third place, those who have heard the Lecture have generally requested that it should be published. Finally, the mode of treatment pointed out in the Lecture for diarrhoea is equally applicable to all kinds of bowel-complaints, at all times, and therefore should the epidemic cholera never again appear in this country, this Lecture will be perhaps equally useful.

August 20, 1833. S. Graham.

LECTURE

Almost every writer on physiology, who has made any pretensions. to originality, has attempted to define or explain vvhat'is. signified by the word life : hut if a want of correct knowledge, and of. a sound judgment, has not led me to an erroneous 'opinion on the subject, all have- failed, through an endeavor to find, in the principles and properties, common to inorganic matter, the elementary causes of organic life.

While, however, so much obscurity, if not* impenetrable, mystery, hangs over the nature of organic life, the vital conduct, or the means, and manner, by which life maintains itself in Hs organic domain, against the power of counteracting agents, and influences,, is "better understood : and the continued, antagonistic conflict between 'vitality, in accomplishing its functions, and the more primitive affinities of in-v organic chemistry, was beautifully expressed by our late distinguished Doctor Rush, of Philadelphia, when he said that " Life is a temporary victory over the causes which induce death." . In producing each and, all of its peculiar and legit- ' imate 4 results, vitality necessarily overcomes the laws, and counteracts the affinities of inorganic matter; and exerts molecular affinities, of a. totally distinct and opposite character, — which result in aggregations and structures, entirely different from those of inorganic matter : — and hence it is true, that all the inorganic affinities in Nature, are adverse to organic structure, and life : and hence also," it is true, that life maintains its power, and performs its functions, in opposition to the ordinary laws of inorganic matter, and, within its own appropriate domain, resists the operations of those laws, while its power is paramount.

Thus, the vegetable seed, which, being deprived of life,

would soon yield to the action of the more primitive laws of

matter, and by the process of what we call decay, pass into

other forms : — yet while its vitality remains, it resists those laws, and preserves its form and structure, and vital properties and powers so perfectly, that even after a lapse of centuries, if placed in genial circumstances, it will vegetate, like a last year's seed, and develope its appropriate form of plant or tree.

By the same power, the hybernating animals, lying in a torpid state, without nourishment, resist dissolution and decay for months ; and in some instances, there is reason to believe, even for many years, and again awake to the active manifestations of life, and the powers of locomotion. And by the same controlling power, the living body preserves its own peculiar temperature, and with little variation, in arctic winters and tropic summers; and converts foreign matter to its own substance ; disposing of the various materials of which itself consists, with the utmost integrity, regularity and precision, according to its wants.

All the interesting effects of organic life are embraced in the economy of the grand vital function of Nutrition.

The food of various kinds, which we receive into the stomach for the sustenance of the body, if the vitality of the stomach were destroyed, would naturally take on a chemical action, and soon run into fermentation and putrefaction, and pass entirely into other forms of inorganic matter : and this is ever the more natural and inherent tendency of the food received into the living stomach. Vitality alone, therefore, overcomes this tendency, and counteracts the inorganic affinities, and transforms the nutritious properties of the several kinds of food, into a nearly homogeneous substance, of a very different character from what it was when first swallowed.

Destroy vitality here, and the process of digestion would instantly cease, and the chyme would yield to inorganic affinities. But vitality, " maintaining its victory over the causes which induce death,'' - carries on the living function, and still farther digests the contents of the alimentary canal, and elaborates the chyle, and carefully conveys it through living, and in some measure, vivifying tubes, to the blood vessels ; and through the office of the heart, ushers it into the capillaiies of the lungs, and by the vital functions of these organs, completes the transformation into living arterial blood: — and this, possessed of all the properties necessary for the nutrition of the body, is, by the vital power and functions of the appropriate organs, distributed into every part of the beautifully complicated system. — where, according to the wants of the several parts and substances of the body, portionsof the blood are detained, and, by a process of purely vital chemistry, transformed into bone, cartilage, muscle, nerve, &,c, while at the same time, particles of each and all of these substances, after having fulfilled their time and purpose in the organic structure, are, by the same vital power, continually undergoing a change back into a limpid fluid, which is conveyed by appropriate vessels, and mingled with the returning blood, that, from every part of the system comes back to the centre, through the veins, dark, and full of impurities, and destitute of those properties which are necessary to nourish the body, and sustain the functions of life.

By the vital powers and functions of the several organs — especially the skin, lungs, and kidneys, the impurities of the venous blood are separated out, and cast off from the organic system, and the blood is completely purified and renovated, and fitted again for all the purposes of arterial circulation.

Thus, from the very commencement of digestion in the stomach, to the last office of the skin and other organs, in throwing off the worn-out and offensive matter of the system, vitality exerts its efficient and controlling power,~and maintains its victory over the causes which induce death : — for if the vital power should be overcome in any stage of this general function, the process would be immediately arrested, and dissolution would ensue. Even the arterial blood, which is itself a highly vital fluid, depends on the vitality of the living vase in which it flows, for the continuance of its life, and for its vital results : — for if a portion of the blood be confined in a section of the living and healthy artery, the vitality of the blood is preserved, so long as the artery remains in a living and healthy state ; but if the vitality of the artery be destroyed, the life of the blood contained in it, is soon lost.

In the same manner, vitality exerts its conservative and controlling influence, over every substance within* its dominion — even over the effete or worn-out matter of the body, restraining it from taking on the action of inorganic affinities, until it is conducted beyond the threshold of organic function and vital welfare.

In order to a better understanding of the economy of the vital power, it is necessary to ascertain the tissue in which vitality more particularly resides, or with which it is more immediately connected.

In the language of physiologists, man has an animal life, and a vegetative or organic life. His animal life comprises his organs and powers of sensation, voluntary motion and volition: — arid his vegetative or organic Fife comprises his organs and powers concerned in the grand function of nutrition : such as appertain to digestion, respiration, circulation, secretion, absorption, excretion, &lg\

Corresponding with this division, man has' two classes, or what, indeed, may almost be called two systems of nerves. The nerves which appertain to animal life, are connected with the brain and spinal marrow, and are distributed principally to the muscles of voluntary motion, and to the sensitive surface of the body, or external skin. The nerves which appertain to organic life, arid which, in regard to the subject before us, are altogether the most important to us, are believed to originate with the organs themselves, in a kind of rudimentary "brain, or bulbous enlargement of nervous substance, Which, is .called a gauglion or knot, of which there is a large number in the different parts of the body.

As the several organs with which they are connected, advance in their formation, these ganglions increase in size, and throw out cords or branches, some of which go to connect them directly with each other, and form a general union, or system of the whole ; while other branches, from different ganglions, interweave and inosculate, and form plexuses, from which, again, n-umerous branches are given off, to supply the stomach, and heart and lungs, and liver and kidneys, and all the other organs concerned in the general function of nutrition.