206 



CHOLERA. 



tanks of the Volga, making Iributary to Its power 

 the populous towns of Saratofl', Penza, Samara, arid 

 Kazan. Kazan it readied on the 5th of September, 

 and on the 26th of the same month its symptoms were 

 first detected in Moscow. The town was immedi- 

 ately divided into forty-seven compartments, wliich 

 were separated from each other by a cordon sanitaire ; 

 ten temporary hospitals were erected, and count 

 Zakrewski, the minister of interior, was appointed 

 by the Emperor to superintend these protective ar- 

 rangements. The emperor himself visited the town 

 wlicn tlie disease was at its height, and when he left 

 to go to Twer, by submitting to a quarantine of eight 

 days, he gave an example of obedience to the sana- 

 tory laws. During the first ten days of October, 747 

 died ; from the 10th to the 20th, 958 perished ; and 

 from the 20th to the 3lst, 1,284 sunk under the dis- 

 ease. At first the mortality was as great as nine- 

 t ciitlis; it afterwards diminished to seven-eighths, 

 five-sixths, three-fourths, one half, and ultimately to 

 one-third. During even the winter months, which 

 fiad been hitherto a complete specific against its pro- 

 gress, when all the rivers were covered with ice, it 

 carried on its work of death ; but the number who 

 were infected gradually decreased, and the mortality 

 proportionally diminished. 



Having now travelled so far north, it was almost 

 universally expected that the cholera would have 

 soon reached Petersburg, and from thence have ex- 

 tended to the shores of the Baltic ; but the capital, 

 at this time escaped, and the disease, taking an al- 

 most opposite direction, accompanied the Russians 

 into Poland. During the revolution of July, in 1830, 

 a body of troops were ordered out of the province of 

 Koursk, in the country of the Cossacks, which was 

 then infected, to march against the Poles. These 

 troops, hi their passage through Podolia, and Volhy- 

 nia, took with them the disease along their entire line 

 of march. The towns of Astrog, Zaslaf, and Luck 

 were infected ; and a few leagues from this latter 

 place the disease passed the Bug, and entered Po- 

 land. Lublin was attacked towards the end of 

 March, 1831 ; by the 1st of April, the hospitals of 

 Siedlec were filled with Russians labouring under the 

 malady ; ten days afterwards it was discovered among 

 the wounded at Praga, which is separated from War- 

 saw only by the Vistula ; and on the 14th it entered 

 the capital of Poland. According to the central 

 committee of health, from 100 to 150 died during 

 the first week, out of every 1,000 sick ; and accord- 

 ing to the Berlin Gazette, during thirteen days, end- 

 ing on the 5th of May, there had been between the 

 town and the camp, 2,580 sick, of whom 1,110 died, 

 and 1,278 still remained under treatment. On the 

 25th of May, it appeared at Riga, and by the 28th, it 

 had reached Dantzic in Prussia, Brody and Lemberg 

 in Austria. On the 26th of June the disease en- 

 tered Petersburg ; early in August it invaded Hun- 

 gary, and by the beginning of September it entered 

 Germany. In Nov., 1831, it reached Sunderland in 

 England, and afterwards spread over the whole 

 island, but was more particularly fatal in Scotland. 

 In March, 1832, it broke out at Paris, where up- 

 wards of 20,000 fell a sacrifice to it in a short time. 

 In June 1832 it appeared at Quebec in Canada, 

 and has since spread over the whole American con- 

 tinent. 



I. Symptoms of Cholera in India. The disease ge- 

 nerally made its attack in the night, or towards 

 morning, with vomiting so excessive that the whole 

 contents of the stomach appeared to be discharged ; 

 and, nearly at the same time, the bowels were copi- 

 ously emptied, as though all the solid matters in the 

 intestinal canal were evacuated. In some cases a 

 watery purging preceded the vomiting by some hours; 



but they more frequently occurred simultaneously. 

 After the first copious discharge, the patient experi- 

 enced a distressing feeling of exhaustion and faintness. 

 with ringing in the. ears and giddiness. The subse- 

 quent discharges from the stomach, and those from 

 the bowels, did not differ from each other in appear- 

 ance, excepting as the matters ejected from the sto- 

 mach were tinged by medicines or other ingesta : they 

 were generally watery, colourless, and inodorous, and 

 resembled in appearance barley-broth, or more fre- 

 quently rice-water. Sometimes they were like milk, 

 occasionally yellowish, greenish, like muddy water 

 or yeast; but the conjee-stools, as they arc emphati- 

 cally termed, which consisted of albuminous flakes 

 floating in serum, or discharges of pure serum, were 

 of the most frequent occurrence. The dejections 

 sometimes took place without effort or uneasiness, 

 but occasionally very forcibly, with simultaneous vo- 

 miting, spasm, and sinking of the pulse. This violent 

 action of the alimentary canal was not of long con- 

 tinuance, the powers of the system being unable to 

 support it : hence the vomiting and purging general- 

 ly ceased some hours before death ; but, in some 

 cases, a discharge of serum took place from the rec- 

 tum, on any movement of the body, till the fatal close. 

 In most cases, some time after the commencement of 

 this affection of the intestinal tube, but, in others, pre- 

 viously to it, spasmodic contractions of the muscles 

 of the fingers and toes were felt ; and these affections 

 gradually extended along the limbs to the trunk. The 

 spasms were imperfectly clonic or convulsive, with 

 infrequent relaxations, were attended with great pain, 

 and left, for some days afterwards, a degree of stiff- 

 ness hi the affected muscles. The pulse was from the 

 first small, weak, and accelerated ; and, after a certain 

 interval, but especially on the accession of spasms or 

 severe vomiting, it sank suddenly, so as to be speedi- 

 ly lost in the external parts. The length of time dur- 

 ing which a patient lived in this pulseless state was 

 remarkable. In a case related by doctor Kellett, the 

 pulse was gone within three hours from the attack ; 

 yet the man lived twenty-two hours hi that state. On 

 the cessation of spasm and vomiting, and sometimes 

 apparently from the exhibition of remedies, the pidse 

 returned hi the extremities for a short time, and again 

 ceased. The skin was cold from the commencement 

 of the disease, and, as it advanced, became gradual- 

 ly colder, and was covered either with a profuse 

 sweat or a clammy moisture. The state of its circu- 

 lation, and its insensibility were sometimes strongly 

 denoted by the following circumstances: leeches 

 would not draw blood from it ; blisters and other 

 vesicatories would not act; and even the mineral 

 acids and boiling water produced no effect ; and some 

 patients were not even sensible of their application. 

 In Europeans, the colour of the surface was often 

 livid ; the lips and nails presented a blue tint ; and 

 the skin of the feet and liands became corrugated* and 

 exhibited a sodden appearance, as if from long im- 

 mersion hi hot water. With these symptoms coexist- 

 ed violent pain of the intestines, with a sensation of 

 writhing and twisting there ; heartburn, which the 

 sufferer compared to a fire consuming his entrails ; 

 excessive thirst ; anxiety, with inexpressible uneasi- 

 ness about the praecordia ; hiccough ; jactitation ; 

 and, notwithstanding the actual coldness of the sur- 

 face, and even of internal parts which are accessible 

 to the touch (the tongue for instance), a sense of heat 

 which impelled the patient incessantly to throw off 

 the bed-clothes. The breathing was much affected, 

 being performed either more slowly than usual (some- 

 limes, for instance, in the advanced stage, only at the 

 rate of seven respirations in a minute), or the inspira- 

 tions were short and sudden, with violent pain from 

 spasm of the diaphragm ; the voice being feeble, hoi- 



