CHOLERA. 



213 



out of ninety.* In taking these estimates into con- 

 sideration, we must always recollect, however, that, 

 in epidemics, there is often a very wide difference in 

 the gravity of the disease at different points or in dif- 

 ferent years, indeed, sometimes at nearly the same 

 point and in the same year ; so that, when we hear 

 of an extremely small loss in proportion to the num- 

 l)er attacked, long experience does not permit us to 

 doubt that in such a case the type of the disease has 

 been very mild. The ravages of the disease in civil 

 life, amid a comparatively unorganized population, 

 where prompt assistance could not always be render- 

 ed to the sufferers, furnish a considerable contrast to 

 this statement from the British army, and strongly 

 confirm the opinion expressed of the importance of 

 early treatment in a malady so rapid in its course, and 

 in which the efforts of nature are so impotent. At 

 Bushire, in the Persian gulf, we learn from Moreau 

 de Jonnes, that in 1821 a sixth part of the inhabi- 

 tants perished ; and at Bassora, in the same year, Mr 

 Rich informs us that eighteen thousand died, of whom 

 fourteen thousand perished within a fortnight. The 

 number attacked hi Moscow from September, 1830, to 

 January of the following year was, 8130, of which per- 

 ished 4385, or fifty-four per cent.f In the small town 

 of Redislscheft, of eight hundred sick, we learn from 

 Doctor Reimann, that seven hundred died in one 

 week. The greatest success which lias attended the 

 treatment of the disease in the Russian empire, oc- 

 curred in the district of Orenburg, the number attack- 

 ed being 3590, of whom 865 perished, or about 

 twenty-four and one-tenth per cent., a result credit- 

 able to the vigilance of the Russian government, and 

 to the skill and care of the medical men employed. 

 The treatment adopted was that of bleeding, calo- 

 mel, opium, warmth, and friction.^ In Scotland 

 about one-half or one-tlurd of those attacked perish- 

 ed, and nearly the same was the case in England. 

 I n Ireland the mortality was small compared to the 

 number of cases reported. 



9. Treatment. While the cholera was only partially 

 known in Britain, and while yet the medical practi- 

 tioners of this country were inexperienced regarding 

 it, violent differences of opinions existed as to its 

 contagious or non-contagious nature. The disputes 

 on this subject, however, have now nearly subsided, 

 and the great majority of medical men are now per- 

 suaded, that the disease is epidemic, and not contagi- 

 ous, in its character. No specific as to its treatment 

 has hitherto been discovered ; although the alleged 

 remedies laid before the public have been numerous 

 and varied. Without entering into the multifarious re- 

 ceipts of different practitioners, we shall here confine 

 ourselves to the mode of treatment adopted by Dr 

 Henry M'Cormac in the Belfast hospital, as being 

 among the most successful that has come under our ob- 

 servation, the mortality in that hospital having kept 

 below twenty-five in every 100 cases. It may be stat- 

 ed, at the same time, that the treatment here adopt- 

 ed differed not in its essential characteristics from 

 that recommended by many eminent physicians. 



" In the great majority of instances," says Dr 

 M'Cormac in his pamphlet on cholera (London, 

 1832), " cholera commences with purging first, the 

 fecal matters contained in the intestinal canal are 

 quickly discharged then, a clear, yellowish fluid, in- 

 terspersed with flocculi, resembling pale whey, or rice 

 water, is profusely passed afterwards. Vomiting will 

 begin along with the purging or subsequently first, 



* Bombay Reports, p. 68, &c. 



t Memoir of doctor Loiler, physician to the emperor nt 

 St Petersburg, dated January. If. 11, and read at the acade- 

 my of medicine at Paris. 



I Substance of a report published by the supreme medi- 

 cal board of Russia- 



the contents of the stomach are cast off, and then, a 

 fluid precisely the same as that discharged from the in- 

 testines, comes away afterwards. In a few rare cases, 

 either vomiting or purging, or both, will be absent ; in 

 this case, there will be great sickness, praecordial op- 

 pression, cramps, and if the disease be not arrested, col- 

 lapse and death. The cramps generally come on when 

 the vomiting and purging have existed for some time 

 frequently, they commence all three together. After 

 a time, the purging and vomiting will cease, whether 

 medicine be given or not, the system becoming ex- 

 hausted, and the blood being drained of its serum ; the 

 cramps also cease in the same manner. Shortly after 

 these disappear spontaneously, the blood ceases to cir- 

 culate on the surface and in the extremities cold 

 sweats bedew the skin a mortal coldness invades the 

 frame, and death soon closes the scene. This is the 

 common, but not the universal order in which the 

 symptoms proceed. 



" It is of the utmost importance to arrest the purg- 

 ing and vomiting with the least delay ; for the fluid 

 discharges are the serum of the blood, and cause 

 weakness and death, as if the blood itself were drawn 

 away. I have often seen a patient pass, in a very 

 short tune, a gallon or more of this fluid, which, not 

 long before, was circulating as part of the living 

 blood. This discharge will not cease of itself; it 

 continues till it brings the patient to the verge of 

 death. It is almost the same, as if so much blood 

 streamed from open wounds. I never knew a case 

 in which an individual attacked with cholera morbus, 

 grew spontaneously well the diarrhoea always ap- 

 pears to go on to the production of collapse and 

 death, unless medical aid be interposed. The reader 

 will then see the necessity of losing no time ; and he 

 will not, therefore, wonder when I tell him, that I 

 do not wait till the discharges and the cramps have 

 made the patient cold and blue, but commence with- 

 out the loss of a moment, to give the most powerful 

 medicines. These medicines, powerful as they are, 

 cannot be productive of the least injury ; but neglect- 

 ed or inefficiently treated cholera, surely leads to 

 death. The following is the mode of treatment which 

 I follow, specifically laid down : 



' ' If a person between ten and sixty, whether male 

 or female, not much broken down or previously debi- 

 litated, be seized with the disease, whether with purg- 

 ing and vomiting, or purging, vomiting, and cramps 

 I immediately take away from the arm, if the pulse 

 be not weak and thready, from ten to thirty ounces 

 of blood, the quantity being regulated by the strength 

 of the individual and the effects produced. To a 

 man or strong woman, I give, while the arm is tying 

 up, a scruple of calomel, with two grains of opium, 

 both hi powder, and washed down with a mixture of 

 some diluted ardent spirits, as gin, whiskey, or brandy 

 united with from forty to sixty drops of laudanum. 

 To an ordinary woman or weak man, I administer 

 half this dose ; to a child the quarter, and to an in- 

 fant the eighth part. If the medicine be thrown off 

 in whole or in part, the whole or a part of the same 

 dose, as it may appear, must be immediately repeat- 

 ed. In two or four hours, or every four hours, the 

 medicine must be repeated, if the symptoms are not 

 subdued. In this case, general directions alone can 

 be given : the whole dose may be given again, the 

 half only, or the fourth part, according to the urgen- 

 cy of the disease ; hi general, however, I find five 

 grains of calomel, and one grain of opium, sufficient. 

 In this, as in many other particulars, the practitioner 

 must use his own discretion. If the complaint be 

 early treated, it will generally be checked after the 

 first or second dose very frequently a single dose ex- 

 tinguishes it at once. Time after time, patients have 

 been brought in with almost incessant purging, vomit- 



