159 
P A T II O L O G Y. 
nuently, rather relieved by prefl'ure of the patient her- 
lelfat the time, but leaving great forenefs and tendernefs 
during the intervals. This ftate continued under four 
days; during it the ftomach was very irritable, and the 
tongue coated and clammy. Jaundice came on at an 
early period ; and the ftools were white, brown, or fome- 
what greenilh, and ftreaked in colours, until the films 
began to pafs, when they were mixed with a full fuffi- 
ciency of bile, but not'at firft of a healthy colour. The 
pulfe throughout was calm, moderate, and natural, in 
none of the inftances amounting to 90.” There was no 
indication of inflammation. In one inftance Dr. Powell 
noticed a confiderable hardnefs and contraction of the 
abdominal mufcles; in another cafe there was fuperadded 
to the above fymptoms a difficulty in palling the urine, 
with pain in the region of the bladder, requiring the ufe 
of the catheter. 
The practice which appeared to Dr. P. moft. advan¬ 
tageous, was the Heady ufe of a mixture of the infufum 
gentianre compofitum and infufum fennae, with the addi¬ 
tion of from ntx. to fltxx. of liquor potaflae, repeated fo 
as to produce four or more ftools in the twenty-four 
hours. Under its ufe the flakes firft feparated, and con¬ 
tinued to do fo in great abundance ; the jaundice difap- 
peared, and the patients recovered health and ftrength. 
During tile paroxyfms, the warm bath, warm fomenta¬ 
tions, leeches, and blifters, are ferviceable as external re¬ 
medies ; and internally, we Ihouid attempt to allay the 
pain and irritation, firft by pretty large dofes of opium and 
hyofciamus, and then ading on the bowels pretty 
brilkly by compound extrad of colocynth, calomel, and 
hyofciamus, aided by purgative enemas to folicit the perif- 
taltic adion. The recurrence of thefe diftreflingattacks 
can only be prevented by regulating the ftate of the 
bowels, and by correding the depraved fecretions them- 
felves. This is to be done by Arid regimen, great atten¬ 
tion to the fundions of the Ikin, and by luch.remedies 
as ad on the biliary fecretion. In conjundion with thole 
meafures, a Heady perfeverance in the ufe of the nitro- 
muriatic acid bath has been ufed in obftinate cafes with 
fuccefs. 
Genus X. Cholera; [fuppofed by Celfus to be derived 
from bile, and pea, to flow, (literary bile-flux ;) but 
Trallian traces it from p^oXac, an inteftine, and pea, (li¬ 
terally bowel-flux;) a derivation which agrees better with 
the phenomena of the difeafe.] Purging and Vomiting ; 
•wind and cramp in the Homach and bowels. 
The caufe of cholera is, as we have before hinted, re- 
ferrible, in common with dyfentery, to a difturbed ftate 
of circulation, induced in the .firft inftance by inadion 
and conftridion of the veffels of the Ikin, and thereby 
communicating a plethoric ftate to the abdominal vifcera. 
In cholera, however, the difeafe afteds more feverely the 
liver and fuperior part of the alimentary canal, and the 
lower bowels feem influenced but in a minor degree. In 
mild cafes, the plethoric ftate of the liver unloads by fe¬ 
cretion, and the bile is evacuated by vomiting and purg¬ 
ing. In cafes of extreme violence, however, no fuch 
effed takes place 5 and hence the old authors feem to have 
fallen into a great error in attributing cholera to increafed 
fecretion of bile : for, as the colonial praditioners have 
well fltown, a copious flow of this fecretion is rather to be 
confidered as falutary or critical than indicative of the 
difeafe in queftion. We have three fpecies of this genus. 
1. Cholera vulgaris, or Cholera morbus. Specific cha- 
rader—Vomiting and purging frequent and copious. 
The following excellent defcription of this difeafe is 
copied from Sydenham. He fays, “ Malum ipfurn facile 
cognofcitur, adfunt enim vomitus enormes, ac pravorum 
humorum cum maxima difficultate et anguftia per alvum 
dejedio ; cardialgia, fitis. Pulfus celer ac frequens, cum 
seftu et anxietate, non raro etiam parvus et inasqualis, 
infuper et naufea moleftiflima, fudor interdum diaphore- 
ticas, crururn et brachiorum contradura, animi deli- 
Vol. XIX. No. 1294., 
quium, partiuin extremarum frigiditas, cum aliis notae 
fymptoniatibus, quae adftantes magnopere perterrefa- 
ciunt, atque etiam angufto viginti quatuor borarum fpa- 
tio aegrum interimant.” The praditioners who followed 
Sydenham described the difeafe as attended from the firft 
by bilious vomiting; but later writers deny this. And 
that clofe obferver of nature, Arelaeus, fays, “In primis 
quae evomuntur, aqua; firniliu flunt ; quae anus effundit, 
ltercorea, liquids, tetrique odoris fentiuntur'. Siquidetn 
longa cruditas id malum excitavit, quo li per clyfterem 
eluanter, primo pitaihflu, n o v bi/iofa ferunlur.'" 
2. Cholera flatulenta, windy or dry cholera. The 
vomiting and purging rareor abfent; great and oppreflive 
flatulence ; retching ; flatulent dejedionsand erudations. 
Sydenham fays, that in the epidemic cholera of 1669 lie 
net with but a Angle inftance of the dry or flatulent fpe¬ 
cies. It feems, indeed, a difeafe of rare occurrence, and 
the difcriminating fymptcm, flatulence, is probably owing 
to the nature of the fwallowed food. 
3. Cholera fpafmodica, Indian cholera ; emphatically 
called “mort de chien.” The dejedions watery ; inef- 
fedual retching; fpafms fucceffive and violent, commen¬ 
cing in thd thoracic and abdominal mufcles. We copy 
the ample account of the fymptoms of this dreadful ma¬ 
lady from the authentic Reports on the Epidemic Cho¬ 
lera which raged throughout Kindoftan and thepeninfula 
of India, in 1817, 18, and 19 ; publifhed under the autho¬ 
rity of the Bombay government. 
“The attack was generally ufliered in by a fenfeof 
weaknefs, trembling, giddinefs, naufea, violent retching, 
vomiting, and purging, of a watery, ftarchy, whey-co¬ 
loured or greenifh, fluid. Thefe fymptoms were accom¬ 
panied or quickly followed by fevere cramps, generally 
beginning in the fingers and toes, and thence extending 
to the wrifts and fore-arms, calves of the legs, thighs, ab¬ 
domen, and lower part of the thorax. Thefe were foon 
fucceeded by pain, conftriftion, and oppreffion of ftomach. 
and pericardium; great fenfe of internal heat; inordi¬ 
nate thirft, and inceffant calls for cold water, which was 
no fooner fwallowed than rejected, together with a quan¬ 
tity of phlegm, or wiiitifh fluid, like feethings of oatmeal. 
The aftion of the heart and arteries now nearly ce'afed ; 
the pulfe either became altogether imperceptible at the 
wrifts and temples, or fo weak as to give-to the finger 
only an indiftindl feeling of fluttering. The refpiration 
was laborious and hurried, fometimes with long and fre¬ 
quently-broken infpirations. The fkin grew cold, clam¬ 
my, covered with large drops of fweat; dank and difa- 
greeable to the feel, and dilcoloured of a bluifh, purple, 
or livid, hue. There was great and fudden proftration of 
ftrength, anguifh, and agitation. The countenance be¬ 
came collapfed ; the eyes fulfilled, fixed and glafly, or 
heavy and dull; funk in their fockets, and furrounded 
by dark circles ; the cheeks and lips livid and bloodlefs ; 
and the whole furface of the body nearly devoid of feeling. 
In feeble habits, where the attack was exceedingly vio¬ 
lent, and unrefifted by medicine, the fcene was foon 
clofed. The circulation and animal heat never returned; 
the vomiting and purging continued, with thirft and 
reftleflhefs ; the patient became delirious or infenlible, 
with his eyes fixed in a vacant ftare, and lunk down in 
the bed; the fpafms increafed, generally within four or 
five hours. 
“The difeafe, fometimes at once, and as if it were mo¬ 
mentarily, feized perfons in perfect health ; at other 
times, thofe who had been debilitated by previous bodily 
ailment; and individuals in the latter predicament gene¬ 
rally funk under the attack. Sometimes the ftomach and 
bowels were difordered for fome days before the attack, 
which would then, in a moment, come on in full force, 
and fpeedily reduce the patients to extremities. 
“Such was the general appearance of the difeafe where 
it cut off the patient in its earlier ltages. The primary 
fymptoms, however, in many cafes, admitted of confider¬ 
able variety. Sometimes the ficknefs and loofenefs were 
T t preceded 
t 
