OBSERVATIONS ON ASIATIC CHOLERA.

207 fever may with bene- pour forth into their cavity the serous portion of the blood, until the vital fluid grafit be consulted. I am acquainted with an extensive parish dually becomes less fluid, and ceases to within the bills of mortality, whose surgeon circulate through the extreme portions of has adopted one little varied plan of treat- the body ; hence the animal heat dimiment from the beginning of the epidemic. nishes by degrees, and there arises a state For a few weeks nearly all his cases re- of spasm, extendingfrom the extremities covered ; and then again, without any alts- to organs most essential to life, and termiration of system, he finds that nearly all nating in tetanus, and a complete paralizahis cases for the few next weeks die. This tion of every function. has occurred more than once, without his Numerous dissections, in which the beingable to refer it to any tangible cause. mouths of the exhalent vessels are always Cholera has for this fortnight past been seen open, and projecting, the remarkable raging at Dumfries with excessive vio- want of fluidity in the blood, and the senlence, having almost depopulated the town. sations which I have experienced myself It is at present prevailing at Edinburgh to during an attack of this disease, have conan extent which has never been known be- firmed me in this view of the subject. Our fore, and with marked fatality. The wea- 1 first indication naturally is to destroy as ther during the above period has been quickly as possible the deleterious cause thick, rainy, and excessively warm for the of the disease, by combating the effects on the abdominal nerves by the month of October, in Scotland, marked by the luxuriance of the vegetable world, the atmospheric and terrene causes before alwild strawberry being actually loaded with luded to. With this view we order uatients the flowers and fruit, and the buttercup in full of a good constitution to drink, flower. This increase of temperature, and early period of the disease, large quantities and endeavour at the peculiar state of the atmosphere that of warm water, tea, &c., has existed for some time past, which I the same tobring about copious perspiration warm applications dare not attempt to describe, is supposed externally. This to be the cause of the increased fatality of cutaneous transpiration, often produced by nature herself, is frequently followed by a the cholera here at present. quick restoration to health, on which acEdinburgh, Nov. 1832. count the use of ice,-in favour of which no rational argument can be adduced,-should be avoided during this period. In common

analogy of puerperal

I

produced

during

by

OBSERVATIONS ON

employ with the same object of restoringthe cutaneous circulation, powerful doses of ipecacuanha: this has been

cases we

ASIATIC CHOLERA.

attended with great success, and we were rarely compelled to have recourse to general d’Honneur, &c., bleeding. When it was necessary to abstract blood, this was done by the application of MONSIEUR,-Je prends la liberté de vous leeches to the temples, or, more commonly, envoyer quelques mots sur le cholera to the scrobiculus cordis ; but in all cases it morbus, en vous priant de les faire insurer was found expedient to second the action of dans LE LANCET. It est mieux pour ge- the emetic by large warm sinapisms applied neraliser le bien qui pourrait en r6sulter in succession to different surfaces ot the pour l’humanité de les faire publier dans skin. Ipecacuanha has no beneficial effect la langue Anglaise. Veuillez compter,Mon- whatever in the second stage of the disease, sieur, sur mon empressement de vous servir, characterised by coldness of the skin, &c. si un jour l’occasion s’ell presente. J’ai Here we may expect a favourable result, bv 1’honneur d’etre, Monsieur, votre serviteur, powerfully on all the surfaces, both D. VERING. external and internal, by means of camphor and cold. Vienne, en Autriche, As nature frequently produces the same Dec. 9, 1831. (’Sects by various means, so in medicine the TnE disease called " Asiatic cholera" same result may be obtained from the most is produced by certain terrestrial and at- opposite agents ; hence we can readily unmospheric causes, which chiefly affect the derstand how cholera may have been cured abdominal nerves, when their energy is in different cases by very different modes of diminished by bad diet, the action of cold, treatment; but as 1 have been able to save or the decline of vital power itself. This 58 out of 40 persons attached by the above

By

Dr. VERING, Chevalier de la Vienna.

Légion

acting

I

morbid influence again produces des j’essene- treatment (varying it only as the temperaments of the bowels, in consequence of which ment, &c., of each patient required), I have the mouths of the exhalent vessels, or the thought it may be useful to make known

surface of the intestinal

canal, continue

to such

a

fortunate result.

208

All precautionary measures, such

qua- from the symptoms of his old complaints have than he has been for many years ; he has been proved actually injurious, and the had no consecutive fever, his spirits and malignity and rapid death which accom- appetite are good, and all his secretions panied the disease on its first appearance in are natural. this country, diminished from the moment The third case, a delicate female, sixty. such means of precaution were abandoned. five years of age, I reported dead in my last. At Vienna, as in many other places, in-i termittent fevers to a great extent preceded The fourth case, Dan. Wilson, has been the cholera, and suddenly disappeared on I, convalescent, without consecutive fever, the approach of this latter disease. At the I, for some days. time I write, when we have few if any ’ The fifth case, Cath. Bruce, terminated cases of cholera, intermittent fever under this woman was a habi. Though fatally. every form is reappearing. The same tual drunkard, though subject to epilepsy, servations have been made by Dr. Wagner and for many months to an incontrollable at Odessa.* We have, therefore, reason to diarrhœa—so much so, that she unavoidhope, from the return of the intermittent became an offence even in the street; fever, that some favourable change has ably and though attacked with cholera in a very taken place in the atmosphere, and that we she improved so wonshall finally be delivered from this destruc- I, malignant form, yet under our treatment, that up to the derfully tive plague. morning of the fourth day I felt sanguine of her recovery ; then, however, she had a rigor, began to complain of pain in the region of stomach, was sick and vomited, became SALINE VENOUS INJECTION very feverish, complained vehemently of IN CASES OF pain in the right arm at the extremity of MALIGNANT CHOLERA, the ulna (she was injected only in the left arm, the wound in which was in good state, PERFORMED WHILE IN THE and quite free from uneasiness), which acquired a deep-purple hue, and spread over VAPOUR-BATH. the hand and up the arm. Shortly after this a similar appearance was visible in By THOMAS LATTA, M.D., Leith. the corresponding part of the left arm ; before death her feet acquired the same hue ; To the Editor ofTHE LANCET. died on the evening of the sixth dav she SIR,-Last week I transmitted to you n. short account of five cases of cholera treated the sensorium was undisturbed to the last. Our post-mortem investigation discoverby suspending the body in a horizontal ed nothing preternatural except in the position in warm vapour, and then inject- cavities of the heart, which contained veins with water with the the charged ing fibrinous depositions ; the liver and sto. protoxide of nitrogen, and holding in solu- mach also were diseased ; the former ention the salts natural to the blood ; this 1 and indurated, larged feeling gritty under used at temperature 970 or 980. Aly rethe knife; the latter inflamed internally, the cases under and acleft treatment, port its mucous coat being’ very thick and pulpy; cordingto promise I now complete my task. other organs healthy. The first case, Pat. Peddie, which was Since treating the above cases, I have a very hopeless one, and certainly beyond of subjecting the plan the reach of any remedy except venous in- had no jection, was dismissed cured ; he never pursued to the test of further experiment, had oce untoward symptom after being in- and therefore reserve my remarks till a future period. Being entirely ignorant of jected. the primum mobile of the disease, I have atThe second case, Geo. Dunn, whose cirto remove symptoms only, first by tempted cumstances were truly desperate, and whose external warmth in a way acceptapplying recovery goes far to recommend the treat- able to the patients ; this not only perinament, has also done well, which much exnently restored the natural temperature, ceeds my expectations. Not only was the but either moderated the discharges, or attack of cholera verv severe and far ad- removed them permanently ; then 1 injectvanced, but his constitution was under- ed the veins, and so subdued these sympmined by the pernicious effects of chronic toms which on the deteriorated depended disease in his stomach and liver, of seven- state of the blood ; the solution I used can. teen years’ duration ; he has had phlebitis, tained a third more saline matter than I but is now well, and declares lie is freer used in my first cases this change I deemed necessary, as less fluid is requisite to rouse * Hufeland Jour, des Prac. Hiel. 1831, p. 126. the system when the vapour-bath is used. as

rantine, the seclusion of the sick, &c.

I orb-

’

opportunity