Observations on the epidemic now prevailing in the city of New-York : called the Asiatic or spasmodic cholera : with advice to the planters of the South, for the medical treatment of their slaves

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OBSERVATIONS

ON

THE EPIDEMIC

NOW

PREVAILING IN THE CITY OF NEV^-YORK;

CALLED THE

ASIATIC OR SPASMODIC CHOLERA;

WITH

ADVICE TO THE PLANTERS OF THE SOUTH,

MEDICAL TREATMENT OF THEIR SLAVES.

BY CHRISTOPHER C. YATES, M.D.

'^ NEW-YORK:

PRINTED BY GEORGE P. SCOTT AND CO.

CORNER OF NASSAU AND ANN STREETS.

1832.

Entbrkd according to the Act of Congress, in the year 1832, by G. P. Scott, in the Clerk's
Office of the District Court of the Southern Uistrictof JNew-York.

INTRODUCTION.

The following pages do not strictly comprehend a treatise
on the spasmodic cholera. They merely contain observations
elicited from time to time by what has been done during its
prevalence in this country. They are intended to point out
the errors which, in the writer's opinion, have occurred in the
management and treatment of the disease ; and, if possible, to
lead to a correction of those errors.

In order to render this pamphlet more useful and instructive
to the reader, it may not be out of place here to point out the
premonitory and fixed symptoms of the malady ; a good descrip-
tion of which, in accordance with the writer's own judgment
and observation, is contained in the following extract from a
report of a committee appointed by the medical society of this
city, signed by John Stearns, M. D. chairman.

" The best writers on cholera asphyxia, generally agree that
it is invariably preceded by the following symptoms :

" The patient complains of lassitude and a partial uneasiness
in the region of the stomach, accompanied with some slight
evacuations from the bowels, insufficient however to excite his
attention or alarm. As these symptoms increase, and the eva-
cuations become more frequent, from two to twelve times
a day, accompanied with increased griping, his countenance

IV INTRODUCTION.

becomes sharp and dark, of which he seems to be perfectly
unconscious. Occasional nausea sometimes appears at this pe-
riod. These symptoms generally continue, varying in severity,
from one to ten days before the second stage supervenes. The
evacuations at first are of a dark brown or blackish hue. As
the looseness continues, they become of a less natural appear-
ance, until they assume the consistence and aspect of dirty
water. Some headache, cramp of the fingers, toes and abdo-
men, slight giddiness, and singing in the ears, accompany these
symptoms. Sometimes a costiveness of two or three days*
duration supervenes, which is immediately succeeded by a re-
turn of the diarrhoea, and in a few hours after by a collapse of
the whole system, with nausea and vomiting."

Of the REMEDIES recommended by the various authors and
writers on the subject from abroad and at a home, I dare not
undertake the record. They would fill as many pages as this
pamphlet contains. The recipes are as numerous as the Ara-
bian tales.

These are, opium in all its modifications, camphor, oil of
peppermint, brandy, capsicum, cajeput oil, table salt, pepper,
mustard, ice, calomel, jalap, charcoal, burnt oats, lard, mint and
cinnamon waters, maple sugar, cataplasms, injections, poultices,
dry and moist heat, frictions, sulphur, hot and tepid baths, to-
bacco juice, cordials, cupping, leeching, bleeding, saline injec-
tions into the veins, electricity, lye, turpentine, soot, hartshorn,
ether, and a thousand et cceteras ; all and every of which have
had and have their successful advocates ! And add to them, as
if in mockery of the desires of nature, the total prohibition of
drinks, particularly cold water, under the most ardent and un-
quenchable thirst !

" Can such things be,

And overcome us like a summer cloud,

Without our special wonder V

INTRODUCTION. ▼

If the disease, as is contended, be of a special character, why
has there not, in the seventeen years of its prevalence, yet been
discovered and adopted a special remedy ? Its mortaUty is
evidently as great and terrific now as it was several years ago,
when it commenced its ravages in Europe. During this period
it has been the subject theme of scientific research, and has
called into action the most noted medical talents ; but, that we
are not, as yet, advanced a single jot in our remedial knowledge,
I appeal to historical and existing facts.

The power of " disinfecting agents," except on stench and
putridity, I deem extremely problematical. We want proof
that the atmosphere is less pure now than at other seasons.
We want proof — only probable proof — that the air contains a
particle of specific infecting matter, or that the morbid cause
does not exist in our own constitutions, and has been accumu-
lating for months or seasons. Twenty years ago I thought,
with the late Dr. Alexander Coventry, that all epidemics had
their predisposing causes operating on the constitution for
months previous to their breaking out, as the seed in the ground,
in due time to spring into fife.

But allowing that imperceptible particles of infectious matter
exist in the atmosphere, what proof have we that the chlorides
will alter their nature or their properties ? Only from this ana-
logical deduction, that inasmuch as chloride destroys the stench
of putridity, it must of consequence destroy the substance mat-
ter of infection — an unphilosophical deduction at best. But let
us come to a case in point. Will chloride destroy the poison-
ous quality of arsenic, the emetic property of antimony, or the
soporific effect of opium ? If not, what right have we to sup-
pose it will otherwise affect an imaginary particle of poisonous
matter floating in the atmosphere ? We cannot know, from
any thing that has yet been discovered, that chlorides have the

▼I INTRODUCTION.

slightest chemical influence on the quahty of any matter except
its odor, much less on that of the matter in question. Hence I
conclude that all the expense incurred for their distribution
throughout our streets and yards is a mere boon to public alarm
and prejudice. The only proof we have of the benefits of
chlorides is in their very useful effect of combining with offen-
sive effluvia, so as to render them insensible to the organs of
smeU and taste.

I am not unaware of the opposition I shall encounter in the
following publication. I am sensible that I tread hard upon
professional corns, and that I am avowing opinions and doc-
trines in discordance with a great majority of physicians.

My system of evacuants in this disease has been condemned
by a number of my brethren.* They say I must be " mad " —
well, be it so. I was honored with the same appellation in the
winter of 1812-13, during the prevalence of an epidemic as
mortal as this, and much of the same character. Then, too,
laudanum and brandy were the order of the day, and they
proved as efficacious then, in our several cantonments and mili-
tary hospitals, and through the northern and western parts of
this state, as do the same remedies in our present epidemic.
Many will remember the great mortality, particularly at the
military stations, where for the first five weeks, on an average,
three out of five died of the " winter fever," as it was termed.
I then published an essay on the disease, founding my views

♦ I avail myself of a note, whilst the above is in press, to state, that about
three weeks ago, Dr. Thompson of Sunderland, in England, was in this city,
and communicated the following facts to a gentleman of my acquaintance.
Dr. T. left Sunderland after the cholera had ceased its ravages. He stated,
that he had seen it and attended it in all its various forms — that no case proved
fatal where emetics or cathartics, or both, were resorted to, in the early stages
of the disease ; and that the physicians eventually discarded the stimulating
treatment, both externally and internally, as utterly useless and unavailing.

INTRODUCTION. VU

on the same principles that I have here adopted. In that case,
however, my " madness " became as epidemic as the disease
itself, and my com-se of treatment was instantly adopted by
both army and private physicians, and the scene was to me a
very flattering change. The disease became completely ma-
nageable.

Again, in 1822, when I first removed to this city, the yellow
fever became prevalent. I treated my patients with emetics.
But here again I was heterodox. Authority denounced
emetics, as not only improper, but dangerous, in this formida-
ble disease, and I was again called "mad." What was the
result? I was successful in nineteen cases out of twenty.
Others lost nearly half of their patients. My treatment was
the result of practice and experience ; theirs of theory and of
"professional authority. My success was too palpable to escape
the observation of physicians ; and I had the gratification of its
acknowledgment from the candid and liberal, and was compli-
mented with the fact of the adoption of my mode of treatment
by others.

Now, in 1832, I am again " mad " ! Well, I hope and trust
that my present aberration of mind may not prove a less dis-
appointment among my professional brethren than my former
attacks. This fact I aver, and can prove, that no case has
proved fatal under my treatment.

Were I to relate the many anecdotes, both tragical and co-
mical that have come under my observation during this disease,
of subjects treated, and reported to the board of health, as
cases of ** Asiatic cholera," they would excite the smiles of
pity, ridicule, and contempt. But this introduction is already
too long.

I have read several treatises and letters, both from Europe
and of this country, on the cholera. They do not, I fear, lead

VUl INTRODUCTION.

to safe results. I will here cheerfully except a letter from Dr.
Caldwell of Montreal, which comprehends more useful and
practical instruction, and is a better guide for the treatment of
this disease than is contained in all the pamphlets that have been
written on the subject ; and the very able and philosophical
communications of Dr. Bronson of Albany, in a series of letters
to the mayor of that city, which do him much credit, and evince
a thinking and independent mind. To me, personally, both these
gentlemen are utter strangers ; hence I am not actuated by
motives of partiality in the expression of my opinions.

In the course of my remarks it will be perceived that I have
avoided as much as possible to enter on speculative notions or
theoretical subtleties. I have endeavored to confine myself to
simple facts, on which only have I founded my deductions.

These facts, and their deductions, have been verified by a
number of cases of indubitable character, and several of a most
malignant nature. The latter particularly demanded, and re-
ceived, the most active remedial treatment that I have thought
necessary to adopt, namely, vomiting and purging by antimony
and calomel; and I can assure the reader, with confidence and
truth, that the result has been invariably successful. As the
disease, in all its forms, has but one general character, it is rea-
sonable to suppose, that but one general course of treatment is
necessary for its cure. That course is laid down in the follow-
ing pages ; and if its adoption should meet with as much success
in the hands of others as it has in mine, the philanthropic mind

can well appreciate the value of my reward.

C. C. Y.

New- York, August 13th, 1832.

OBSERVATIONS ON CHOLERA.

The following article was written on the 18th of June, be-
fore the cholera had made its appearance here :

To the Editors of the Courier and Enquirer.

Gentlemen : I perceive that you have partaken of the
general alarm and consternation occasioned by the recent
reports of the cholera morbus from Canada. Come, gentle-
men, let us coolly, dispassionately, and deliberately examine
the reports, the disease, and the remedy of and for this fearful
cholera.

First, the reports : You will have learnt before this article
is in print, that reports cannot be relied on, in cases where
wonder or admiration are concerned.

Secondly, the disease ; What is it f A malignant cholera
morbus : and only differs from the same disease known as such
by all medical writers, in its being epidemicaL Its mortality,
in jjroportion to the number attacked, is no greater than it has
ever been in this or in any other country. The number of
cases and the liability to the attack, alter not the nature or the
character of the disease itself. When this disease becomes
epidemic or endemic, and at certain periods, like all other dis-
eases, proves more mortal than at others, still it is not the
more or less the malignant cholera ; as scarlet fever is still

2

10

the scarlet fever, though more malignant and fatal at one
period than another ; a fact but too famiHar to our fellow-citi-
zens of New-York for the last two or three years.

It is, moreover, a fact well known, that our old-fashioned
cholera morbus, when severe, is often fatal, and that under a
severe attack, the patient dies within twenty-four hours, and
not unfrequently in a very few hours. A moment's reflection
will bring these recollections to the minds of many whose
friends and acquaintances have died in this city. In short,
the symptoms are the same, varying with trifling circum-
stances, and the eflects are the same. This is my opinion, and
I have formed it on a careful examination of all the accounts
I have read of the history of the Asiatic cholera. Facts, or
histories from which only the facts can be collected, on this
subject, have been before the public for several years. The
Asiatic cholera must be well known to many European physi-
cians, and we are of course in possession of all the remarka-
ble occurrences attending it. Its symptoms and cure have
been commented on again and again, and we have all the his-
tory of its origin, duration, and progress. We have even in
our own city a physician who has not only had the experience
of several months in the observation and treatment of this
disease at Smyrna, its fountain head, but has himself been an
unfortunate subject of its influence. If then, I thought there
was any thing remarkable, anything inconsistent with the legi-
timate treatment of European cholera, to this physician would
I confidently appeal, for a knowledge of those remarkable
distinctions, and on his information would I confidently found
my course of treatment. Yet in the face of such authority,
of such means of information, of a knowledge of all precau-
tionary and defensive measures adopted in other countries, to-
gether with the report to our national legislature — yet, I say,
in the face of all these, our city authorities have been advised
to send a commission to Canada where the disease has broken
out, and where it is said that nearly nine out of ten die : and
for what ? To ascertain the police ? Nonsense. New-York,
an old, experienced city, where epidemics have prevailed fre-

11

quently, to send a commission to Canada for police instructions
against infections or contagions, is truly ridiculous. What
then is the object of this commission ?

The character of the disease and its remedy ? Surely there
has not been such remarkable success in the Canadian mode
of practice as to justify a hope of much enlightenment on that
subject ; but let that pass. The public fear must be soothed ;
and the panic is so universal in this city, that if a yelloic flag
were displayed from some conspicuous building as the sign of
cholera, I would not answer for the screams and tortures that
would be uttered and suflered by sympathy in less than twenty-
four hours. I speak from experience in these matters ; I have
witnessed many epidemics, and the effects of popular excite-
ment on such occasions.

And, gentlemen, this cholera is not such a wonderfully new
discovery as some people persuade themselves to apprehend.
It was known epidemically in London ages ago. Yes, this
very cholera, with all its prominent symptoms, is described by
Sydenham as an epidemic in London about the year 1676.
He says, " At the close of summer the cholera morbus raged
epidemically, and being rendered more severe by the extraor-
dinary heat of the season, was accompanied by more violent
and inveterate convulsions than I had hitherto observed.
For not only the abdomen (which is usual in this case) but all
the muscles of the body, and especially those of the arms and
legs, were affected with terrible spasms, so that the patient
would sometimes leap out of bed, and writhe himself all man-
ner of ways, in order, if possible, to mitigate their violence."
He makes no other difference in the treatment between this and
the ordinary cholera, than the use of the same remedies more
powerfully applied.

Sydenham was a wise man, a false theorist^ but an excel-
lent physician. He has here described the spasmodic cholera.

I now come to my 3d proposition — the

Remedy, — But before I enter distinctly on that part of my
subject, I shall, for the better elucidation of the grounds of
my opinions, notice the prominent symptoms which distin-i

12

guish this disease in its mild and its aggravated or malignant
state, and the strong analogy the latter state bears to the
effects of poison from arsenic.

I shall have need to remark upon the treatment proposed
and recommended by the " Edinburgh Board of Health." I
shall take the definition from their celebrated and learned
Dr. Cullen, who confessedly in his description of diseases
may be considered the best authority. He describes its
symptoms truly ; and that is all I ask for my present pur-
pose.

*' In this disease, a vomiting and purging concurring toge-
ther, or frequently alternating with one another, are the chief
symptoms. The matter ejected both upwards and downwards
appears manifestly to consist chiefly of bile.

" From this circumstance, I conclude that the disease de-
pends upon an increased secretion of bile, and its copious
effusion into the alimentary canal; and, as in this it irritates
and excites the motions above mentioned, I infer, that the bile
thus effused in larger quantity is at the same time also of a
more acrid quality. This appears likewise from the violent and
very painful gripings that attend the disease, and which we can
impute only to the violent spasmodic contractions of the in-
testines that take place here. The spasms are commonly
communicated to the abdominal muscles, and very frequently
to those of the extremities.

" In the manner now described, the disease frequently pro-
ceeds with great violence, till the strength of the patient is
greatly, and often suddenly, weakened ; while a coldness of
the extremities, cold sweats, and faintings come on, an end
is put to the patient's life, sometimes in the course of one
day."

Now, I contend that the cholera above described is the
same with that which has lately appeared in Great Britain,
and now said to be imported through emigrants from that
country into Canada, and from thence threatening our own
cities, with this, and this only difference, that the latter is of
a more malignant character* That the remedial treatment

13

ought to be radically the same, ditVering only with the inten-
sity of the symptoms, and increasing in power in proportion
to the violence of the disease.

Here then we have a disease whose symptoms not only, but
whose effects prove to a moral certainty the existence of a
highly deleterious and morbid secretion in the first passages
of the alimentary canal — that this morbid matter is of an acrid
and vicious nature, producing a painful, griping, and spasmo-
dic action in the intestines, and, in proportion to its intensity,
calls into sympathetic action the muscles of the abdomen and
of the extremities. This secretion is sometimes so acrid and
of so poisonous a nature, that its effects on the system bear a
strong analogy to the effects of arsenic. Physicians have
often mistaken the symptoms of poison by arsenic for cholera
morbus ; and I distinctly recollect that in the first case of poi-
son by arsenic to which I was called, unsuspicious of the
cause, I thought it a case of cholera, and I sat by the bed-
side of the patient several minutes before the suspicion of poi-
son entered my mind.

It was this strong analogy in the respective symptoms of
cholera and mineral poison that undoubtedly excited the sus-
picions of the people of Paris that their waters and liquors
had been poisoned with arsenic.

The interest of the subject will, I hope, be an excuse for this
long preface to my concluding position. Now then, for the
Remedy :

First. Remove as speedily as possible, the offensive matter
from the stomach and intestines in the manner that nature
indicates by her perhaps too feeble efforts, vomiting and

PURGING.

Secondly. Allay the spasmodic affection by anodynes.

It is evident, that while the morbid or poisonous matter re-
mains in the bowels, causing the most intolerable, tormenting,
and excruciating pains, eating and corroding as it were the
parts in contact, I say, it is evident, that under such circum-
stances the patient must die, unless this matter is ejected,
either by the spontaneous efforts of nature, or by active
artificial means.

14

How then shall we proceed? Pursue nature and common
sense, and administer vomits and purgatives ? Or, shall we
adopt the more scientific course recommended by the
"Edinburgh Board of Health !" Gracious heaven! "opium
and camphor! !" and that in cholera morbus, while the poor
patient is writhing in agony from the noxious poison that is
constantly gnawing his vitals — *' opium and camphor P"* For
what! to lock up, to retain by force, and against the efforts
of nature, the villainous poison in the system ?

I would ask what physician could be so mad, so scientifically
mad, as to use the most active remedies to retain the offend-
ing secretions where nature and common sense indicate the
propriety of encouraging their most speedy evacuation ? Yet
such is the tendency and such the effect of opium and cam-
phor, and carminative drafts. The fatality said to have oc-
curred at Quebec, where almost every case proved fatal,
would induce one to believe that the Edinburgh recommenda-
tions had been adopted to the very letter.

For my part, I do not believe that this disease would be
half so fatal if left to its own natural efforts, as it is under such
unnatural and ill judged treatment. And I do further think,
that a proper mode of treatment, under the views taken of it
by all respectable writers for ages past, with the addition of a
more bold practice on the established principles of its cure,
would disarm it of its terrors, and subject it to the power of
remedies. This disease has for the last fifteen years raged in
Asia as an epidemic. Its mortality in the country of plagues
is not to be wondered at : but in a European or American
climate, it ought to be, and I believe can be, rendered compa-
ratively mild and innoxious.

In the spotted fever, or cold plague, as it is called, which
prevailed in Vermont, New Hampshire, &tc. in 1811, and the
subsequent amelioration of the same fatal disease as it appeared
in this state during the winter of 1812-13, in the character of
an epidemic bilious malignant fever, manifesting many of the
symptoms attributed to the prevailing cholera — I recollect a
similar panic prevailed among the physicians, as now — and.

15

because a bilious disease appeared in a new form, it there-
fore was thought to require a new, or unheard of treatment.
At that period, too, we had the advisers and the advocates of
opium, camphor, wine, brandy, and all the family of stimu-
lants. Bleeding was recommended by some — -sweating by
others. Under this mode of treatment the disorder proved
fatal in from four to six cases out of ten, where medical aid
could be procured ; but in those parts of the country, parti-
cularly in the western part of this state, where the population
was too scattered to enable the sick to obtain medical aid, the
mortality was not half so great. I had this latter fact from an
intelligent farmer, a member of the legislature from Ontario
or Niagara county. But where a more rational mode of
treatment was adopted — where, instead of opium, camphor,
and other stimulants, to stop nausea, vomiting, violent pains
in the head, chest, and extremities, torpid action of the vessels
of the skin, coldness of the extremities, he, the attention of
the physician was directed to emptying the first passages, by
vomiting and cathartics, that dreadful epidemic lost its terrors
and became as manageable as a common fever.

How far, or whether any impression favorable to the stimu-
lating or quieting plan of the " Edinburg Board of Health,"
has been made upon our physicians I cannot say. Judging
from the character of those with whom I am acquainted, I
doubt, nay disbelieve any concurrence in any such doctrines.
Many of our physicians have had some experience in epide-
mics, and they will bear testimony in favor of my views. They
cannot think that because measles and scarlet fever have been
for the last year more mortally epidemic, that therefore they
should pursue an opposite course of treatment from that
adopted by them in former or more mild stages of those
diseases.

I then recommend, as the best and most effectual remedy for
malignant cholera, when, or in whatever shape it appear, that
immediate resort be had to such medium as will cleanse the
stomach and bowels, and after such evacuation, to allay the
pains and spasms by small and oft repeated doses of lauda-

16

mini, say ten drops every ten minutes till the patient is com-
posed. Camphor and peppermint are both obnoxious to a
diseased or irritable stomach, and have fashion only for their
support in any complaints. Cholera morbus generally ter-
minates in a few hours. After a free evacuation of the con-
tents of the stomach and intestines in the first hours of attack,
all danger is past.

These are my views and opinions of the Canadian cholera,
or whatever title you choose to give it. The remedy is simple,
and consists in removing the immediate cause, and calming the
distressing consequences by suitable anodynes. I hope my
fellow-citizens may never have an opportunity to test the truth
or fallacy of my doctrines, which, as far as opinion goes, are
but the same as those of many of my predecessors ; but if
they should necessarily become a matter of consideration, I
shall feel a consciousness that I have done my duty in laying
before the public an opinion formed on the result of many
years experience in my profession. I shall at least have the
consolation to know that I have made this communication

from motives of

HUMANITY.

LETTER TO DR. B. P. STAATS,

Health Oflicer of the City of Albany.

July 12, 1832.
Sir — I did conceive that the epidemic cholera now prevailing
in the Canadas, whether of Asiatic, European, or American
origin, came under the head of that species of disease termed
by nosologists cholera morbus. I also believed that this
disease was subject to similar varieties, grades and intensities,
from a diflerence in the prevaihng exciting causes and consti-
tutional susceptibilities, as in typhus, bilious remittent, bilious
malignant and yellow fevers, and 1 intended to oiler a few re-

17

marks, as suggested to my mind from some experience and
observation on the nature, tendency and cure of tliose diseases.

Anticipating the time when both our city and yours would
be visited by this threatening pestilence, I had commenced,
on the first of the month (July) some observations on the
subject; but the performance of my intention was suspended
by the sudden appearance of the disease in this city, in order
that I might learn by experience what I otherwise could have
treated of solely upon the authority of others.

On the 4th of July I availed myself of an opportunity to
see three cases of reputed " Asiatic Cholera." They proved
fatal. I examined each case minutely — received satisfactory
replies to all my inquiries, although one was at the time in
articulo mortis.

From this period, and whilst this communication is pro-
gressing, I shall visit the " cholera hospitals " from time to
time, and state such facts and opinions as shall be dictated by
my observations.

It is almost impossible to write on any practical subject in
our profession, without occasionally diverging into theoretical
deductions ; but as all deductions are mere matter^of opinion,
I shall claim no credence beyond probability.

The disease now prevailing here is not the Asiatic cholera.
It is no cholera at all, and the term is a misnomer. We have
before us the history of the Asiatic disease, and partially of
the Canadian type of it. I have examined the reported cases
in our cholera hospitals. I have especially noticed those whose
symptoms indicated dissolution, and who have since died.
I have made my observations on both questionable and de-
cided cases, and have not seen a single one that was marked
by any symptoms of cholera morbus. No similitude to
Asiatic cholera other than in the simple fact of extinction of
life, I make this assertion in the face of hundreds who are
daily visiting the hospital, and consequently hazard contra-
diction and disgrace if I falsify facts. I shall now state pre-
cisely what fell under my own notice.

I found, in the examination of the cases, that there was not

3

18

only a general, but an almost particular similarity of symp-
toms. A somewhat restless and a bloodless countenance —
an evident recession of the blood from the surface and extre-
mities, occasioned by a feeble and asthenic action of the
heart, or of exhaustion from excessive stimuli — consequently,
cold skin and extremities. This abstraction, as it were of
blood, and consequently of heat, from the surface of the
body, gives a sombre hue to the countenance, and a shrivel-
ling of skin, which are perceptible in all the dangerous cases.
There was no agony, no severe pain, no vomiting, no
diarrhoea, not a groan nor a complaint during the time I was
passing from room to room, and from patient to patient. To
my question, have you any pain ? the universal reply was, no,
or but a slight uneasiness in the bowels. To the question,
were you seized with violent pains and cramps ? No. — In
some few cases the attack had commenced with looseness, or
a little pain in the bowels. There is not that remarkable
dark or blue appearance so much talked of, and I could per-
ceive no other appearances than I should have expected from
asphyxia or drowning. Death seems to have no terror 5 and
life is extinguished as a lamp whose oil is exhausted.

That some cases have occurred of violent cramps and
spasms, I am fully aware. I only say that these symptoms are
not common to the disease in question. I can say so con-
fidently, while in passing about half an hour in the midst
of fifteen or twenty cases, I neither saw a spasm, a contortion,
an emission either by vomit or stool, nor heard a scream nor
a groan.

I am sure that, in what I have stated, you will not re-
cognise the disease with which common fame has credited us.
Our malady however is a mortal one as far as it goes. Death
occurs in a very short period, and I cannot learn that a
single decidedly marked case has as yet recovered. There
are in this, as there always will be under similar circumstances,
an abundance of imaginary or medical cases, which at any
other season would hardly call for medical aid. I have
this moment returned from a visit to the hospital — ou^ of

19

about twenty cases, there are not more than three with the
marked appearance of the reported disease.

Having now stated that the disease is not the Asiatic
cholera, nor cholera of any description; you will naturally
ask me what it is? A question much easier asked than
answered.

A cholera presumes bilious matter secreting either super-
abundantly or acridly, so as to produce violent pains and
spasms in the intestines, the abdominal muscles, and the
muscles of the legs and arms, and almost incessant vomiting
and purging. Cholera morbus is a genus of disease arranged
by Cullen in the class neurosis and order spasmi, and is
defined " a purging and vomiting of bile with anxiety,
painful gripings, spasms of the abdominal muscles, and those
of the thighs. There are two species of this genus:

" 1. Cholera spontanea, which happens in hot seasons with-
out any manifest cause.

" 2. Cholera accidentalis, which occurs after the use of food
that digests slowly, and irritates." This spasmodic affection is
altogether symptomatic, and has the same and no othei*
relation to the exciting or irritating matter in the duodenum,
than a cough has to any irritating matter that may be inhaled
into the lungs. Cramps are the mere result of exciting
causes in the stomach or intestines. In some they never
occur ; in others the slightest irritation brings them on.
Every nurse is familiar with this symptom, where crudities or
indigestive substances become offensive to the stomachs of
children ; and physicians know that some persons are always
cramped from vomiting.

I find that this symptom — this cramp — which in truth
comes as a relief to the stomach in like manner as the incubus
does to apoplexy, is made the great bugbear and terror of
this disease.

Spasms are never dangerous, and they always come in aid
of nature against some deleterious attack upon the nervous
system. Witness tlieir severity and continuance on the weak

20

female frame for days, and sometimes weeks, without any
ill effects.

But, you again ask, what is it? I can only say, that,
judging from the cases I have seen, the disease prevail-
ing here under the name of Asiatic cholera, is not that dis-
ease. That it is no cholera morbus, but a species of pest
or plague, indigenous to every place where its ravages have
been known. It is to the universe what typhus, bilious
and yellow fevers, hooping cough, measles, influenza, chicken
pox, dysentery, ophthalmia, he. are to certain districts
of country. This disease is not, as I expected to find it,
of a bilious character. The evacuations from the stomach
and bowels contradict the suspicion ; they are watery and
less feculent. The majority of the patients in the cholera
hospital have informed me that their evacuations were bilious,
both from stomach and bowels, when they were first attacked :
these cases were not dangerous. They were common cholera,
and so light that they hardly deserved the name. How
far laudanum, camphor and brandy will change this character
into malignant cases, I leave for you to imagine. There
is probably a deficiency of bile, and in its place we can
only imagine some unnatural, poisonous, and morbid secre-
tion distilling from the gall-bladder into the duodenum, of a
nature little, if any, different in its effects from prussic acid
or arsenic. Judging from its operation, it is, according
to its intensity, as fatal.

The symptoms in some of the most violent cases, as re-
presented to have occurred in Canada, do certainly bear
a strong analogy to the effects of poison from arsenic, even to
the extent of post-mortem examination. The same suffering
and agonizing contortions of body and anxiety of counte-
nance, the same appearances in articulo mortis, and the same
rapid decomposition on the extinction of life.

So remarkable were these facts at the commencement of the
disease in Paris, (I now speak of it as it appeared on the
continent of Europe) that a panic prevailed amongst a portion

21

of the inhabitants of that city, suspecting that their water,
and other liquors, were impregnated with arsenic or other
mineral poison.

I shall now state what I consider to be the exciting cause
of this singular malady; a malady in which the powers of life
seem to be blasted like a leaf from autumnal frost. There is
no previous fever, no efl'orts in the vascular system to rid
itself of morbid excitement, but they wither under this pesti-
lential sirocco without the power of resistance. If nature could
infuse a sufficient power of action into the arterial system,
were it but sufficient to aid in the expulsion of the offensive
poison, art might more successfully lend her helping hand;
but in this case there is complete and almost irremediable
prostration. The action of the heart grows weaker every
hour, congestion takes place as the blood recedes to the
heart, and the patient dies as from asphyxia.

What is to be done f To answer this, we must theorize till
experience decides. We must assume one of two propositions :
first, that the disease, as far as we can trace a cause, is owing
to the concentration of a morbid, virulent, and highly noxious
secretion from the hepatic organs into the intestines, which
there produces the deleterious effects observable ; or, second,
that there is a general morbid poison pervading the whole
vascular system, and sinking into inertness by a direct ab-
straction of the powers of life. I have adopted the first of
these propositions, as being in my judgment the more rational
and accordant with what I have previously seen in diseases
bearing the strongest resemblance to the one in question.
On this opinion is, of course, founded my principle of cure.
This may be summed up in a few words : where deleterious
or ofiensive matter enters into the stomach or bowels, nature
sickens at the intrusion, and exerts her efforts to throw it off.
If the matter have not gone beyond the stomach and bowels,
she rouses these into action to regurgitate, or carry it off. If
it has gone beyond these, and entered the secretory vessels,
she defends herself by a fever to throw it on the surface by

22

perspiration. This course nature pursues to cure herself. If,
however, a poison should enter the system beyond the power
of nature to reject, art must come to her relief, or lingering
disease or death must follow.

In the disease under consideration, whatever may be the
secretion, so complete and so rapid a typhoid state of the sys-
tem follows, as to render the stomach and bowels too feeble to
rid themselves of the morbid matter. Their eflbrts are partial
and inefficient, vainly struggling to overcome the noxious mat-
ter, as they would an over-dose of opium or arsenic, and the
corroding evil is sufiered to prevail in death. It is to this en-
feebled power, this sinking state, that I would wish to give
energy and the tone of reaction, by assisting nature. I would
endeavour to rouse the stomach into action, to stimulate the
ceasing powers of the heart, to throw into rapid circulation
tlie languishing blood, and, if possible, simultaneously to eject
the morbid matter from the first passages, and, by an artificial
fever, recover the lost action of the surface of the body. And
how is this to be done ? Through the medium of the stomach,
and in no other way can I conceive it possible. Your fric-
tions, steamings, and bathings, are mere mites in so formidable
a condition of the system ; your enemas are of no avail ; your
blisters, leeches, and embrocations are worth nothing to a
patient sinking under typhoid oppression. Your diffusible
stimulants, laudanum, brandy, &:c. only confirm the disease,
lock up the passages, prevent if possible all evacuations, upon
which the cure depends, give the common cholera a type
of malignancy, and close the "blue" or "black" scene in
death. It must be done by a pow^r superior to the disease,
or it will fail to conquer. The exciting cause, if stronger than
life, must be removed, or the patient must die. And it must
and can only be removed by active emetic and cathartic medi-
cines. It has been objected to this course that emetics are
inadmissible, ill timed, and dangerous, in a disease where the
stomach is already too irritable, too feeble, or loo exhausted
to admit of tlieir use. Indeed ! Let us examine into the

23

medical philosophy of such an objection. Suppose that a
person takes six grains of corrosive sublimate — an incessant
vomiting and drastic purging ensue — the person soon becomes
exhausted — the powers of the stomach lessen, and cramps seize
the limbs. Would a rational practitioner in this case argue
against the administration of an emetic on account of "too
great irritability, exhaustion, weakness, &:c. ?" The idea is
preposterous. No ; he would use every means in his power to
excite a new action in the stomach, and disburthen it of its
morbid contents.

Again, suppose a person to swallow half an ounce of opium ;
the effect of this goes almost immediately to the heart — the
stomach gradually becomes torpid — the efforts to vomit are
feeble — prostration ensues — and the appearance of death marks
the countenance. Here also, upon the objectionable principle
to emetics, their effect would aggravate the disease. But what
is the fact ? And where is the physician who would hesitate
a moment on their exhibition ? What, I will ask, would be
the effect, in either of the above cases, of laudanum, brandy,
peppermint, and camphor ? Let common sense answer the
question.

My remedy then is, to vomit or purge off the offending
matter, be it what it may ; and if pains or spasms continue to
exercise the system after a free evacuation, especially by the
bowels, give ten drops of laudanum every ten minutes until
they cease ; or at once give a full dose, of ether a tea spoon-
ful, and laudanum fifty drops, mixed together in some liquid
agreeable to the taste.

If the vomiting in this disease should be too incessant, and
reject a full dose of an emetic, of which I prefer the tartrite of
antimony (tartar emetic) before all others, I would, as I have
been obliged in cases of yellow fever, dissolve twenty-four
grains in eight ounces of water, and give a table spoonful
instantly after each ejection from the stomach ; in such case,
after eight or ten spoonsful have been taken, a small portion
will have touched the coat of the stomach, when longer inter-
missions will soon follow, and eventually a complete emetic

24

effect be produced. When once the first passages have been
cleared, all danger from the disease is over ; mucilaguious
drinks, and occasional gentle laxatives finish the cure. This
treatment is applicable to malignant cholera, and I shall rely
on it for the treatment of the prevailing disease, which wants
but one symptom to constitute it the Asiatic disease, and that
is cholera. All the cases that I have seen in the hospital,
which I have considered as ordinary disease, have in their
commencement ejected bile. These will recover if they are
not frightened into a worse stage, from their situation, or me-
dicated into the disease. I would by no means have it under-
stood that I would administer emetics in the forming state or
first stages of the disease, unless accompanied with symptoms
of nausea or vomiting. For premonitory symptoms I would
and have now successfully used, a powder consisting of two
parts of tartrite of potash (soluble tartar) and one of jalap —
dose twenty grains every two hours till it operates freely; or,
if more convenient, castor oil.

1 shall now consider the other proposition, and suppose the
disease to be a general and not a specific agent of the un-
known cause ; that the secretions in general have become
contaminated, and that the heart and vascular system are
withering under their morbid influence.

Upon this hypothesis, I will agree, that the general course
of prescription and practice recommended and pursued by the
majority of our physicians, in the administration of laudanum,
brandy, camphor, and other diffusible stimulants, may be
correct. But I would prescribe them on a very different
principle from that avowed by its advocates, viz. to subdue the
pains, spasms and nausea at the stomach. This state of the
system presents for consideration a question, not between
pain and ease^ but between life and death ! The heart must
be stimulated by the exciting power of these diffusible and
powerful agents, through its only medium (except the lungs)
the stomach.

In such case, where high stimulants are admissible in order
to bring on reaction of the heart and blood-vessels, I think

25

that physician cannot have profited much by experience who
would hesitate to add antimony to their powers.

What medicine have we that is more actively diaphoretic,
or perspirative f Is it not noted for its powerful tendency
to the skin in the most obstinate and debilitating fevers, and is
not that a prevailing object to be obtained in this disease ?
As well might you object to the abstraction of blood in all
cases of oppressed circulation. And if too much blood can
produce a dangerous state of debility, which requires its ab-
straction, so can too much vomiting-matter, producing similar
effects, claim a similar remedy for its relief.

I wish to guard you against the impositions daily practised
on this community by false reports. Our health police is
most injudiciously formed, and withal embarrassed by con-
flicting opinions between its members and the physicians, and
between one portion and another of the physicians themselves.
There are almost as many opinions and doctrines as there are
doctors; and they and the board of health become more
choleric than the poor sufferers under their respective cares.
Our board of health is so constituted, that it cannot or does
not refuse the acceptance of the report of any licensed physi-
cian. Of this description there are a hundred courageous
enough " to seek reputation in the cannon's mouth ;" and
there is not a filthy hole unsearched to find some drunken or
starving wretch who may have some symptom that will justify
a report, or send him to one of the hospitals. Should the
latter be done, then indeed is his case deplorable. Appalled
by fright, disease and death on one hand, and the doctors on
the other, science cannot save him, and he dies a martyr to
the cause of cholera, cajeput, and camphor. The reports in
our city are false; and from the best information that I can
gather, and from my own observation, I believe that the cases
of what is termed Asiatic cholera, which have appeared in this
city from the 1st to the 12th of July, do not average more
than six a day. The number of cases reported yesterday
(11th July) is 129! Rely upon it, not more than 9 of them
are what may be called Asiatic or malignant cholera. If

4

26

I have one desire chief in my mind, it is that I might
have the pleasure of your company, and pay a visit to our
several hospital departments, there to witness what is here
styled " Asiatic cholera," and you would then more fully ap-
preciate the truth of my statements.

I believe that as yet not a single physician, nurse, nor
attendant in our public institutions has been attacked ; nor
can I learn that an indisputable case has occurred in any indi-
viduals, except among the poorer class of foreigners, and the
poor, filthy, and drunken of our own country.

I now close with my best wishes that you may be spared
this calamity, or be more successful in curing terror and
disease than we have been, in this our devoted and libelled
city of New- York.

TO BENJAMIN ROMAINE, ESQ.

Sir, New.YorJc, July 20th, 1882.

In our conversation yesterday, on the character and
treatment of the prevailing epidemic, you expressed your
surprise at the unnatural and inconsistent manner in which
physicians treated it. The fact of our agreeing in opinion
was the more gratifying to me, as I have reason to esteem
your ideas on such a subject more consonant with unbiassed
judgment than those of a majority of the medical profession
of the present day. I know that you have witnessed, and been
familiar with, every epidemic that has prevailed in our city
for the last fifty years ; and, although not a physician yourself,
I know that you have watched and scrutinized the symptoms
and treatment of those several diseases with the eye and the
judgment of a philosophical inquirer. I know that you have,
during the most calamitous times, associated and been intimate
with the most learned and eminent physicians of by-gone

27

days, that you have learned and appreciated their opinions
and practice; and that you have been a strict observer and
commentator upon a subject where common sense has ever
taken the lead of wild theory and authoritative practice. To
have my own opinions therefore approbated by a mind imbued
with such qualifications for judgment, is as gratifying as it is
complimentary.

A physician who has studied his profession in books, and
tested authorities, by years of practice at the bed-side of his
patients, ought to be qualified to form his judgment of the
character and nature of every and any disease that might
come under his observation, or whose symptoms should be
truly described. The relationship of remedies in a new dis-
ease he can only judge of by analogy, or by personal adminis-
tration. For any information beside these two points he must
resort to his own learning and his own experience — beyond
these no authority can avail him. The falsity of authorities
stares him in the face from as many sources as there are
authors : and instead of exercising his own judgment, founded
on his own experience, he becomes lost in the wilderness of
conflicting dogmas and theories, which render his course of
practice a game of hazard.

After reading an hundred authors on the theory and prac-
tice of physic, whose opinions and treatment are at variance
with each other, and whose inconsistencies cannot be reconciled
by the common measure of reasoning — who, although start-
ing from the same point, and having the same object in view,
yet diverge into several and separate directions, I ask, what
reliance can be placed on such authorities ?

Do I profess to be a physician, I should certainly be com-
petent to know my remedy when I see and examine the dis-
ease I am to treat. The physician ought to be like the natu-
ralist, who meets an animal, or plant, or a mineral, which is
new to him, or has never been described by authors — he finds
the family it belongs to, and whatever its variety, he traces it
back to its order. So will an experienced physician, when he

28

meets with a disease whose symptoms are novel to him, be able,
from some associate symptoms, to observe \is family and trace
it to its order. If now his own judgment, the result of former
experience, the knowledge of the powers and susceptibilities of
the human system, the properties and operation of medicine, do
not give him sufficient confidence to rely upon his own re-
sources, without continually seeking after and applying to
authorities in order to guide his judgment, he is not fit to be
trusted in any disease, much less in one of a dangerous cha-
racter.

Our epidemic cannot most assuredly be so singular, so un-
common, so foreign to all analogy, since our physicians are
literally quarreling as to whether certain cases are the new or
the o/c?-fashioned cholera of our country. There must, at
least, be a family likeness. The malady that afflicts us at
this time is evidently of domestic origin. It is folly, and an
idle waste of time, to trace it to Asia. It is not contagious —
a fact also indisputable. It is mortal — a fact amply proved.
To say that *' the disease is not dangerous, and can be easily
cured," is mockery. Its fatality has been proved — its danger
has been proved, or the conduct of our citizens and authori-
ties is a mere farce.

Those who sink under it have, from their mode of living,
rendered their systems susceptible to this peculiar species of
disease, and I believe that the general constitution of the in-
habitants partakes more or less of this predisposition. It is
idle to ask for a remote cause : but it is not half as likely to
be in the air as in our food and drink.

I believe that the number of cases which would naturally
slide into the asthenic, or deadly stage of the disease, is much
less than that of those who are daily medicated into it by the
popular mode of practice, adopted from imitation or authority.
Many, also, who are daily reported would never, I apprehend,
become cases even of the second stage, were it not for the un-
timely abuse of opium, laudanum, camphor, &;c. — remedies
slavishly adopted and pursued both in the suspected and inci-
pient state of the disease.

29

Almost every sensation, be it ever so slight, that the imagi-
nation, or a little rumbling of the intestines, or uneasy diges-
tion can produce, is immediately construed into a " premoni-
tory symptom," and is forthwith followed by medicines, which,
instead of proving, as intended, correctives, are in reality the
means of locking up and retaining the morbid secretions, if
any exist, and induce the very state of things they were in-
tended to prevent.

There should, in no instance, be given any thing but mild
cathartic medicines, where there is neither nausea, nor vomit-
ing, nor a preternatural diminution of heat on the skin. In
cases where the natural heat of the skin isXpither increased rfor
diminished from its usual standard, accompanied with nausea
or vomiting, I would have immediate recourse to an emetico-
cathartic, composed of four grains of tartar emetic and six
grains of calomel.

Where spasms occur, I consider them merely symptomatic
of the irritating effect of the secretion in the first passage of
the intestines, and instead of soothing, palliating medicines, I
would, by the first and most active means in my power, remove
the morbid matter : and in case the symptomatic affections
cease not with its expulsion, it is then in time to resort to pal-
liative or anti-spasmodic remedies.

I believe that the real cases of this mortal malady bear but
a small proportion to the artificial ones ; and it is not to be
wondered at, when every indisposition to which a *' premoni-
tory symptom of the Asiatic cholera" can be referred, is, by
a certain class of our profession, considered a sufficient foun-
dation for special report, and treatment " in all such cases
made and provided." Of this I have witnessed a number of
instances.

In confirmation of the truth of my last position, I need
only refer you to a circumstance which occurred in Canada.
It seems that a stranger of singular appearance came to Mon-
treal while the epidemic raged at its height, and proffered his
gratuitous services to the afflicted, in prescribing a new and
certain remedy for the disease. Common fame has given

30

much credit to his success. His name is Stephen Ayres.
His prescription, as given in the Montreal papers, was

Two spoonsful of charcoal.

Two do. of lard.

Two do. of maple sugar.
That this prescription has the slightest power on the system
in so formidable a disease, my credulity cannot digest. Its
value and prophylactic powers consist in its entire inertness or
its mild cathartic nature ; yet the fact speaks volumes. Happy
would it be for our city were certain of its professional mem-
bers as sensible men as Stephen Ayres !

In times of universal sickness, there has always been a kind
of epidemic fancy amongst the otherwise healthy but timid
portion of the community, which reads and breeds symptoms.
At these times the mind, for want of the usual stimulants that
support it in the active and busy concerns of life, becomes
enervated by dieting, as it were, on sympathy, as well as be-
ing the victim of fear and apprehension. Hence every alarm-
ing report is calculated to increase its fears, and it readily
yields to the slightest and otherwise unobserved variety of
sensations to which it is daily subject. It is a well known fact,
authenticated by medical history, that the human system can,
through the medium of imagination, be brought into a state
of that most terrible of all diseases, hydrophobia. And I
can testify from my own observation within a few days past,
that I have witnessed several cases of common and every-day
irritability of the stomach and intestines, ushered into the last
and mortal stage of the prevailing epidemic by apprehension
and laudanum.

But, to return to Dr. Ayres and his plan of treatment. In
the Montreal Herald of the 7th inst. is the following article :

"FACTS ARE STUBBORN THINGS.

"When the Indian chiefs from Caughnawaga visited Mon-
treal with the view of obtaining, if possible, some stay for the cho-
lera, which was so rapidly depopulating their village, they re-
paired to the house of Mr. Joseph Lancaster, where they were

31

kindly entertained whilst search was made for Dr. Ayres, who
returned with the chiefs, taking with him a supply of his mate-
ria medica. The deaths up to that time were sixty-two.
There were then existing sixty-three cases, and in the course
of the first twenty-four hours thirty-six new cases occurred,
making in all ninety-nine. A very respectable person who
left Caughnawaga yesterday morning, and whose word cannot
be doubted, affirms, that when he departed, ninety-three out
of the ninety-nine were up and walking about, and he fully
expected to find the other six convalescent upon his return.
Such extraordinary success had naturally raised in the breasts
of the Indians a veneration for their preserver, little short of
worship. His successful practice, however, there, as in Mon-
treal, had been the source of jealousy and bad feeling in a
quarter where it was the least to be expected."

While copying the above extract, a circumstance occurred
to my mind, the relation of which will apply strongly to the
confirmation of the success of Dr. Ayres' treatment, and will,
in no small degree, open our eyes to the delusion under which
the public labour with regard to the epidemic. I allude to
the successful mode of treatment of Monsieur Chabert, the
noted "fire king" and " professor of antidotes to poisons."
He appears to be a plain, intelligent, and benevolent man ;
has seen much of the world ; has gathered a number of recipes,
and understands well the human character. I have seen this
man, in the presence of a large assembly, composed of medi-
cal and other scientific men, take upwards of thirty grains of
phosphorus, which I administered myself, at a dose, while not
a man in the room would have dared to take five grains for
fear of being poisoned ; and probably without any other anti-
dote than his own good sense and confidence in the nature
and power of the material. In a conversation with him on
the subject of this disease when it first made its appearance in
this city, he asked me whether I did not consider it of a bilious
nature f I answered him, " most assuredly the disease must
be bilious if it is a cholera," and that the cure would depend
" on the most active and prompt remedies that would evacuate

32

the contents of the intestines." Mr. C. appeared pleased with
my suggestion, and told me that in his travels through South
America he had, among the natives, met with a vegetable
substance whose action on the stomach and bowels was almost
instantaneous y and manifested a disposition to test its efficacy
in the cholera morbus now prevailing. I observed to him
that if such was really the effect of his remedy, I doubted not
that he would be more successful than many of our professional
men, who threatened a mode of treatment of an opposite cha-
racter— retaining instead of evacuating the bilious secretions.
I have not again met with M. Chabert except through the me-
dium of the newspapers, where I find him offering his gra-
tuitous services to the public. I have since frequently called
at the hotel where he resides, and there learned that he had
from fifty to one hundred calls daily from invalids who had or
thought they had the ** premonitory symptoms." I have at
least as much confidence in the statement in his advertisement
that ** he had treated 528 cases and lost four by deaths,"
as I have in our daily city and hospital reports. Now what
does this statement of facts argue f M. Chabert gives active
cathartics together with his specific anti-cholera drops, and
our city and hospital physicians, with a ^ew exceptions, ad-
minister laudanum, brandy, paregoric, camphor, &;c. Look
at the success of the two modes of treatment. Does it not
prove that the mortality among us which spreads terror through
every section of our country, and creates the most gloomy ap-
prehensions among those who have yet to suffer, is owing to
a course of treatment at tear vdth medical philosophy, common
sense, and rational practice ?

I cannot for my part be persuaded that a twentieth part of
M. Chabert's patients have any real " premonitory symptoms,"
any more than I can believe that our city and hospital reports
comprised that proportion ; but I can very easily compre-
hend that the gently-physicked portion of them will get well,
and that that portion which are scientifically drugged and
opiated will get sick in good earnest, and many of them die
in their existing state of mind and body.

33

I do not hesitate to declare it boldly, that if the laudanum
and brandy treatment were to be abandoned for one week, we
should have but few deaths a day of epidemic cholera, except
among the beastly intemperate. I know that it is degrading
to our profession to draw this inference, but I believe it to be
strictly true.

It has been gratifying to learn that several of our old and
experienced practitioners treat the disease according to its
symptoms ; and that the ordinary indispositions of the season
are met in their ordinary course of treatment : hence, these hare
no "cholera cases" to report, no *' cholera deaths" to record,
beyond their usual number. They do not give opium in every
little ache and pain that alarm the fearful and nervous. Our
epidemic might in truth be styled cJwlera opiata.

One word more on the subject of medical missions from
various parts of the country to our city, to " see the disease,
and learn its mode of treatment." If those who compose
them, instead of exercising their own judgment, adopt the
opinions and treatment prevalent among us, and recommended
in several foreign treatises, it would have been better had they
staid at home, and met the disease ** with a christian resigna-
tion to the will of divine providence," and, in that event, they
and their constituents would have been gainers.

TO DR. HENRY BACON,

ST. Mary's, Georgia.

NeW'YorJcy Aug. 1, 1832.
Sir,

In a former letter I mentioned to you what were my
opinions of the " Asiatic cholera," its character, remedies, &c.
and shall now reply to that portion of your letter wherein you
ask my opinion of quarantines, cordons, and medical police.

No quarantine regulations in this or any other country
appear to have had the effect of preventing the spread of this
disease, allowing it all to have been of the same character.

5

34

Every physician of eminence in Europe and in this country,
who has watched and studied the progress of the epidemic, has
pronounced it non-contagious, and many facts assure us that
it is not infectious. Quarantine regulations have, however,
been all the fashion in Europe, and we have adopted them in
this country in the face of contradictory facts to their effi-
ciency.

The more sensible and thmking portion of the community
with us, are ready to allow that its progress is not by con-
tagion ; but they deem it expedient to yield to the terrors and
apprehensions of the panic-struck multitude, and acquiesce in
conceding to their fears and their prejudices, what reason and
past experience have exploded as useless and unavailing.

If the leading men and the authorities of towns and cities
would consult the past events, in connection with the progress
and unstemmed current of the pestilence, they might easily be
convinced of the utter absurdity of warding off a non-conta-
gious epidemic, by any power but the interposition of Pro-
vidence.

If this pestilence can one day be seen to spring up on the
shores of the St. Lawrence, and on another day in the city of
New- York, leaving untouched the intervening country for
% distance of more than 400 miles, what signifies your non
intercourse 9 Some future historians will record our folly and
our credulity in the same chapter of events with Salem
witchcraft, divining rods, and animal magnetism.

Boards of health are, and have proved to be, a pernicious

system of medical police. They create and sustain a fear, a

curiosity, and a feverish anxiety which is constantly in a high

state of excitement, and possesses a morbid craving that is

never satisfied with common fame, but must be satiated with

intoxicating wonders! I have, day after day, witnessed this

remarkable excitement manifested at the approaching hour

of the report of the board of health, both in the year

1822, during the yellow fever, and at the present period, and

its subsidence in a few hours into perfect indifference until the

next day's reaction. Boards of health are calculated to spread

35

alarm, to possess the mind with apprehension, which expe-
rience has proved to be a great exciting cause of disease.

Boards of health are mere receptacles of reports of cases,
and reports of cases are a premium on falsehood. A class of
physicians whom neither merit nor circumstances have brought
before the public, now avail themselves of a medium to
notoriety, and calculate their consequence and their talents by
the number of cholera cases they may have under their care.
Through this medium they usher themselves into public
notice, and batten on public credulity. The respectable
portion of the medical profession, whose pride and inde-
pendence forbid a resort to false pretensions, as well as a great
number of our intelligent fellow citizens, can bear witness to
the truth of my assertion. I have it in my power here to
introduce a number of facts to sustain me beyond all cavil,
but these facts are too unquestionable to admit of doubt.
** Boards of health" are injurious and unnecessary.

They are unnecessary, because they do not contribute
to any essential benefit, but on the contrary effect a great
deal of mischief through the imposition of falsehood and mis-
information. They are obliged to accept, and consequently
to report all cases represented to them as cholera, not only of
imaginary character, but in a hundred instances in this city of
manufactured cases, where, upon inquiry no sickness had ex-
isted, or no being had resided.

As a substitute, and complete accomplishment of all that
may be desired by information intended to be elicited by
a board of health, I would advise a daily report of deaths
only. This would be a sufficient criterion, a sufficient notice
to every citizen interested in the premises, and the best and
only rational guide to his judgment, of the progress and
danger of the disease.

As to sanitory cordons, they are ridiculous in the extreme
to any person who has given the subject a moment's serious
reflection. I shall not waste a sentence on them.

In anticipation of the disease, I would advise that all the
poor and indigent families in your district, town, or village,
should be visited by a committee. In houses or cabins where

36

many are huddled together, with the appearance of poverty
and fihh, I would advise an immediate distribution of their
inhabitants into commodious quarters, whence, if the disease
should appear among them, it would be unnecessary to re-
move them.

It is my firm belief, and founded on no light conceptions,
that every patient should die or recover in his own bed, and
without removal.

To come to this conclusion, it would be only necessary to
imagine the agonizing association which must necessarily
occur to the mind of the patient, when the very act as it were
of removal assures him of his doom ; and also the state of feel-
ing at being placed amongst the groaning, the dying and the
dead, all pleading hopelessness to his case.

It is not these objections alone that count against the
removal of patients, but the act of removal not only hastens
death, but prevents many recoveries. I have known some to
die on their way to the hospital, and others shortly after their
arrival, who would probably have recovered, if they had been
permitted to remain in their own beds. And what can pos-
sibly be offered in objection to this course? Surely there will
always be sufficient medical aid and charitable attendance to
patients at their own houses. But in case of a superfluity of
domestics, or an incursion of transient poor, I would by all
means have a provisionary station for their accommodation.

I have now given you a sketch of my views on the subject
of quarantines, &lc. as respects the prevailing epidemic; the
filling up I leave to your own good sense. I hope that this,
and what I have previously written on the subject of
** cholera," as it is called, will be considered a full reply to all
the points of inquiry in your letter.

ADVICE TO THE PLANTERS

OF THE SOUTHERN STATES.

If my views of the character and treatment of the prevail-
ing pestilence be correct, or as much, or more so, than any
heretofore promulgated, I cannot perhaps do you a greater
service than tendering you such advice as several weeks expe-
rience and constant intercourse with the sick of this city, have
enabled me to furnish.

Humanity as well as interest pleads for suitable care and pro-
tection to your slave population. Negroes, in this part of the
country, have sickened and died in full proportion to the intem-
perate white population. You have reason to be seriously ap-
prehensive of great mortality on your plantations, unless you
take timely measures to guard against the evil. Anticipating
then the fact of its appearance amongst you, permit me res-
pectfully to advise you of the course I deem most favourable
for an alleviation of, if not an exemption from its malign influ-
ence.

1st. Multiply the number of your slave huts or houses, in
order to leave as few as convenient in the same building, with
sufficient room to accommodate those of each family in case
of sickness, without the necessity of a removal — I say empha-
tically, a removal. My reasons for this have been given, and
are in your hands.

2d. Inspire your slaves with fortitude against, and con-
tempt for, a disease, which they ought to be made to beheve
proves mortal only to the dissipated, the lazy, and the filthy.
By strongly inculcating these impressions, you conquer the
greatest exciting cause to an attack.

3d. Let a vigilant observer, who has acuteness enough to
do his duty without exciting either the suspicion or alarm that

38

his office may occasion, be daily sent to watch over the state
of health of the slaves. The strongest index to indisposition
will be found in a diarrhoea or purging, slio-ht or profuse, as
the case may be, attended with more or less pain over the re-
gion of the bowels. In some cases, where the morbid secre-
tion in the bowels is more intense, pains and cramps in the
legs, he, will ensue. In this stage of the disease, not one in
a hundred ought to die, except the really intemperate, whose
constitutions are a home for this plague.

The above may be considered as the premonitory, or rather
suspicious symptoms, and it will he safe to treat them accord-
ingly. The state of the bowels should therefore be daily in-
quired into and reported.

Such planters as may not be able to obtain medical aid
from a physician, I would advise to procure, as a family me-
dicine, the following powder : Take of tartrite of potash, or
soluble tartar, ten ounces, powdered jalap, six ounces. These
must be well mixed, and immediately put into a wide-mouthed
bottle or jar, and kept stopped from the air. On the first ap-
pearance of suspicious symptoms, a teaspoonful of the powder
may be administered every two hours, till it has produced
an evident cathartic effect. Two or three doses will, in ge-
neral, suffice. This almost invariably relieves the pain and
purging, and seldom will a repetition of this, or the adminis-
tration of any other remedy, be required. At all events,
opium, in any shape, is not essential to a cure, and ought to
be used in general only by a medical man as a mere pallia-
tive. But I would advise that each planter have a quantity
of " liquid laudanum" in his house, to administer in particu-
lar cases, I mean, when, after a free evacuation from the
powder, an acute or torpid pain or sensation should conti-
nue in the bowels or at the pit of the stomach. In such case
give ten drops of laudanum every quarter of an hour, till the
pain is alleviated. Upon a recurrence of unfavourable symp-
toms, I would advise a recurrence to the use of the powders.
A pound of the powder mixture contains about sixty doses.
Plaisters of mustard, warm baths, frictions, &ic. Uc, have

39

been recommended. I have no faith In them, nor in any thing
that does not go at once to the fountain head of the malady,
and remove its exciting cause. I do not believe this can be
reached by any external means.

I shall now close this letter with an admonition to those
who have no medical aid at hand, that in cases where the
disease has assumed its worst or sinking stage, where the ex-
tremities become cold, shriveled, and bloodless, with or with-
out nausea, vomiting, and purging, they would, as a last re-
sort, and a confident hope of success, administer an emetic.
For this purpose I prefer the tartrite of antimony, or tartar
emetic in a full dose of four grains, or, one grain every ten
minutes, till it operates, in a solution of cold water.

As there is sometimes in this disease an incessant thirst, I
have invariably and successfully indulged my patients freely
and fully in the use of cold water, in small, but repeated
quantities.

If this letter shall eventually contribute to the benefit of
those concerned, in saving either life or property, the writer
will have his reward.

New. York J August, 1832.

40

CONCLUSION.

My first and greatest object in publishing my ideas respect-
ing the " Cholera Spasmodica," is to impress on my medical
brethren abroad, who are yet to become acquainted with this
spreading pestilence, that the cases of real asthenic or typhoid
" cholera" are very few, and those few principally confined to
the filthy and intemperate. That the cases of a more respec-
table character of persons attacked, are rather the result of
alarm, and common cholera, treated in a most injudicious
manner. For instance — in case of a slight or common affec-
tion of the stomach or bowels — a common diarrhoea — if you
administer, as is now usually done, a dose of laudanum, and
other ingredients of an astringent nature, you create an arti-
ficial disease, which unhappily calls for an increased reappli-
cation of remedies, and a resulting increase of the disease.
The consequences are obvious. To guard the profession
therefore against a too hasty decision in their treatment of
" premonitory symptoms," I shall, to exemplify the truth of
my premises, adduce some more facts which have come to my
knowledge through the Montreal papers, respecting the suc-
cess of Dr. Ayres' treatment. Is there an intelligent and un-
biassed physician that can misconstrue the cause of Ayres'
success ? If not, to such, I need only remark,

" Si hoc nosciSi sit tihi satis scire*^''

[From a Montreal Paper.]

The Caughnawaga Indians* — JosephLancaster, in his " ap-
pendix to the Gazette of Education," printed at Montreal,
on the 11th July, states, that a deputation of two of the
Caughnawaga chiefs came to his house on the 26th of June,
in search of Dr. Stephen Ayres, who reported that there had

41

been 126 cases of cholera at their village and 60 deaths.
When the doctor saw them, and was made acquainted with
their wishes, he said, I know I could do you good, but Mon-
treal is so full of sick and dying, that I cannot leave it. He
however sent a deputy, a man who had visited a number of
cases with himself, and knew how to prepare the salutary re-
medies, promising to go over in a few days himself. An extra
caleshe was hired to accommodate the chiefs, and loaded with
charcoal, and every material for compounding the medicine,
with bottles, and a quantity of the remedy ready mixed. One
or two of the first cases attended were almost at the last gasp
before they could be visited, and expired before the remedies
could be applied. After this beginning, success attended
every effort, which is corroborated by the report of the resi-
dent missionary. On the 2d July, Dr. Ayres went down to
the village of Caughnawaga, and observing that his deputy was
doing his duty faithfully, and having visited a number of cases,
and completed the confidence so happily begun, returned to
Montreal; and on the 10th the deputy returned, with the gra-
tifying news, that only two cases remained, and that all the
sick were doing well, walking about, or at work. The
whole number of cases, as above, from the 18th June to the
26, was 126, and 60 deaths; and from 26th June to the 9th
July, 99 cases, and but 8 deaths. On the 11th July, Colonel
M*Kay reported, that he had visited the village of Caughna-
waga, by special direction of Lord Aylmar ; and had seen
and inquired into the facts in relation to the cholera, and was
perfectly satisfied of the truth of the cures performed by the
simple and salutary remedies of Dr. Ayres. The chiefs were
then required to make a special report, which they did on the
same day, at the Indian office, and reported fully, finally, and
favorably"

In his appendix of July 16, Mr. Lancaster says, Caughna-
waga is reported to remain in good health, and adds, accounts
from St. Johns, represent the charcoal mixtures, even in its
impure state, as most useful ; and that '' its excellency has been
acknowledged at Lachine and the Cedars."

6

42

[From the Montreal Record.]

"We have received a verified account of the state of the
Indian village of Caughnawaga before and after Dr. Ayres
extended his cholera practice to its population. It appears
from this document, that the doctor's assistant was despatched
to the village on the 26th, and returned the next day with the
missionary's report of the existence of 126 cases and 60 deaths
having occurred in eight days ! The practice of the doctor
had now commenced, and his assistant returned to the village.
On the 2d of July, the seventh day from the practice being
begun, the missionary reported a total of l30 cases, and only
four additional deaths ! The doctor now visited the village
in person, in company of two of the Indian chiefs, to see the
patients, and to assure himself that his deputy was pursuing
his directions. On the 10th, the assistant returned to Mon-
treal, there being no longer a single cholera patient in the
village to require his services. On the same day a report
from the missionary at Caughnawaga was exhibited at the
commissariat office in Montreal, which gave a total of 68
deaths ; so that from the l8th to the 26th of June, there had
been 60 deaths in eight days ! and from that time to the 10th
of July, during which the doctor's practice was in operation,
there were only eight deaths in fourteen days ! On the 10th,
Col. M^Kay visited the village, in obedience to special com-
mands, received from his Excellency Lord Aylmar, and having
inquired into the facts, reported himself perfectly satisfied with
the salutary results of Dr. Ayres' practice.

" The combined testimony of Col. M*Kay and the mission-
ary, corroborated as it is by the special report made on the
1 1th inst. by the Indian chiefs, and by the many Indians who
are living evidences of the efiicacy of Dr. Ayres' practice thus
fairly tested, is sufficient, one would think, to silence detrac-
tion ; yet an article is making the round of the public jour-
nals, the tendency of which is to derogate from its merit, and
throw discredit on its sanitary virtue. It is not true that Dr.

43

Ayres' practice has failed at Chateauguay, as is asserted in the
article we allude to. Indeed he has not practised there at all.
One of his remedies, as it was given in the papers some time
ago, has been resorted to for a cure by many persons afflicted
with cholera in different parts of the country, as well as at
Chateauguay, and we have heard, with complete success, ex-
cept at the latter place, where one case is said to have ended
fatally. But who would be so partial and unjust as to attempt
to throw discredit on any medical practice because, in the ab-
sence of the physician, and without any consultation or com-
munication with him, a man afflicted with cholera is said to
have unsuccessfully availed himself of a reported remedy ?
The article, however, evidently tends to detract from the me-
ritorious and valuable services rendered to the public by a cha-
ritable stranger ; fair play is a jewel, and the doctor's poverty
does not license or justify detraction from the fame his prac-
tice had deservedly acquired. His practice has been confined
to Montreal and Caughnawaga, and its pre-eminent success,
which, as we have seen, is well attested, affords the best evi-
dence of its value."

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