ARMED FORCES MEDICAL LIBRARY Washington, D. C. ■*, * A N 1NAUGURAL DISSERTATION ON THE CHOLERA MORBUS. SUBMITTED TO THE PUBLIC EXAMINATION or THE FACULTY OE PHYSIC, UNDER THE AUTHORITY OP THE TRUSTEES OF COLUMBIA COLLEGE, IN THE STATE OF NEW-YORK, WILLIAM SAMUEL JOHNSON, LL. D. Prefident; FOR THE DEGREE OF DOCTOR OF PH YS ON THE SIXTH DAY OF MAY, 1794. ic, A By HENRY MEAD, Citizen of the State of Conne£ticutf Such, fuch is life, the mark of mifery, p!acrd Between two worlds, the future and the part 3" • •, \ . . r „ To time, to ficknefs, and to death a prey, "'■•i' rv.'>•'•■ It finks, the frail pofleflion of a day. Johnson. NEIF-YORK: Printed by T. and J. Swords, Printers to the Taculry of Phyfic of Columbia College, No. 167, William-Str-«r. 794-— ./•■■ TO THE Rev. ISAAC LEWIS, D. D, Greenwich, Conneflicut; Pleafe to accept this, as a mark of efteem and friendmip. From your moft obliged and humble fervant, s ^ The AUTHOR. - ^00031 T O MALACHI TREAT, PHYSICIAN; JOHN R, B. RQDGERS,M.D PROFESSOR OF MIDWIFERY IN COLUMBIA COLLEGE; This DISSERTATION (f Js moft refpe&fully infcribed, by their obliged and indebted Friend and Pupil, The AUTHOR \ d O l DISSERTATION ON THE CHOLERA MORBUS. HERE is no difeafe, perhaps, more ing, or which requires the more irraae afliftance of the Phyfician, than ChoIerQJlhh* circumftance, together with the frequency of its occurrence in this climate, makes it a fit fubject for careful attention and accurate inveftigatio 1. From the rapid progrefs of the difeafe, and the extreme debility it produces, it frequently La- minates in death in the fhort fpace of Lwey:!]T four hours, and medicine, unlefs adminiftered in the early ftages, will often prove inefficacious. When ( 3 ) When I reflect on the diverfity of opinions that have been offered reflecting the caufes of cholera, and confider, that the more aged and experienced in medicine have differed much on this fubjeft, I feel a reluctance ill hazarding an opinion, and in offering the following pages to public view; but, the laws of this College make % it my duty, and my dependance on ,the candor of the reader will induce him to view 'this as my firft facrifice on the Altar of Science. ------.-- ll—MB—llili ---- ^ Hiftory and Definition. THJjjS difeafe is faid to be confined moftly to hot cilmates and warm feafons. Dr. Sydenham obferves, that it happened moft frequently in England . the month of Auguft, but that it appeared fometimes toward the clofe of fummer, when the weather was unufually warm. Sir Clifton Wintringham afferts, that he has feeif it occurring in all feafons of the year, but that it happened moft frequently when the wea- ther was the warmeft, and the vicifttudes the greateft ( 9 ) greateft in the fame day. In this climate it is generally the moft prevalent in the months of July and Auguft; but it does not appear to be wholly and altogether confined to this feafon, for it fometimes happens at any feafon of the year, or whenever the weather is unufually warm, as has been obfervcd above: neither do we find it confined to any particular age or conftitution, but the bilious and relaxed, and particularly children, are the moft frequent fubjects of this difeafe. It is likewife obferved, that the paf- fionate are very often attacked with the cholera. The moft diftinguifhing marks of this difeafe are, a frequent vomiting and purging of a larg quantity of bilious matter, which puts.on 4»f\- ent appearances at different ftages. Dr. Cy .£H thus defines it: " Humoris biliofi vomitus, *jdi " dem fimul dejectio frequens, anxietas torrrui- " furarum fpafmata." This he places in r/:: clafs of Neurofes, and order Spafmi. The m it evacuations confift of the ufual contents 01 u,s ftomach, which fbon become of a greenifh'ccnour, and towards the clofe of the difeafe more hifce the natural appearance of the bile. If the. fymptoms are violent, they often change to a, B bloody ( io ) bloody and dark appearance, and are faid by fome to look like the wafhings of flefh; but for the moft part they confift of an unufual quantity of bile through the whole courfe of the difeafe. The patient is firft attacked with a difagreeable fenfation about the region of the ftomach, con- fiderable anxiety and dppreflion, a flatulent diften- tion and griping pains of the abdomen: a naufea* vomiting and purging fbon fucceed, which, as the difeafe advances, are attended with a fpafmo- .jc affection of the abdominal mufcles, that *& frequently extended to the extremities and j^ier r'-ts of the body, particularly to the calves ;■:" the J.-.'tjs: the abdomen now becomes fore and r ai.%1 >o the touchy the patient is very reftlefs, ,./.''* -rlifV is fmall, irregular, and at times fcarcely perF* able, attended with a difficulty of breath- ing.'7'The extremities grow cold, a cold foetid fw;^t 1 reaks out, the countenance becomes pale, T.cco g,; and convulfions foon fucceed, and, if left t j nature, death will foon ciofe the fcene. There appears to be but little if any pyrexia attending this difeafe, unlefs protracted for feveral days-, the hurried, irregular pulfe, and difficult refpiration. ( « ) refpiration, are owing to the fpafmodic affection and irritability of the fyftem. The fymptoms of this difeafe are fo well marked, and fo evident in all its ftages, that I am difpofed to think the above defcription will be fufficient to diftinguifh it from any other. Dr. Cuxlen divides cholera into two fpecies.-, the one, fpontaneous, and arifing in warm feafons without any manifeft caufe •, the other, accidental, or when arifing from any poifbnous matter taken into the ftomach. The caufes of the latter^ajse too evident to need any further inveftigation -, but the former, which we are now to confider, I fhali' endeavour to defcribe according to the idtEdd.1 have been able to form of its nature a}id dii tin&ion. -- In order, then, to a more intimate-knowledge of this difeafe, and for the purpofe of effecting a fpeedy and fafe cure, it will be firft necefTary to pay fome attention to its caufes. Caufes. ( ** ) Caufes. THE liver is an organ of fuch importance to the animal ceconomy, that any alteration from its healthy action, or fecretion, has given rife to fome of the moft obftinate and alarming difeafes to which the human race is fubjected*, but the little knowledge we have of glandular fecretion renders the caufes of fuch difeafes intricate and obfcure; and as cholera moftly arifes from this fource, I mall only attempt a few remarks, ac- cording to the moft received opinions. j J*?&e caufes of this difeafe may be divided into proximate, and remote; the latter comprehending ilie luredifponent, and occafional or exciting caufes. Predifponent Caufes. PREDISPOSITION is faid to be that &are of the body which favours the operation cii ot.^r caufes in producing difeafe. Any thing, then, that will tend to relax and debilitate the fyftem, may be confidered among the predifpo- nent ( *3 ) nent caufes of cholera; and fince it is almoft entirely confined to warm feafons and hot climates, and fince Phyficians, ancient as well as modern, unanimoufly agree, that fuch climates and feafons are the moft productive of all bilious difeafes, and as the cholera is more or lefs dangerous in proportion to the previous degree of heat, we muft confider this as one of the moft frequent predifponent caufes. The unwholefome effluvia which fills the atmofphere of large towns and cities, produces great predifpofition, as we fee from the frequent occurrence of the difeafe in thofe places. Dr. Rush, when fpeaking of that kind of cholera which affects children, obferves how extremely agreeable it is to fee the little fuffer:. j revive as foon as they 'efcape from the cf£y r.'.-, to infpire the pure air of the country.* From the above circumftance it appears, that thefs are the general predifponent caufes of this ciuesfe; •and the application of fudden cold (efpecially if combined with moifture) to the fyftem, thu.a predifpofed, acts as an exciting caufe. Much has been faid of acidity and the fummer fruits, as an exciting caufe of this difeafe; and what has given * See Rufli on the fubjeft of Cholera. ( *4 ) given rife to the fuppofition is, there being fo frequently an acid in the ftomach, and the matter evacuated often of an acid nature. But this, I believe, is rather an accidental fymptom, which arifes from the relaxation and debility of the di- geftive organs, always happening previous to an attack of the cholera, when, being rendered incapable of performing their ufual office, digef- tion is impeded; and we may readily conceive why acidity, and other crudities in the ftomach and inteftines, fo often accompany this difeafe. From thefe circumftances I am inclined to believe that acidity may be a frequent attendant on cholera. But as the difeafe has very often happened inde- •f ci-:T:".it of this, and without any previous change - tx x in diet, or in the manner of life, that ..Mi 1 be obferved,* and even in thofe that have I; ed entirely upon flefh, I am difpofed to doubt ic.at it ever acts as an exciting caufe ;-f- and when- • • :r it does happen, it may, with more proprie- ty, be confidered only as producing greater pre- dif^ofition. Proximate * Cullen's Firft Lines. f See the fecond volume of Medical Comment, where there is an objection to the fummcr fruits ever producing this difeafe. ( H ) Proximate Caufe. NOTWITHSTANDING the proximate caufes of difeafes in general have been involved in fo much obfcurity, and have fo often baffled the moft laborious ftudies of man, there are none, perhaps, more evident than that of cholera. It being moftly confined to the ftomach and intef- tines, and more efpecially to the duodenum, and the almoft conftant effufion of a bilious matter, *v toms, we muft then endeavour to xep. tone of the fyftem and prevent a reentry . ^ the difeafe.- To effect this,- we may have rt- courfe to all thofe medicines called tonks,. fuch as bitters, and many of the aftring'nts; among thefe we may rank allum, which v*\s -apare tonic, without exciting any ftimu'an:. eft^ is certainly a very powerful remedy. iV- lumbo, either in infufion or in po-vder, is a cei!-: ( 22 ) cellent tonic, and has been known powerfully to co-operate with laudanum in allaying both the vomiting and tormina. The Peruvian bark is a very good tonic; it may be given in the various forms of decoction, infufion, or in fubftance. To thefe we may add the ufe of good old Medaira, or found Port Wine,' with the frefti and whole- fome air of the country. The diet ihould be cordial and nouriming; the meat ihould be roafted or broiled, the patient ihould not over- load his ftomach, but eat a little and often, and tffe gentle exercife. &avin<**finifhedthe fubject of this differtation, / *' " * rhe reader will meet with no difappointment Tfantof novelty. So much has already jet,-; Taid on this, as well as on almoft every other medical fubject, by perfons of eminence, that nothing new can be expected from a young and -diffident candidate.—Should the obfervations which hatfe been made be found to agree with the i*^eived opinions, and to anfwer the pur- £>r which they were intended, my wifhes ^ amply nccomplifhed, and I fhall ever re- tain ( 23 ) tain a fenfe of the greateft obligation to thofe gen- tlemen under whofe aufpices my medical purfuits have been conducted. ^\ Med.. Hwt. wz. ^1*7 0 WW <■ >i v.:.'":~'-r:MiTO*;35ib«wpisffiil®il