DIET AND CHOLERA, SHOWING THE VITAL IMPORTANCE OF WHOLESOME DIET, AND THAT ITS IMPURITIES AND DEFICIENCIES ARE THE CHIEF CAUSE OF CHOLERA, WITH ITS PREMONITORY SYMPTOMS AND TREATMENT, IN A SERIES OF LETTERS, ORIGINALLY INTENDED FOR INSERTION IN THE " TIMES. " BY WILLIAM BAKNAKD BODDY, SURGEON, LATE MEDICAL SUPERINTENDENT OF THE CHOLERA HOSPITAL " The pestilence that walkcth in darkness." " The destruction that wasteth at noon-day." LONDON: SAMUEL HIGHLEY, 32, FLEET STREET. 1848. LONDON: PRINTED BY A. REDFORD, 24, ALBION PLACE, WALWORTH. PREFACE, The Author, in justification of himself, and the views, and opinions he has formed respecting the causes, symptoms, and treatment of Cholera; considers it proper to premise, that the following brief remarks (with perhaps some slight additions), were originally intended for insertion in the Times, and sent for that purpose to the Editor, in the month of August last ; otherwise perhaps, it might be inferred, since some of the ideas have a close affinity to those of a document put forth by the Board of Health, and which appeared in that journal on Saturday, 7th October, that they were borrowed therefrom; and, consequently, that he had been guilty of plagiarism ; or, in other words, that any 4 originality of thought, or idea which may here be found, whether bad, or good, was to be attributed to them, (the Board of Health), and not to him ; so that, should praise be awarded, or condemnation inflicted, either party should have their just amount. For, while he will feel amply compensated should they be productive of the smallest amount of good, or tend to lessen the fears of the timid, by throwing any light, however glimmering, upon the movements of this most mysterious complaint, he is careless of the censure of the critic, or the polemical disputant ; since they have been advanced in a righteous cause, and with a tolerable knowledge of the subject to which they refer. In corroboration of the latter opinion, he, without any more introductory remarks, in the way of Preface, at once lays before the reader the following documents. "Albany Road, May 16th, 1832. " My deak Sir, " Having been informed that there was a Motion to be laid before the Governors and Guardians, relative to the remuneration of the medical gentlemen who treated the pauper cases of Cholera in this parish, I gladly take the opportunity of expressing to you, officially, and individually, my conviction of the important services you have rendered the parish of Nevvington, during the recent epidemic. Nothing could possibly exceed the zeal, humanity, and I may be permitted to add, the skill, displayed by you during that trying occasion. 5 The candour and readiness with which you promoted and facilitated the statistical, and scientific investigation of the disease, deserves my individual thanks, and, I may add, the gratitude of the profession. " I am, Dear Sir, " Your faithful Servant, " W. B. O'SHAUGHNESSY, M.D., District Inspector. "W. B. Boddy, Esq., Parish Surgeon." ' Newington, Surrey, July 6th, 1832. " Sir, 11 1 feel great pleasure in transmiting to you the enclosed copy of a Resolution of the Governors and Guardians of the Poor of this Parish, which was confirmed at their Meeting, held on Tuesday last. " I am, Sir, " Most respectfully, " Your obedient Servant, "JOHN INVILLE, " Clerk. "W. B. Boddy, Esq." < ST. MARY, NEWINGTON, SURREY. " At a Meeting of the Governors and Guardians of the Poor of the Parish, held in the Vestry Room, on Tuesday, the 20th day of June, 1832, It was Resolved, — That this Board cordially thank Mr. William Barnard Boddy, for his prompt attendance on the Poor of the Parish during 6 the time of that awful calamity called the ' Spasmodic Cholera/ was visiting the Poor, and deeply feel that he has shown by his conduct that he felt his duty paramount to the danger to which he was personally exposed ; and, by his great exertions (having the care of the Hospital under his entire control), has saved the Parish a considerable sum, or they would have had to provide a District Medical Officer at a great expense to the Parish. Resolved, — That this Board cheerfully presents the Sum of Forty Pounds, as a gratuity for the Zeal, Attention, and Skill, at all times exercised, and for his great humanity and punctuality." Errata. — At bottom of Page 22 read on as follows :Ķ— Though, in many instances, from their so little interfering with the usual run of our health, and daily avocations, they may not have been noticed ; hence has arisen the erroneous impression that, when the collapsed stage has been introduced, it was in the enjoyment of perfect health. DIET AND CHOLERA. To the Editor of the Times. Sir, — The Cholera, before which most hearts appear to tremble, is now steadily, and irresistibly on its march of death ; and it is more than probable, ere long, this gloomy visitant, will again lighten on our shores, with all its train of accompanying evils ; and while all appear to anticipate this sad event, no plan has hitherto been devised, or system adopted, in any way capable of retarding its progress, or positively effecting a cure. And this is mainly attributable to the very limited knowledge we have as to the cause, or seat of this disease, and the laws which govern it. It defies human speculation, laughs at the physician, and triumphantly advances, unchecked and uncontrolled, in opposition to all the barriers which human ingenuity and skill, almost in every part of the globe, have placed against it; and, in many instances (apparently), the means which have been instituted for that purpose, and have been found successful in arresting other maladies, when tried here totally fail, and appear rather to give it accumulated speed and force. This may appear strange and problematical to those unconversant with its mysterious movements; but 8 those who have been much associated with it, and watched its progress, in opposition to the best prescribed means, will admit the truth of this assertion. Most diseases, I might say all, have become governable and brought into a state of abeyance, by the united wisdom of the legislature, and skill of the physician, and some nearly destroyed ; but when they approach this, their united wisdom and skill quails before it — the former unable to detect " the pestilence that walketh in darkness," and the latter to cope with " the destruction that wasteth at noon day." As to its cause : it is a disease of great obscurity, and made up of endless contradictions; capriciously shifting its attack at every fresh onset, and presenting itself under an endless variety of form and circumstance ; no state of society is exempt, no atmospheric change impedes, and no locality can boast of its immunity ; sometimes it outruns the wind, and then, with the fleetness of a steam engine, stems it. In the forlorn abodes and localities of the poor, where the air is saturated with every impurity, and, like gunpowder, seems only to wait for the ignited match of pestilence to awaken the death that sleeps within, it is frequently not to be found ; but like a fastidious epicure, hastens to the palaces of the rich, and feasts upon the mighty of the earth. Were it not for occupying too much space in your valuable paper, many startling facts might be detailed, bearing on each ; but two> which came under my own immediate observation, appear so very remarkable and inexplicable, that, with your permission, I will detail them. A strong healthy young man, fearless of this disease, became suddenly its victim ; he interrogated me, with that subdued whisper (one of its characteristic symptoms) as to the nature of his attack. Gently as possible I explained it ; then, with his countenance assuming, as far as it could, much firmness, he turned to his weeping wife and said, 9 " Don't believe it, I have no Cholera." He repeated this, with little variation, at each interview. In the last, when the poor fellow (who was now evidently fast sinking) found that I was still of the same opinion, he said, -" You shall soon see — give me my clothes ;" and, with a tremendous effort, he stood upright in his bed, and forthwith proceeded to dress himself; but had scarcely commenced, when his strength suddenly failed, and he fell. I went immediately to his assistance, but it was useless, he was dead ! This case exhibited neither fear or dread, but a bold mind exercising its powers in the grasp of death. And yet, remarkable as this case may appear, it might be antagonized by others, nearly as singular, where fear evidently seemed to be the exciting cause. In a court in Kent Street, the entrance to which is very narrow, but opens to a tolerable width when within, there are houses, facing the north, two stories high, consisting merely of three rooms, one above another; opposite are low sheds (inhabited) of one room each, on the ground, but no outlet on either side, nor at the end of the court.* In the first house there were then living three families, one in each room ; the middle room contained a man, his wife, and three children ; and here began its mysterious and fatal work, without, apparently, any assignable cause (except it be diet) for, in the short space of four or five days, the whole of this family were swept away, while health reigned above, below, and around, and continued so. Now, when we look at the various conditions of the human family, in reference to their means of resisting contagion, we are much struck at the vast disproportion existing between them; for while the upper, and more respectable classes appear surrounded on every side by • I have deemed this slight topographical description necessary, in consequence of the sudden and fearful irruption of this disease, and its equally singular and sudden departure. B 10 means available for that purpose — airy situations, cleanliness, and a multitude of minor comforts, their poorer neighbours, especially in large cities, have none, or very few, of these accidental blessings ; yet, strange to say, they have fallen alike victims to this disease. Admitting this, then to be an incontrovertible fact, we must look further and deeper than " defective drainage, neglect of house and street cleaning, imperfect ventilation, and deficient supplies of water" (Times, 10th of August) for the cause. The very first case which occurred in Newington, was a respectable woman, who had not been out of her room for years ; the locality was good, and every thing in her apartment, though humble, was very clean. Neither locality in itself, as such, nor defective drainage or ventilation, have anything to do in the developement of this disease, be it ever so low or confined ; it altogether arises from a very different source. I am quite aware that this notion is entirely in opposition to the generally reoeived opinion ; but it has been forced upon me, despite my preconceived ideas on the subject, by a great number of facts, which I witnessed when we were suffering under its infliction in 1832. In the district over which I then presided, there were localities of all shade* and varieties ; but there were two, one especially so, where there was a great accumulation of filth of every kind, and through which ran an open sewer, impregnated with the same. Now here, it would have been thought, had this disease anything to do with locality and impurity, was just the place to show itself, in character the most frightful. But no, it passed over, and was found stalking boldly on the high roads, and entering the habitations of the more respectable classes. From these remarks, or, more strictly speaking, facts, it must not be understood, that I am indifferent to cleanliness, ventilation, &c, ice. ; certainly not ; but quite the contrary ; for there cannot be the least doubt that they tend materially to general 11 health, comfort, and tranquillity of mind ; and the public cannot be too thankful to a wise legislature for the interest it takes, and the efforts now making to accomplish those objects; but that these, and these alone, I am perfectly satisfied, will not, for one single instant, retard the progress of this disease, neither will they in the least mitigate its severity ; they are useful only as subsidiary agents, and in no other light should they be contemplated. The question , therefore, is not how we shall arrest its career, because come it will, but how we shall destroy or modify its malignity when abiding with us, and render it, as much as possible, harmless. There is in the constitution a principle always ready for the reception of disease, or, if I may use the word, a soil suitable to the growth of any form it may assume, and which is developed more or less actively, or rendered more susceptible or callous, in accordance with the nourishment it receives, whether bad or good, digestible or indigestible ; and the atoms of which it is built up are kept in tone and strength thereby; and, of course, the more regular they are administered, and of a kind suitable to our nature and wants, and no more, then does it experience that buoyancy of spirits, strength and vigour, which are always powerful barriers to the inroads of disease, especially Cholera. But if those supplies do not keep pace with the wants, and the common wear and tear of our system ; or if they fail as to quality, or even time, for any lengthened period, then does it materially suffer, and much more so if allied to bodily fatigue ; the minute atoms become weakened in their cohesion ; the constitutional vigour, in the relative proportion, unstrung, (similar to the relaxed chords of a musical instrument); the spirits droop, and busy fearful fancy awakes ; and, in this weakened condition, yields itself passively to any disease that may be crossing its path, and more particularly that to which there is a constitutional 12 tendency or bias. It is this, which causes disease to the sailor in a long sea voyage ; it is this, which, to the retreating and harassed soldier, whose supplies are cut off, or sparingly and impurely administered, is much more destructive and terrible than the victorious sword of the pursuing conqueror. Health ! life ! " exist 'st on many a thousand grains that issue out of dust ;" delightful may be the place, pure and refreshing the breeze, and clear and pellucid the stream, but without good and wholesome food "we sicken and so die;" and yet to this element, so essential to life and health, was singularly enough attributed the disease of Cholera with which we were afflicted in the spring of 1832, even by the sufferers themselves ! Therefore one avoided bread, another meat, and another fish, fruit, vegetables, &c, under the preposterous idea that they had become suddenly polluted at their source, and were producing death instead of life ; and had these vague fancies been as practically carried out, as they were then believed, the work of destruction would have been much greater, and, of course, attributed to the disease it was intended to shun. But, strange as this may seem, there was some just ground for the belief, and more truth in the supposition than would at first sight appear ; not that food in a good or healthy form, could, or ever did produce Cholera, but when impure and unwholesome it did, and in most instances, I am quite certain, it could almost invariably be traced to that cause. Under the above erroneous impressions, therefore, it was, that the bountiful provisions of Providence were indiscriminately condemned. The nourishment we derive from the flesh of some animals is not so compatible to the well-being of our constitutional wants as others, particularly the swine, which was altogether prohibited by the Jewish lawgiver, independent of its spiritual enactments, because it produced 13 "leprosy." Now, pork is largely consumed in England, especially by the poorer classes, and, in ninetynine cases out of every hundred, is almost invariably succeeded by diarrhoea ; and we need not be surprised at this, when we look at the filthy habits of this animal ; its impure feeding, and liability to the diseases of measles and scarlet fever ; but when we know that they are often in this state killed, and sold as an article of food to them, the liability to disease, of course, is much greater. But this is not all, as relates to this class of society ; for almost, I might say positively so, every article upon which they subsist, is impoverished by vile adulterations, and worse, putrefactions — their limited means enabling them to procure only the half decomposed refuse of the vegetable market, and the half tainted meat from the butchers' shambles. The more wealthy command all the luxuries of life in abundance, and agreeable to their inclinations and appetites, feast accordingly : over-indulgence, however often repeated, at last exhausts the healthy tone of the stomach, and blunts the keen edge of desire ; and, in order to produce a false appetite, condiments of various kinds and degrees are substituted ; so that, in fact, the food becomes nearly as vitiated by these additions, as • that of the poor man's by subtractions — the one of necessity, the other of choice. Extremes meet, and here " the rich and poor meet together," — for, under both circumstances, the animal economy must severely suffer, and the " life, which is the blood," becomes weak and serous; and though, for a time, from the great reluctance health has to depart, the growing evils of an impure and unwholesome diet may not be perceived or apprehended, yet, insensibly, from the perpetual inroads made upon the constitution, and the delicate seat of life, the efforts to resist disease become weaker and weaker, till, at last, the whole mass is left without any internal 14 active principle of sound health available to resist or overcome its effects. Disease approaches all, under one form or another, and each will feel the infliction of that which his constitution is most susceptible of; hence arise those hereditary tendencies to peculiar complaints, which are of daily observation ; it is remarkable, that the children of those parents who died of this disease, when it formerly made its appearance in St. Petersburgh, were the first to suffer during its last visitation. And the Cholera, if I may embody this disease, has walked in close contact, for days together, with thousands of individuals, eager to gain admission, but the strong and vigorous frame repels his internal approach : its composition is in no way congenial to his reception, for the atoms of which it is built, are as firm and sturdy battalions, guarding at every point the citadel of life, and being unable to effect an entrance, he flits away, and demon-like, seeks a more fitting subject, where he can instil his poison, and complete the work of disease and death. The principal object of these remarks, it will be seen, then, are, to show the very great importance of good, healthy food, and the regularity of its supply; for on this alone depends the power we have of throwing aside disease, particularly the one to which this letter refers. Our great Creator made food, in its endless variety of form and character, expressly for man; and having surveyed his work, and finding it suited to the benign object he had in view, said, "to you it shall be for meat," and pronounced it " good." Therefore, let no one, under the foolish, I might say wickad impression, conceive that these bountiful gifts are pernicious; every climate has its peculiar kind, every way suited to the race which inhabits it; and if used, not abused, in the way he originally intended, productive of that good he wisely designed. Without going to the 15 animal, it is very remarkable how the vegetable kingdom, in every part of the earth, exemplifies this. In our happy, favoured isle, without going any further, we have abundant proof, particularly in our fruit, how admirably it has been adapted for our well-being ; certain fruits, for certain seasons of the year; succulent, acidulated, saccharine, in endless variety, agreeable to every taste and age, and beneficial for all ; but taken in an unripe or partly decomposed state, they are very pernicious, since it frustrates the good originally intended, and produces the very evils they were designed to overcome. Now, then, if these things, which were expressly created for man, be so very deleterious to health and life, under those various changes to which I have referred, by rendering him much more susceptible of disease than he otherwise would be ; how much more destructive, then, must that be when superadded, which he himself has "invented," to v steal away his brain, and drown his senses in forgetfulness." A constitution so exhausted and broken down, seems only to want this last, and most fatal of all to life, to render it complete. An impure and overloaded state of the stomach is invariably followed, for a shorter or longer period, by either sickness, constipation, or diarrhoea, all a precursor of Cholera, and, in fact, two of its very symptoms ; but, from their prevalence, they are thought of too lightly, and looked upon with indifference, under the erroneous impression that they will effect their own cure ; or if a remedy is sought for, it is by'following up some old family nostrum, or quack's elixir; or, what is, I was going to say, worse, the prescription of some inexpert compounder of drugs, who, entirely ignorant as to the cause of these symptoms, gives his remedy, and gives at the same time, though unwittingly, an additional impetus to the evil he intends to cure. Can it be wondered at, then, that when a disease, like the Cholera, 16 is flitting about unseen, except in its consequences, and in every direction seeking for victims, that a constitution, so weakened by impure food, so shattered by intemperance, and, withal, a remedy so applied, can, by any possibility, escape ? " Prevention is always better than cure," therefore, temperance, in all things, should be strictly cultivated. The diet should be light and nutritious, stomach never overloaded, suppers avoided, particularly of a heavy character ; in fact, Old Parr's maxims should be studiously followed out — " Never to eat till you are hungry, nor to drink till you are thirsty ; keep the head cool by temperance, and the feet warm by exercise." The mind will become more calm, the spirits more cheerful and elastic, and sleep more quiet and invigorating; and with these powerful auxiliaries, an invulnerable character will be imparted to the constitution, which, as far as any means can do, will blunt the poisoned arrow of this disease, and render it powerless. Prevention, here is everything ; the cure, alas ! in most instances, nothing ! for when a genuine case of Asiatic Cholera, I mean in its collapsed form, has seized upon its victim, the attack is generally so overwhelming, and its course so fearfully rapid, particularly if supervening upon such a constitution as I have endeavoured to depict, that, before any remedy is brought to bear, the patient dies. Having alluded to remedy, or cure, I would just remark, before I conclude, that I found more benefit to accrue, under the collapsed state, from large doses of calomel and opium, rapidly administered, than from any other form of medicine whatever, with a bountiful supply of cold spring water. There must appear, to the uninitiated, something very reasonable in the latter, for when it is rememberd that this malady is invariably attended with most intense thirst, there is no liquid, with which we are acquainted, so calculated, without producing any evil, to allay it. 17 But still I deem prevention to be the most important, and the few remarks I have made, and hints thrown out upon this subject, will, I think, if properly attended to, have the the desired effect. I would therefore, with all the persuasion I am master of, urge upon all, anxious, of course, to escape such a formidable disease, to be extremely careful in this matter; and though some may not heed this kind advice and warning, and thereby, perhaps, entail upon themselves the calamity foreseen ; yet others, of whom I hope there are a vast number, will ; and in so doing have the best chance of escape, or, if assailed, render its attack mild and harmless. I am, Sir, Your most obedient Servant, WILLIAM BARNARD BODDY. Saville Row, Walworth, August, 1848. I would here draw particular attention to the fact, that the preceding letter was addressed to the Times nearly two months before the last document was sent out by the Board of Health, and the " close affinity" to which I have before alluded in the introductory remarks, will be very apparent (in some important particulars) when comparing the two together. Therefore I must claim the merit, should it be considered due, for having thrown out any hint tending to arrest or mitigate the severity of this disease. Further — in order to show that I have not been an inattentive observer of any theory bearing on this complaint, so that I might, as far as I could (independent of my own views) be in possession of every suggestion essential to its elucidation, or proposed remedies, calculated to hold out a cure ; I think it likewise right to say, that the following c 18 letter, which appeared in the Times of September 20th, was in reference to a previous document put out by the Board of Health, which was announced as containing a specific cure, and was said to have been almost miraculously discovered amid the mouldy tomes of some old Arabian doctors. To the Editor of the Times. Sir, — The curative treatment of Cholera, as suggested by "An Officer long resident in India," and backed by an " M.D." of some standing in the same quarter of the world, requires, I think, an answer. Will you kindly, therefore, allow me space for the following brief remarks ?—? — The rather mysterious manner with which this cure is introduced to the world, as springing from the sublime researches of some old Arabian physicians, is, in my opinion, most profound quackery ; and calculated, unless checked, to do an uncommon deal of mischief, — insomuch, that, should the remedies here proposed be acted upon, they will be found to have little influence in arresting a severe attack of Asiatic Cholera. The curative or remedial agency of assafcetida, black pepper, and opium, of two grains each (with the exception of the latter), is perfectly ridiculous. You might give an infant the two former, almost without any apparent good or evil accruing therefrom ; but opium (and where is the medical man who is not fully acquainted with, and alive to its virtues ?) is something ; and, if so many cures have been effected in India as has been stated, it is to be attributed 19 to that, and that alone ; the others are mere moonshine ; if they were considered serviceable it should be in scruple doses — twenty grains. And then we are informed, as a most profound secret, that ten grains of calomel may be given if the liver is congested ! — Perfect nonsense ! The medical profession know full well, ay, and every tyro therein, without this pompous communication, when calomel should or should not be given. But then, they give it much more wisely and well, in conjunction with the opium, and nearly after this form, — calomel from five to ten grains, with two or three grains of opium, every half-hour, or hour, should the attack be overwhelming; and, since it runs its course with frightful rapidity, the treatment must be as bold as the attack. But, the height of the absurdity is giving a " tablespoonful" of some cooling drink every hour ! Good Heavens ! can it be possible that this (evidently kind) gentleman has ever witnessed an attack of Cholera ? If he has, and cures have been brought about by such slender means, why then the disease of India is of a very different kind to what we have seen of it here ; therefore his suggestions and recommendations are not worth a straw. Why, Sir, one oĢ its most distressing symptoms is almost inextinguishable thirst; and how the homoeopathic dose of one tablespoonful of water every hour is to relieve it, or produce the least amount of good to the sufferer, the disciples of that school best can tell : and lam sure they will feel quite overjoyed to find their weak theories supported so stoutly by the " wise men of the east." Medical men in England, and on the continent as well, found that water was a most powerful auxiliary in the curative treatment of this malady. At first, however, when they were not so conversant with the disease, and the remedies compatible with its symptoms, it was, with the exception of small doses, withheld, under the erroneous impression that 20 " sick men desire most that which creates their evil." But, as they became more acquainted with their enemy, they saw the necessity of giving it plentifully, and accordingly they were allowed as much as they chose, and always with the most surprising benefit. In conclusion, there is nothing in that document (which appeared in The Times of Thursday, September 14), worth any consideration ; for, what has there been recommended has been tried again and again ; it is nothing new, with all its boasted discovery ; and I, for one, am much surprised that the Board of Health should have allowed such a flimsy affair to go forth as " a cure for Cholera." I am, Sir, Your most obedient Servant, A MEDICAL MAN, Walworth, September \9th } 1848. The tendency of this letter, as is manifest, was to show the weakness and inefficiency of those remedies there referred to ; and whatever cause may be assigned for their sudden withdrawal, as incompatible with the disease, it is very certain nothing more has been heard respecting them since its appearance. At last, however, a document from the Board of Health made its appearance, bearing the impress of a thoughtful and just consideration of the importance of the subject in question. This appeared in the same paper on the 7th of October, wherein is laid down their rules as to treatment, suggestions as to prevention, and causes as to the development of this malady ; in fact, another remedy, which, to me, at least, appeared not in accordance with the views I hud 21 formed, from some acquaintance with it. It was, therelore, under these impressions, I addressed a third letter to tiiem, which is nearly as follows :—: — To the Editor of the Times. Sir, — Can you afford me space in your valuable journal for the following brief remarks upon the premonitory symptoms, cause, and cure of Cholera, as put forth by the Board of Health, and which appeared in your columns on Saturday last, the 7th of October. To all the minor details of that document, too much attention cannot be paid, since they appear calculated to effect the good contemplated ; but, to the more important, and that which is vitally essential, particularly the predisposing and curative, I think open to every great objection. The chief predisposing cause of Cholera is to be attributed to a defective diet, in connexion with an impure constitution, and not to locality, or any other circumstance whatever, though they may, in conjunction with the former, render the system more susceptible ; but in no way do they engender the virus. On the Continent it appears to have been very destructive ; but when we look to their food, and general manner of living, we have something like a solution as to the reason; for instead of its being of a wholesome and nutritious character, it consists of coarse rye-bread, and sloppy messes, — the former of a laxative nature, and both yielding but little nourishment. For what other reason can be given ? — why, " 15,000 died in Paris, while, in the city of London, its victims, not even by the highest calculation, reached to one-tenth of that number."* Why, any one can * Times, lGth of October. 22 almost anticipate the answer; it is — because we eat much more animal food than they; and our feeding generally, though, in many respects, very impure, is considerably better, imparting that muscular strength and vigour, almost the inherent birthright of Englishmen. And the Board of Health appear to have some idea of this sort, when they recommend that " the diet should be solid, rather than fluid, and those who have the means of choosing (alas ! for those who have not) should live on animal food, as affording the most concentrated and invigorating diet." But on this good advice, accidentally thrown in, as it were, since no particular stress appears to be laid upon it, very important and serious consequences depend, which are these — that those, and only those, who have the power of procuring such, will have those qualities imparted to them, whereby they will be enabled to resist this malady ; and those who, unfortunately have not, will be the first victims of its malignity. The premonitory symptom given by the Board is diarrhoea; true — but only in part ; but this is not the first, by many. About a week or a fortnight before the disease is fully set up (I mean the collapsed state), there are a number of slight indications that the system is not quite in its usual trim ; trifling, apparently, in amount, but of immense importance when we look to what they lead. The appetite is variable* stomach qualmish, with slight pain and distention ; the bowels irritable — sometimes relaxed, sometimes confined, but more frequently the latter ; and the mildness or severity of these symptoms will very much depend upon the natural state of health, and vigour of the constitution, but more to the quality of the food upon which, of late, it has been subsisting. However, it does not follow, that these symptoms invariably lead to this disease, since, for the reasons before adduced, the soil may not be congenial to its full development ; but whenever its climax has arrived, it has always been preceded by them. 23 THE CAUSE. If good, and wholesome diet tends to prevent, — its opposite must lead to this disease; therefore, it is attributable to crude, undigested food, produced by its unwholesomeness and unfitness for the stomach and nourishment; and since, under these circumstances, it cannot be properly prepared for transit through the bowels, decomposition takes place among the particles, flatulency is engendered, and all the symptoms, before enumerated, are produced. Now, whether it be slight diarrhoea, or constipation, at first, the cause of the mischief is identically the same, — an undue accumulation of impure undigested matter in the canal, — and the diarrhoea is a healthy effort of nature to get rid of the offending mass. And as a remedy for this, I would draw particular attention to what has been proposed by the Board of Health. The old remedies, which were thought of very highly by our forefathers in medicine, and possessing, as they fancied, very extraordinary qualities for that purpose, such as " chalk mixture, aromatic confection, opium confection, tincture of catechu," &c, have long since been exploded by the modern school, in consequence, of their unfitness, and because they aggravated the disease. Now, would it be believed then, that these are the very remedies now launched before the public for that purpose ? But such is the fact. Mark ! — the bowels are overloaded, and anxiously seeking for relief, by symptoms not to be mistaken, and kindly put up for that express object; and the reason for giving them (the old remedies), if I understand it rightly, is to keep them so — that is, to prevent the diarrhaea — to check that salutary flow, and suspend, or throw back, if possible, the impurities nature has been trying, again and again, to free 24 herself from. This is attacking a symptom, not a disease, — striking at a shadow, instead of the substance. " The sweet oblivious antidote To cleanse the full bosom of that perilous stuff," Must be sought for by very different means, otherwise we shall woefully fail. Truly, if diarrhoea supervene upon a constitution already weakened and shattered by long disease, which is generally a precursor of dissolution, then these remedies may be administered; but here, a very different line of treatment is imperatively demanded. TREATMENT. The very numerous remedies, which have been so highly lauded from time to time as specifics, have, all alike, fallen powerless and impotent before this malady at the hour of trial ; so that the practitioner has not only been baffled, but altogether perplexed as to his plan of operation, and doubt and uncertainty still bewilder him. Seeing, then, that the enemy with which we have to contend is so formidable an opponent; and that no weapon, at present, however tempered, has been found strong enough to dislodge him from his position, it is of vital importance to ascertain whether we have any means whereby we may not only cripple, but destroy him altogether, before he takes possession of the citadel ; or, in other words, are the symptoms, if seized upon in an early stage, capable of being destroyed, so as to avert the fearful consequences so much to be dreaded ? If this can be answered in the affirmative, the terror with which this disease has hitherto been invested, becomes greatly diminished. It is, then, my firm opinion, after much attention to the subject, that it may ; but by methods of a very opposite character to those we have just contemplated. Delays are dangerous, for, in proportion 25 D as the symptoms advance, the stronger and deeper they entrench themselves ; and by procrastination we lose most important time, and have two evils, instead of one, to contend against; since the constitutional vigour becomes weaker, in proportion as they increase — consequently, the earlier they are attended to, the bolder may be the attack. I would then say — Do not stop this discharge, under any consideration whatever, which is only a symptom, and not the disease ; but facilitate, as speedily as possible, the exit of the impure, undigested, irritating, fseculent matter, the sole cause of all the disturbance ; for nature will not be appeased, nor the symptoms alleviated, until that is brought about, for so long as it remains undisposed of, just so long will the diarrhoea. Remove the cause, and the effect will cease, is an old axiom which cannot be too carefully remembered here. Should the patient exhibit, in the general, a naturally robust constitutional cast, and the symptoms being taken early, an active purge, without any loss of time, should be given, and followed, at stated intervals, by a mild aperient, until the bowels are fully relieved of their contents ; which will very soon take place, by a dislodgment of large masses of offensive matter ; and this treatment should be pursued for a few days, the doses, of course, being proportioned to the mitigated severity of the symptoms, which will soon be manifest, by a gradual cessation of the diarrhoea, and consequent tranquillity of the bowels. Having now, very imperfectly, I am afraid, pointed out the mildness of the symptoms of the disease at their commencement, likewise the fearful consequences to which they may, by possibility lead, if unheeded ; and shown the importance of immediate attention thereto, and the means, in general, by which they may be overcome ; I think I may, from a perfect knowledge of the subject, hold out the 26 cheering prospect, that if complied with, this malady, which, in the sequel, is so fierce in its attack, and so ephemeral in existence, may, by God's blessing, be robbed of its sting, and disarmed of its terrors. I am, Sir, Your most obedient Servant, WILLIAM BARNARD BODDY. Walworth, October 12th, 1848. The above has been considerably enlarged from that originally sent to the Times office ; not that there has been any change of thought, or variation of opinion, as every day's detail, in the public prints, appears to confirm most of my views : but because I considered it necessary to be a little more explicit, so as to make them, if possible, easier to be understood. There is one exception to this, however, which cannot have escaped the reader who has followed me thus far, and that is, a quotation from the Times, relative to the number of deaths in Paris, which did not appear, it will be observed, until four days after this letter; but it seemed so strongly to corroborate the opinions I have advanced, that I could not refrain from producing it here, as collateral evidence. Having arrived thus far, we will now enter a little more into detail respecting the treatment, which has been, at present, only very summarily hinted at. I have hitherto, as was originally my intention, and which I have strenuously endeavoured to keep, purposely refrained from all medical technicalities, all conventional expressions, choosing rather to clothe my thoughts in such language, that none need mistake, and all can comprehend. 27 The treatment, therefore, which I am about to suggest, will, for the same reasons, be divested of its mysteries, and presented in the same unmistakable character : the only apology I have to offer, if one be needed, for this breach of professional etiquette (as it will be termed by some), is, that it must be borne in mind, the object for which it was originally intended ; and it is therefore essential that this rule should still be strictly observed. The kind of medicines which appear to me best calculated to effect the object contemplated, are the following : Powder of Jalap . . 10 grs. Calomel .... 5 grs. Essence of Peppermint . 5 drops. This may either be taken in the form of powder, or made into three pills, by the addition of a little water, or one bolus, according to fancy. The evening is the best time for taking it ; but that, after all, must depend upon circumstances — bearing in mind the constitution, and the stage of the symptoms. To be followed by — Epsom Salts ... 1 oz. Infusion of Senna . . 5 ozs. Compound Tincture of Senna 1 oz. Strong Peppermint "Water . 6 ozs. A fourth part of this mixture may be taken every four or six hours, commencing early in the morning ; or about six hours after taking the above. Should there be much pain and irritation at the commencement, or at a later period, then the following may be taken — Calomel ... 5 grs. Powder of Opium . 1 gr. to 1Ģ grs. Powder of White Sugar 5 grs. 28 to be taken in some thick substance, the smaller the better, and as before. To be followed by — Epsom Salts . . . ] oz. Common Magnesia . . 3 drams. or Powder of Rhubarb . .2 drams. Laudanum ... 30 drops. Strong Peppermint Water . 5 ozs. Compound Tinct.ofCardamums I oz. to be taken like the former. During the taking of these remedies, particular attention should be paid to the diet, which should be light and nourishing. All fruit should be strictly prohibited, and acids of every kind. Brandy and water may be taken, should any thing like weakness take place, and strong beef tea, with spice. Sometimes in an early stage, there is great irritation of the stomach, which becomes considerably aggravated, if allowed to progress ; so much so, that it is requisite before administering any remedy, to precede it by effervescing medicines, to prevent their rejection : and a very agreeable form is the following — Tartaric Acid .... 2 drams. Syrup of Orange Peel . . 1 oz. Tincture of Orange Peel . . Ģ oz. Cinnamon or Cold Spring Water 6 ozs. To be taken with a fourth part of the following mixture, in a state of effervescence, occasionally, or before each dose of medicine- Carbonate of Soda ... 2 drams. Pure Spring Water ... 4 ozs 29 Taking therefore everything into consideration, this plan may be pursued for few a days with perfect safety; after that, however, (presuming of course, that the bowels have been freely acted upon), should the symptoms not subside — that is, the dirrahcea continuing, with a great deal of bearing down, as it is called, then the following plan may be adopted. Chalk and Quicksilver (a powder) 5 grains Powder of Rhubarb ... 5 grains Ditto of Opium . , . . to \ grain This is to be mixed together, and taken night and morning, or three times a day, if the symptoms are not mitigated ; but it is more than probable now, that the bowels will not only become quiet, but perhaps a little confined ; this need not, however, excite any apprehension or fear, when we remember how freely they are supposed to have been acted on, even though it continue for a couple of days, provided there is no pain — nor any other bad symptom : if, however, at the end of that period, they have not been so, then the powder should altogether be withheld, and a dose of the first pills taken at bed time, and one of the mixture in the morning, as before recommended. While administering the powder, and in order to expedite the cure, the bowels may be fomented with hot water, or with any ingredients added thereto as fancy may dictate ; since it is perfectly immaterial, provided it be hot — for the virtue consists in that, and that alone. It is a very common attendant, under any form of disease, for the feet to become cold, which ought not be allowed ; and every means should be adopted, not only to get them warm, but to keep them so. Some persons' bowels are naturally irritable, therefore, it is highly necessary, at all times, that attention be paid to them — such as the choice of food, a prompt compliance to nature's 30 demand for their relief, and securing them from cold winds, by new stout flannel. As soon as the stomach will bear food of a solid kind, nothing 1 is comparable to a mutton chop, which may be taken with dry bread — the staler the better — with plenty of pepper and salt, but no vegetable, on any account, for some days after; the drink, a table spoonful of brandy in a tumbler of cold spring water. But presuming under this plan, which must invariably be adopted at the commencement, whatever be the result, that the Dirrahcea continues without much pain or bearing down, as well as the sickness of the stomach ; then a hot mustard poultice should be applied over the whole of the bowels, the effervescing medicine continued, and the powders more often repeated, with occasionally a little of the following mixture, — Aromatic Confection ... 2 drams Prepared Chalk .... 1 dram. Compound Tincture of Cardamums . 1 oz. Tincture of Opium | dram. Strong Cinnamon or Peppermint Water .... 6 ozs. Two table spoonsful occasionally. But it might be said " Ah ! you reprobated this mixture just now," so I did, and so I do still, under the form of symptoms produced by an overloaded state of the canal, as described — the which, nothing could be more mischievous : but I am supposing a state, which I am perfectly satisfied, will rarely occur, provided the symptoms be taken early and treated according to the rules here laid down ; but if from any unforseen circumstance, and allied with a natural tendency to irritable bowels — they should pass into the 31 above state, it may then be given, but sparingly, and in conjunction with the powders. We have now traced the preliminary stages of this disease, which, " Like powerful armies, trenching at a town, By slow and silent, but resistless sap, In his pale progress, gently gaining ground, Death urg'd his deadly siege." We have seen the various changes, and laid down a succinct plan of treatment, so as, if possible, to check them : but, should it not and the disease approach completion, it will be highly necessary for us to survey its climax, which is termed " Asiatic Cholera," their culminating point. Keeping in view my previous remarks as to the sudden introduction of the collapsed stage, without, as it has been alleged, any assignable cause, and which, I have, I hope satisfactorily disproved, in consequence of the mildness which they sometimes assume ; I shall, forthwith, proceed to lay before the reader the last terrible symptoms of this most frightful malady. The following case, which is one I have chosen out of some hundreds, appears to me, from the marked severity of the symptoms, the fierceness of their developement, and the rapidity of their career, with many other attending circumstances, peculiarly adapted to exhibit what this disease, called Asiatic Cholera, really is, as to appearance; for it seemed, when passing in actual review before me, something very mysterious, and gave then the idea, as it does now, upon retrospection, that it was the " Disease of Death;'' a direct visitation of the Almighty. Were it of any avail, I could enumerate a series of cases, but there would be so little variety as to the detail of each, that it would be merely a recapitulation of the same symptoms and treatment, attended almost by the same unfortunate results. This case, therefore, is the embodyment of facts as they 32 transpired, and though very marvellous, derives not the least support from fiction or imagination. THE CASE. A poor woman (whose name I now forget), but who was well known in Kent Street, at that period, 1832, was seen walking along, as usual, with a roll of papers in her hand, apparently in the enjoyment of perfect health, when she was seen suddenly to fall, helpless and prostrate, into the entrance of a shop door, just as if she had received a violent blow on the head ; and there she laid, without the least strength, and totally unable to assist herself. She was in that state brought to the Cholera Hospital, York Street, Wai worth. When I saw her, she presented all the appearance of having suffered under a long and painful disease ; in fact, it was like the concentration of all its symptoms in their most horrible form, pressed into the small period of an hour, and she was apparently dying ; occasionally she vomited most fearfully, which was severely aggravated by any attempt at alleviation, by its being immediately rejected ; the dejection from the bowels was as sudden as its cessation, similar to the rushing of water through a pipe, and from the quantity, which was wonderful, appeared as if the whole structure of the body was passing into fluidity. There was not so much spasm in the bowels as I have frequently witnessed ; but the cramp in the legs was agonizing in the extreme: she was deathly cold, and the feeling presented to the hand was like damp marble, in winter; no pulse, tongue cold, the eyes sunk in their sockets and floating languidly, in an envelope of thick mucous, and from their subdued expression, spoke more of apathy than pain ; the countenance shrivelled, and shrunk, and of a leaden hue ; the voice sepulchral, sliding into a hoarse low whisper; the whole of the body was suffused with a blue tint, and was cold and clammy ; 33 the feet and hands almost approaching to black ; and on seizing me by the hand ( for we did not wear gloves as they did in Hamburgh), it gave a most singular feeling, as though embraced by wet cords, half frozen, which I felt in imagination for hours afterwards ; she threw herself into all manner of attitudes, which appeared from their continued repetition to afford a momentary relief; and though so deathly cold, was complaining all the while of an extreme internal heat, and intense thirst; she was even devoid of feeling in the extremities, either as to touch, or the apprehension of warmth ; which I discovered while applying the " Naptha Bath," for although she was made so hot by it, which would have produced considerable inconvenience to a person in health, she expressed herself, on enquiry, whether she derived any comfort or warmth, as not being conscious of either ; at this I was rather astonished ; and in order to test an idea which at that moment arrested my attention, as to the cause, I pinched her gently, asking at the same time, " Does that pain you ?" " Pain ! " " What pain ?" " Why that ! " pinching at the same time with more strength. " Don't you feel that ? she feebly whispered, "no ! " And I am disposed to believe that both her legs might have been amputated without any increased manifestation of distress. In the midst of all this amount of suffering, reason, never for one single moment left her ; she was perfectly collected to the last. All the aggravated symptoms, such as the vomiting, purging, spasms, and cramp, now gradually subsided; and but for the occasional low whispering (relative to her supposed mission), and long deep breathing, might have been pronounced dead. In this state, without any material alteration or change she continued ; when about six hours after the attack, " the weary wheels of life at last stood still." Whatsis this which has been very feebly presented to our view ? Is it disease ? No ! Death ? Yes ! Then if death X 34 could be personified during life, what has been here depicted is an illustration : and the poet's question, " Who can paint death's portrait true ? " appears to be consummated by the above picture, though inadequately and very imperfectly drawn. THE TREATMENT here pursued was all that art and experience could devise or humanity suggest ; and in perfect accordance with the remedies which seemed most calculated to alleviate, and if possible, effect a cure. But what could it do in a case like this ? We shall see. We were not to be intimidated, though appearances were so much against us, but at it we went, boldly and perseveringly : she was immediately stripped and put into a warm bath, impregnated strongly with mustard, and powerful friction, by the hands, was continued all over the body for the space of half an hour. She was then taken out, rubbed as dry as possible before a large fire, then enveloped in flannel and put into a warm bed ; five grains of calomel, with one grain of opium was now given and repeated every half hour, (the case was desperate) followed up at intervals with hot strong brandy and water. Hot mustard poultices were repeated over the abdomen and chest, stimulating linements of various descriptions, were continually applied to the other parts of her body, particularly the legs ; and when that was discontinued, the Naptha Bath, with its stream of hot air, was immediately brought into play; so that there was a perpetual series of applications, no interregnum of time, however short, was allowed to intervene ; upon the abandonment of one, another instantly took its place ; we did all that was possible to be done untiringly, and with hope before us; but, alas ! the weakness and impotency of human means, however prompt and energetic, against such 35 a direful disease, if disease it may be called ; here they were weak as the " seven green withs," which bound the strong man ; for in direct opposition to all our attacks, it sternly defied our power, and advanced to completion, without one symptom being mitigated, or for one single instant retarded. The plan of operation in the above case, is what I strongly recommend for general adoption, in the collapsed stage, though unsuccessful here; since it appears to me, with perhaps some few slight additions, the only one calculated to effect the object so much to be desired. If under the consideration of such an important subject, I am permitted a short digression, I will briefly detail her history, for while it exemplifies, " the ruling passion strong in death," illustrates at the same time the activity of her mental powers, unsubdued even to the last. She was a singular character, and from the knowledge of her eccentricities, I have been enabled to trace, as if it had only occurred yesterday, her short tragical career of six hours, in which I was engaged as a performer. She thought she was delegated to effect some great moral changes in the world, a theme on which she was never tired of expatiating, and continually engaged ; the roll of papers, were the documents she had penned, detailing the various subjects of her high mission, and the changes about to take place, addressed to different statesmen : under this delusion, she has wandered for days and sometimes nights ; calling, or fancying she had upon them, to disclose more particularly, how the great work was to be accomplished ; — whenever I met her, the subject was immediately introduced, by "Doctor, the work is advancing beautifully; here's a fresh letter ; we shall soon have glorious changes ; my plan must be adopted, &c." On entering the hospital and seeing me, the subject was instantly broached, nearly in the same words, and she appeared in the midst of her sufferings, totally absorbed, when talking of the good to be effected through her 36 instrumentality; and while the various remedies were applying, every now and then was seen referring to her papers, and making- feeble efforts to put down some fresh matter with a pencil, but which she was unable to do in consequence of her great weakness ; during one of these attempts, and while trying to explain, to me some of her views — her head gently fell back — and she expired. Every thinking man forms his own views upon the subject which engrosses his attention, assisted by the light he may derive from those who have preceded him ; but the modern appearance of this disease, comparatively speaking, precludes the possibility of deriving much assistance from any other source, than that which has been unfolded to him who has had the opportunity of extensively witnessing and treating it : it is in consequence of this, that we have such conflicting opinions in reference to this subject ; hardly any two agreeing as to what this disease really is, where situated, how produced, the laws that govern it, whether it is contagious, influenced by the state of the atmosphere, traceable to locality, or to noxious effluvia ; all is doubt and uncertainty. Every medical man who has witnessed much of this complaint, is justified, and ought to give his opinion, for it is only by such a combination, doubts are to be removed, and something like certainty arrived at. However, investigation is now fully awake ; and the weapons are preparing in all quarters for the destruction of such a formidable antagonist, and it will be somewhat strange, if out of the number one cannot be found strong enough to effect that purpose. The anatomist has been busy with his knife, the physiologist in his research, and dissections have repeatedly been made, to seek, if possible, for the origin of this malady, which has shown itself in all the phases of society, and under almost every variety of circumstance : — the former pointing out lucidly all the changes which have taken place as to 37 structure, enlargements, absorptions, adhesions, tumifactions, congestions, effusions, decompositions, and whatever else is presented to his view, as incompatible with life and health. Microscopical investigations have likewise not been wanting, to aid by their assistance, a deeper enquiry ; the blood has been minutely scrutinized, and changes almost as multitudinous have been discovered; so that humanly speaking, nothing might be lost sight of in furtherance of this object. And the physiologist, shrouding himself in the mystification of his theories, views with great intenseness all that has been disclosed ; and learnedly and ingeniously too, explains, or thinks he does, as to the cause of those varied appearances. All this is highly commendable, and manifests the great anxiety always displayed by the profession, for alleviating, if possible, the sufferings of humanity ; yet it has not revealed the seat of this complaint, nor removed the veil which still envelopes it ; all is dark and distant as ever ; and those organic changes which have been supposed as the production of this affection, appear more the consequence of long insidious disease, than the growth and formation of a few hours. The treatment appears to be just as vague, and uncertain ; every one apparently, capriciously following out the bent of his own inclination and views — and cures and specifics are as plentiful in the market as the supposed causes of the disease are numberless. To what then must all this be attributed — since a total failure of each has been evinced when put to the test ? If I might be allowed an opinion, it is, that we have either mistaken the nature of the disease, or the means whereby it is to be arrested. There has evidently been of late years, and which still continues, a very great change in the character or type of the diseases to which the human family is subject, perhaps more so in England than in any part of the world — for while some have been assuming a milder form, others appear to be 38 characterised by greater severity and intenseness ; why it is so, lam not able to say, only such is the fact. Many reasons may be adduced in the way of explanation for those various changes ; but however ingenious and pleasing the research might be, it would after all only terminate in theories and speculations. Diarrhoea, one of the most prominent symptoms leading to Asiatic Cholera, as it is termed, is one of the most prevalent functional disturbances in the world — it is the safety valve of the animal economy; children almost under every ailment suffer from it, and nearly every disease is preceded by it. Diarrhoea, or purging, is that upon which the medical man depends for eradicating disease, except in some few instances; it commences almost with our existence, and generally accompanies us at our departure. This affection, however, which is so universal, has latterly ran a course counter to what we have usually been accustomed to witness ; that is, from some hitherto inscrutable cause, it has assumed a new type ; not that there is a new type in connexion with the symptoms of diarrhoea, but that they have had a tendency of late, under peculiar circumstances, to produce such havoc in the constitution, that it has been unable to bear up against the overwhelming consequences to which they lead ; therefore, I am disposed, not to consider the collapsed stage of Diarrhoea, or Asiatic Cholera, as the disease, but the sequel ; in the same way as I should look at the termination of any lingering disease ; which, always before death, presents rapidly a number of symptoms not observed before, during its progress, and which, in many respects, closely approximates to the one now under contemplation. While there is life there is hope ; and it is true, that some, in the last gasp of death as it were, have been miraculously restored to life and health ; so have many in the collapsed stage of Cholera, but the treatment is a forlorn hope, and upon which, no dependence 39 whatever can, or oi'^ht to be placed, since it is the symptom of death, and not tof disease. Before concluding, I would draw particular attention to the following statement just received from Smyrna, because if anything more were wanting to strengthen the opinion already advanced, that good wholesome food, is the greatest barrier to the ultimate formation of this complaint, then this would seem to supply the deficiency. The population of that City is of a very mixed kind, and each, of course, from their different religious creeds, confined, as one of the articles of their faith, to a peculiar mode of living and diet, fasts, feasts, &c. ATTACKED. DEATHS. Ottomans .... 1,642 1,212 Jews 706 308 Greeks 546 429 Catholics .... 182 145 Armenians .... 126 105 From this it is very remarkable how little the Jewish population suffered in comparison with the rest ; since it proved fatal to the Ottomans in the ratio of 74 per cent. ; to the Greeks 77 ; to the Catholics 80 ; to the Armenians 84 and to the Jews only 43 per cent. ; what reason therefore can be assigned for their immunity. Remember their living is always of the choicest and purest kind ; no animal with anything like spot or blemish, is permitted them to eat of, it is altogether condemned as impure and unfit for food ; all their rules as to eating are expressly laid down, and from which, without breaking their faith, they cannot swerve : they drink but little spirits, and in fact are altogether a very temperate race ; it is to this therefore, and nothing else, that they so singularly escaped. Much might be advanced upon this very interesting part of the subject, but it would be extending this little pamphlet to 40 too great a length; I shall therefore finish by a brief recapitulation of its leading features wherein I have endeavoured to show ; That, the main cause of this fearful complaint is to be attributed to impure or deficient nourishment, in conjunction with a constitutional bias : that the symptoms constituting dirrahcea are depending -thereon ; and, if unchecked, the collapsed stage, to which they tend, has invariably been preceded by them ; and, moreover, that the final attack, called '* Asiatic Cholera," because it was first manifest in that part of the earth, is a new type as regards the results, and therefore is the sequel and not the disease; consequently is not depending or produced by locality, noxious effluvia, impure drainage, marsh miasma, or any other circumstance whatever; although, it is admitted, they may, by debilitating the powers of life, render it a little more susceptible. That an early attention to the symptoms is the only time we have within our power to check the results so much to be dreaded ; inasmuch, that any attempt at cure, when the last stage has set in, which is characteristic of death, is never to be depended on — prevention therefore is everything — the cure alas ! nothing. Conclusion — " We conquer many evils at first with great facility,which being long neglected become insurmountable ; therefore, though it may be glorious to overcome a great evil, the easiest way is to prevent it." Bedford, Printer, Albion Place, Walworth.