ESSAY OK THE ORIGIN, SYMPTOMS, AND TREATMENT, OF CHOLERA MORBUS, AND OP OTHER EPIDEMIC DISORDERS, WITH A VIEW / TO THE IMPROVEMENT OF SANITARY REGULATIONS. Moxfog piv r Sxiyos, to 3e pvpiov abutt ovsiap T'ivst kvtypoevm alii 7re4>uX«y/*eva avtyl. By T. FORSTER, M.8., F.L.S., M.R.A.S., COBRESPOMDING MEUB. OF THE ACAD. NAT. SCIENCES AT PHILADELPHIA, ET CETERA. LONDON: KEATING AND BROWN. PARIS AND STRASBOURG: TREUTTELL AND WURTZ. 1831. CHELMSFORD : PRINTED BY MEGGY AND CHALK PREFACE. AS the reader may be desirous before perusing the following Essay, to learn what are the facts actually ascertained with respect to the existence and progress of Cholera Morbus in Europe in general, and in this Country in particular, I have thought it fit to give the result of the latest authentic accounts which I have received or been able to collect on the subject. It appears that on the continent this disorder is changing its course, without much abatement of the violence of its symptoms, which, however, vary in some measure in the different countries, which become, by turns, the objects of its attacks. It is evidently subsiding in the North of Europe, but seems to be pursuing its way into Egypt and Arabia, and other parts of Africa and Asia, as if returning, by a circuitous course, into India, from whence it has been said to have sprung. Meanwhile cases continue to break out in the outskirts, as it would seem, of the central pestilence, which resemble it in certain points, but are neither so violent nor so generally fatal. In France and other countries of Europe, for example, cases have occurred exhibiting almost every variety of symptoms, but consimilar in this, that the biliary system is deranged; and that too with more or less of the characteristics of true Cholera of India. In England many well established cases exist, spread about in different parts of the country, in a manner which would justify the belief that the malaria occasioning the Cholera has been for some time actually pervading our Isles, while the unfrequency of severe cases must lead to the conclusion that we are not yet within the range of its central malignity, and may, therefore, afford good reason to hope, that we may, for the present, escape the more fearful ravages of this disorder. At the same time it would be wrong to conceal the fact, that cases continue to encrease in various parts of the country. My object in the following pages has been to clear up the groundless alarms excited by ignorant persons, respecting contagion, and to assure the public, on the strength of a very long and elaborate enquiry, that the excitingcause is purely atmospherical, and consequently wholly beyond the reach of human prevention. At the same time I have set down in the plainest manner I could, what precautions ought to be taken, in order to mitigate its severity if it should arrive, by diminishing the predisposing causes. Such will indeed be found of great importance, and should be promptly acted on. ii PREFACE. With regard to particular places, already attacked, I shall be at all times ready to communicate to individuals such news as may come to my knowledge; but it would be unfair, in a publication likely to be extensively spread abroad, to establish local prejudices against any towns or counties, by naming them as infected, nor shall I detail particular cases. To do so would be to create those very fears which predispose to the disorder, and would thereby defeat one of the objects contemplated in this imperfect attempt to break the spell of terror, and to rescue the commerce and social intercourse of this and other countries, from the danger which Boards of Health and illjudged sanitary restrictions have hitherto involved them in. I am aware that there is some conflicting evidence on the question of contagion/; but be it remembered that within the last century, judicial proceedings, founded on evidence were taken against Witchcraft and Incantation ; this humiliating consideration will induce us to sift the mass of testimony adduced, and to rely for truth on the united counsels of men of genius, talent, and observation alone. All the evidence for contagion vanishes before the proofs of the contrary doctrine : in this position of affairs then, let us hope that men will show their wisdom, by a prudent application of all those measures which seem calculated to prepare the human body for the evil, instead of wasting time and ingenuity in a fruitless attempt to avert that which is irrisistible. P.S. Having just examined the very latest accounts which have come to hand, both manuscript and printed, I am induced to repeat what I before said, that alarms have been injudiciously created, which the actual state of the disorder and the chances of danger do not warrant. New cases certainly occur in various parts of Europe, and in the British islands; but these are comparatively few in comparison with the terrors raised about them, and have chiefly occurred to persons who might well be considered predisposed to disorder. After carefully perusing the official and other accounts just this moment arrived from abroad, it is but just to observe, that some of the English reporters have expressed opinions favourable to the doctrine of contagion ; but the very circumstances, on which they have grounded such an opinion, have been such as to confirm, to my mind at least, the very opposite doctrine ; moreover they have, been generally of a conflicting nature ; nay, even in the long string of detached sentences which constitute our official reports, one paragraph frequently appears contradictory to another : while in the accounts of the foreign writers, clearness of views and consistency of description are equally remarkable. I shall conclude by observing that up to this moment every account that I have perused, has tended to confirm the opinions advanced in the ensuing pages. Before I conclude, my readers might expect that I should notice the latest reports of MM. Russell and Barry ; I have in fact perused them ; but I confess that to my mind they appear, like the rest of the iii PREFACE. English accounts, to be contradictory, and to contain hasty conclusions founded on imperfect views, and convey to my mind additional proofs of the nonexistence of contagion. — For example, Article 6 of the Report is at variance with Art. 1. — Again, Art. 5 contradicts the whole tenor of the document, for it implies that the malaria was abroad ; and, besides this, it contains an assumption of the fact, that the bodies of the invalids had been predisposed. It is also quite a gratuitous assumption to say that boats and other barks introduced the disorder ; for let it be recollected, that such boats are always passing to and fro in all places and directions ; and it is notoriously contradictory to the other accounts of the same disorder, that Cholera has been more spread in those places which have had communication, than in those where communication had been interrupted by sanitary regulations. Lastly, the very admission, Art. 8, that seclusion from infected patients exempted individuals from the disease, where currents of air were also excluded, leaves us to infer that it was by draughts of the malaria accidentally let in, that the atmospheric disorder was introduced. But after all, what would be the force of this document, even if it were consistent with itself, when balanced against the united opinions of intelligent continental writers ; on the solid basis of whose extensive and repeated experience and authority — living, as they do, on the spot — the Prussian and other European Governments have at length broken up their Cordons and Quarantines ? It may be stated also that the reestablishment of free communication has not in any way reintroduced or augmented the disorder in any one instance. The cases in Sunderland and other places, of several in one family being infected at once, shows how much predisposition of body (which might belong to all the members from consanguinity) had to do with the actual occurrence of the complaint on the arrival of the malaria. To the sanitary rules contained in the 3d section of this essay, page 50, the reader will pay particular attention, as being of the greatest importance in establishing and preserving that health of body and cleanliness of habits, which conduce so materially to the mitigation of Cholera Morbus, as well as to that of any other epidemic that may arrive. Boreham, Nov. 12, 1831. a MM. les Editeurs dcs Journaux Etrangera. MESSIEURS, Par les observations que j'ai l'honneur de vous adresser, dans l'Essai suivante, je me propose de r6soudre la question difficile de la cause dv Cholera Morbus; et d' indiquer au me"me temps les mesures qu'il faut prendre, par precaution, contre ses effets. Quand l'Humanite' demande la destruction de ces funestes obstacles que les cordons sanitaires mettent au commerce mutuel de la charite" entre dcs nations voisines ; et quand l'lndustrie se plaigne dcs restrictions que le quarantin impose sur la marchandise ; la Prudence, de son cote", s'empare dcs remedes necessaires, en attendant son approche. J'ai fait pendant plusieurs anne"es dcs recherches sur l'origine dcs epide'miques, et je suis convaincu, a la fin, qu'elles tiennent tout-a-fait a l'atmosphere. Je sais Men qu'il existe encore dcs me'decins gui voudraient empecher Pentre"e de cette maladie par dcs cordons sanitaires ; mais je puis leur avertir d'avant, que cc serait e'galement facile d'empecher une phalange de grues par un cordon de viscum, ou changer le course dun orage passager, par un conducteur de l'electricite' artificielle. Je vous invite done, MM. les Editeurs, a de"pouiller de ses ailes et de ses talons un chimere dont j'ai long temps connu le danger et Pillusion. Si vous croyez que les faits, au moms tres remarquables, que j'ai constate" dans cette brochure, sont dignes d'etre re'pandu, par le moyen de vos Gazettes, en les inserant vous pourrez rendre dv service ala socie'te', a cette epoque quand la Science, deja en marche, se promesse de fouler aux pieds tous les erreurs dv monde. Je suis, &c. L' AUTEUR. To Messieurs, the Editors of the Public Journals. GENTLEMEN, The following observations, which I have had the honor to offer to the notice of the reader, have been printed with a view to call the attention of the public to the real origin and nature of the prevailing Cholera and other Epidemic Disorders, in order to prevent, if possible, the vexatious obstacles to commerce, and to the free intercourse of man with his fellow creatures, which the superfluous establishment of cordons and of quarantine are so likely to interpose ; and at the same time to point out those sanitary precautions and rules of health which will lessen the destructive virulence of the disorders, in such places as may become the subject of its visitations. In furtherance of these views, I solicit your assistance to select such quotations therefrom, as in your better judgment appear calculated to effect the same; or, at least, to call forth and give a wide range to that patient and unprejudiced enquiry which shall lead to the refutation, if erroneous, or to the adoption, if found true, of the doctrines which I have endeavoured, in this hasty and imperfect Essay, to place in a conspicuous point of view. Your's, &c. THE AUTHOR. The reader may consult the following authorities corroborative of ihe doctrine which I hold ; but in the meanwhile I cannot pass over the laudable exertions which the intelligent portion of the Foreign and English Press are making to dispel the false alarms about contagion. Hoffman, Dissertatio de Morbis. Meyer, be Morbis Endemiis, 1737. Tullv, Essai surles Maladies de Dunkerque. Wintringham, Treatise of Endemic Diseases. Galenus, Fragment, ex Aph.p. 34. Alberti, Dissert, de Morbis Aestivis. — Hal. 1745. Wilson, Short Retnarks upon Autumnal Disorders, 1765. Baeck, Tal om Farsoter, fyc. — Stockholm. 1765. Comm. Lips. Suppl. Dec. 11. p. 69. Vogel, N. Med. Bibl. vi.B. p. 189. Beuger, Diss. de Aeris Potentid in Epidemicorum Morborum Generatione — Hal. 1727. Borellus, Observat. Cent. iv. n. 42. Caranta, De Nat. Auri, (in nauibus cum ingenti numero tnurium.) Commerc. Lit. Nor. 1782, p. 204. (Uffeiiheimensis.) De Darguiville, Morb. Epidem. — Anni 1693, fyc. — Emetic, et Phlebot. Laudes. — Paris, 1693. Ephem. Nat. Cur. Dec.U. Ann.v. Obs. 169, et alibi. Forster, Researches about Atmos. Phaen. 2d. Ed. Lond. 1815, p. 165 Farina, Ortus et Occasus Morb. Epidem. — Romae, 1672 — 12. Fischer, Diss. de Morbis Epidem. — Erf. 1727. Forwattning, Of Provincial Doctorernas Berattelser. — Stockh. 1765. De Gorter, Morbi Epedemii Brevis Descripiio et Curatio per Diaphoras. — In Harderov. 1733. De UAny,Epidemiaf^erna quae Uratislavium. — Anno 1737,c#«>?7,1737. 'innOKPATHS, lib. vii. Epidem. Huswedel, Bericht, wie bey einfallender Krankheit, jeder sick verhaltensolle — Hamburg, 1603. Koker, Diss. de Morbo Epidemico, Anni 1719. — Lugd. 1720. Kruger, Beschreibung der einheimischen Krankheiten wie dieselben durch himmlische Influenz aus der Lust die Menschen, anno 1692 inficirt. Braunchw. 1692 — 4. Lepecq, de la Cloture, Journal de Med. T. xlvii. p. 387, 483. — T. lvi. p. 193. (Normandiae.) , Anleitung Epidemische Krankheiten, zu Beobachten. — Leipzigk, 1785. A. D. B. lxviii. p. 105. LoSCHER, Diss. de Phenom. Septentrionale Luminoso nee non Morbo Epidemico, Anni Currentis. — Witeb. 1721. Ludollf, Diss. Gen. Febr. Epidem. Concep. — Erf. 1753. Ludwig, Advers. I. ii. 1. Menzer, de Morb. Epidem. Antiquis. — Basil, 1740. Mertens, Pracktische Bermerkungen iiber Verschniedene Volaskrankheiten. 1785. Nun, de Spieciebus Morb. Epidem. fyc. fyc. — Erf. 1758. Pohlius, de Morb. Epidem. ab a'e're Atmos. — Lips. 1749. Sauval, AnMorbiomn.es, omnibus fiant temporibus.—V&ris, 1706. Schenck, Obs. vi. 103. Sydenham, Op. p. 42. 129. 137. et passim. Vaber, Morb. Epidem.— 'Viteb. 1717. Wintringham, Works, I. n. 1. Act. Nat. Cur. Vol. \\. obs. 6. Alberti, Diss. de Palendromia Morborum. — Hal. 1750. Buchner. Diss. de Primis Viis Morborum Periodicorum sede fre quentissimd.—H&l. 1768. — Bald. Ausziig. I. 81. ¦ -, De Morb. Periodicis, (in general). — Hal. 1754, Darwin, Zoon. Sect, xxxii. 6.— xxxvi. ii. 3. fyc. Ephem. Nat. Cur. I. iv. and v. — 11. iii. 40. Franck, De Period. Affect. — Pavia, 1791. Marescot, Period, in Morbis, Sjc. fyc. — Paris, 1575. Medicus, (Fr. Cas.) Geschicte Period. Krankh. — Carlsrub, 1764. De Neufville, Diss. indol. Morb. Period. Hypochon. — Gottengen, 1785 Plouquet, de Morbis Periodicis. — Tubing. 1783. Dv Port, Ergo Trepiutiaov Causa, fyc— Paris, 1623. Riedlin, Lin. Med. 1695. Spichenbergen, De Morb. Period. — Leyden. Stahl, De Affectibus Periodicis. — Hal. 1702. Testa, Bermerkungen iiber die periodischen Verclnderungen und Enscheinungen in Krankheit und gesunden Zustande dcs menschlichen Kbrpers.—Leipz. 1790. Salzb. Med. Chir.— Zeitung. 1791. 111. 5. Valentini, Decl. Panyg. n. 3. de Morb. Period.— Francof. 1701. Spurzheim, Physiog. System. London, 1816. -, On Insanity. London, 1817, p. 190, et sequel. Crause, Dissert, de Morbis Nocturnis et Nocturnis Morborum Exacerbationibus. — Jena, 1709. ScARPA, Malatie deglie Occhi, (alfino del libro.) On the Nocturnal Blindness. Darwin, Zoon. vol. ii. (Curious case of), and Class IV. ii. 4. etsequel. Annal. Fuldenses, 810. Annual Regist. 1772, 310, et alibi Baeck, Tal. om. Forsot. pub. at Stockholm, 1765. Baronius, vol. ix. 809. Badham's Memoirs, vi. 389. Courant, 1798. Curries Mem. 135. Forster's Atmos. Diseas. — Lond. 1817,*: Essay on Fever.— «Lond. 1819 Friend's Hist, of Med. p. 564. Hist. Col. 318. Hoffman, Dissert, de M. R.—1705. Jamaica Gazette, Jan. 29, 1798. Justin, lib. xix. cap. 2. Lanciscus, 146. Livy, Lib.vii. 1. Lind, On Trop. Climat. 122, and alibi Magdeburg, Hist. Cent. ix. Muratori, ii. 513, and sequel. MAITLAND, Hist. Lond. Mem. Am. Acad. i. 129. MEYER de Morb. Epid. 1737 Orosius, vol. 4. Parker's Hist. Brit. 360. Paulus, Diac. alibi. Pistorius, Germania Script, ii, 38. Plutarch, in Fit. Marcel. Rutty, on [Feather, 413. Rush's Works, ii. 238. Sinclair, vi. 672. Seneca, N. Quest, vii. 16. Sydenham, Op. alibi. Short's Hist, of the Air, 2 vols. Bvo. Smith's History of Cork, p. 40. Thuanus, Lib. i. and iv. Van Troil, Hist. Iceland. Webster's Hist. Epidemics, 2 vols. Bvo. 1800. ESSAY. At a time when a pestilential epidemic is making a fearful progress over a large portion of the civilized world, I trust that no apology need be made for any additional information, offered to the public, on its origin and treatment, and that, notwithstanding the vast quantity of desultory speculations which have issued from the press on the subject, the following practical remarks and observations, founded on historical evidence, will not be considered as superfluous. I shall avoid all needless introduction, and at once divide the subject, for the ease of reference, into three distinct sections :—lst.: — 1st. On the Causes of Cholera Morbus and other Epidemics ; 2nd. On the peculiar Symptoms of Cholera Morbus and other Epidemics ; and 3rd. On the Treatment of Cholera Morbus and other Epidemics, as regards Prevention and Cure. A long acquaintance with the history of epidemics, and repeated examination of the detailed accounts of writers, together with my own observations in different countries, have conduced to the opinion which I hold, that these popular disorders are all, as it were, members of one family, the symptoms of each particular complaint varying in different countries, and in different periods, according to essential varieties in the exciting cause, which 1 believe to belong to certain conditions of the atmosphere which traverse the surface of the globe, according to peculiar and hitherto little understood laws, like other phenomena of which the air, in its various states, appears to be the vehicle. But whether these causes of disease result from qualities imparted to the insalubrious air itself? — Whether they depend on specific B 2 impregnations of foreign substances, — or on the generation and spread of peculiar animalcula? are questions which positive proofs are still wanting to solve ; and of which the solution has hitherto derived but little aid from any reasoning from analysis, or the application of the doctrine of probabilities to the store o,f facts already gathered together. I have, therefore, sought in this essay to curb my natural inclination towards hypothesis, in order to avoid error, and have advanced no doctrines but what are of a practical nature ; nor attempted to establish any opinions of my own, except such as can be shown to be founded on the solid basis of experience, or the well established history of the disorder in question. My object is to expose the fallacy of the dangerous and absurd doctrine of contagion, and to show that Cholera and other epidemics depend on exciting causes, which are atmospherical, and over which quarantine and other measures of pretended defiance to the disease have no real controul ; and that all that sanatory regulations can do is to fight with the predisponent causes, by preparing the body against the disorder, by ventilating apartments, by removing filth, and by adopting such fumigations and other correctives as experience has proved to be useful. After discussing the causes of Cholera in the first and the symptoms in the second section, I shall proceed in the third to point out some of the best of these sanatory rules, in order to put the public in the fittest state of defence against the possible, though as I hope, improbable occurrence of the complaint. If the reader get tired of the discussion of the causes and symptoms of Cholera, he may glance hastily over the two first sections, which are principally addressed to medical men ; but to the third or practical part I request particular attention. 3 Sect. 1. — On the Causes of Cholera Mobbus and other Epidemics. Perhaps it will be best to state at once my opinion on these disorders, and then the subsequent facts and observations will show what reason I may have for entertaining it. It seems then that this disorder, and all others of similar kinds, depend on a specific external excitement, which falling, as it were, on the people from above, have on that account been called Epidemic, in contradiction to another class of disorders which, inhering in the constitutions of certain races and nations, are called Endemic : the former fall on the whole people at uncertain intervals, and select their victims among the weak and predisposed persons ; the latter are like heir looms in certain families and tribes ; these cut off in the course of generations the weakly born subjects, or those who subsequently provoke the latent disorder by bad habits. There is yet another class of diseases which partakes of the character more of the former, as they seem dependent on the air or soil of particular parts of the world, and what might be distinguished as Topical Epidemics, as the elephantiasis in Egypt and many others. It will be seen below that Lucretius, Virgil, Ovid, and other poets, as well as the medical writers of old, have described all these disorders with great accuracy, as I shall presently show. None of the above disorders appear to be propagated by contagion ; " on the contrary, they break out, in a vast number of cases, in a long line of villages and towns all at once, as if by the sudden influence of the atmosphere ; but then, after the disorders have been once excited, certain varieties of them may be afterwards in some instances propagated by inoculation, as the small pox ; or by contact or proximity, as the plague and some other fevers ; but in the majority even of these disorders, the only danger from proximity to the patient arises often from a predisposition to 4 the disease, or from the want of a free ventilation ; in the latter case, the exhalations from the bodies of the malades serve to enhance the evil of the prevailing malaria, and thus subject the attendant to a greater chance of catching the disorder, while he is waiting on the patient. Those persons who attend only to this mode of getting the disorder, take up hastily the doctrine of contagion, forgetting at the same time to notice the more general source of the malady which is already abroad. This is precisely what has happened with regard to Cholera Morbus, and in this view of the subject I am supported by the principal sanatory councils of Europe, who have at length abandoned the vexatious restrictions of quarantine, and are by degrees breaking up their cordons sanitaires. But before I proceed to show how greatly authority preponderates on the side of the doctrine which I maintain, I shall submit to the reader the following facts in the history of Epidemics, which facts are wholly irreconcilable with the doctrine of contagion ; but are capable of being easily explained, on the supposition of peculiar stimuli existing in the air. I grant there is still a difficult question left unanswered; namely, what these morbific states of the air actually consist in, and why, at different times, such very different symptoms should be excited by atmospherical causes. That on the most ordinary occasions atmospherical changes affect both the health and spirits is well known, and in many instances it seems that the electric state of the air is the principal agent : the pain felt in the head, in the teeth, or in any weak or injured part of the body, before thunder storms, is a familiar illustration of the influence alluded to : the feverish headaches and listlessness felt by many persons on the occurrence of east wind is another ; nor ought we to overlook the sudden effect on the digestive organs and general health produced by change of situation and of air. But still in cases of Epidemics of a decided and peculiar character, we 5 must look for something more than this general influence ; for since philosophy shows that there must in reality be as many causes as there are effects, and as all the known epidemics differ from each other in their symptoms ; so we must admit the existence of an almost infinite variety of morbific qualities inherent in the insalubrious atmosphere on different occasions. At one time small pox rages epidemically and devastates a whole country, as in 1773 in England and Scotland; at other times measles, hooping cough, or scarlet fever prevail, sweep along in a certain course, and at length disappear. One thing with regard to epidemics ought to be particularly noticed as pointing out a sort of progressive malignity in the infecting air ; it will be found that epidemics of the milder sorts precede, follow in the train of, and also circumvade the central pestilence ; thus after there have been various fevers in any given place, at length a more decided pestilence comes, and in its outskirts again the lesser epidemics prevail. Now I ask — How is this circumstance to be explained, if we admit the origin of these disorders to be from contagion ? Does not this gyration of epitomes round a central disorder of greater malignity, strongly bring to our mind the manner in which whirlwinds, and storms which are whirlwinds of greater extent, usually take place; and force us to conclude, from analogy, that the morbific atmospheres in question may obey laws analogous to those of atmospherical phenomena, of -which electricity is the agent. During the late central fever at Gibraltar, other places in its vicinity, on the Continent, were afflicted with slighter Epidemics. And on the present occasion, while the more severe symptoms of Cholera Morbus were successively afflicting Russia, Poland, and Prussia, its epitome appeared in France, Germany, and England, in the form of bilious diarrhoea. I could enumerate the same sort of thing in twenty or more instances. Now there is nothing in this that looks like contagion ; it is, on the contrary, analogous to well 6 known facts in meteorology, and reminds us of the gentle wetting which those get who are lightly touched by the skirts of a shower, while persons who happen to be under its centre are drenched to the skin with water. Again, when an electrified cloud passes over our heads, the effects produced on those situated under its central parts, differ from the influence exercised by its outskirts on the nervous system of persons who may be below them. Ido not pretend, by this analogy, to infer that the direct agent in pestilence is some modification of electricity, though there are very striking facts which favour this opinion ;* but I contend that the cause is derived from some peculiar condition of the air. The variety observable in different Epidemics is so great that many persons have ascribed them to different species of invisible insects, each kind having an appetency for some particular part of the body ; so that on one occasion the air shall be infested with a moving phalanx of animalcula which seeks the gall, or liver, and produces Cholera ; while on another occasion our diminutive enemy, being of another sort, attacks the skin, in which it makes nests, occasioning pustules and eruptive Epidemics. These insects might move in large bodies in the air, taking a particular course, either with or against the wind, according to their respective natures ; and then, when they settled on predisposed lunar bodies, the progressive symptoms of the disorders occasioned, might correspond to * If a division of the lunar month be made into four weeks, in the middle of each of which one of the four changes of the moon shall take place, then it will be found that what I call the lunar periods of irritability will occur in those weeks in which the new and full moons fall, and not in those of the quadratures. And what shows, as much as anything else, that electricity is the medium through which this influence is exerted on our planet, by its satellite, is, that earth- quakes, volcanic eruptions, meteors, waterspouts, gales of wind, violent storms, and other known effects of the electric fluid, have been proved, by extensive enquiries that I have made, to have usually happened at those periods near to the conjunction or to the opposition of the moon. The rustic sacrifices which the country nymphs of antiquity used to make to the young crescent moon, to which Horace alludes in Ode 23 of lib. iii. in order to avert pestilential winds, had probably a reference to the lunar influences which I have described above. — This influence of the moon, through the medium of the air acting on the brain, has given rise to the term lunacy and mania, applied to mad people. 7 the three or more progressive states of insect existence — the larva, the grub, and the fly! This notion, fanciful as it may seem, is not without its analogical probability :, for, in those insects which are visible, arid which occasionally infest our gardens, our flocks, and even our own persons, we find that large bodies of them come with a change of wind or weather, and on another change die or disappear. Let us only take an example from peculiar blights, as they are called. It seems to be one of the characteristics of insect life, that they prevail in particular seasons, and at certain times of year, in prodigious numbers : in 1826, for example, ladybirds swarmed all over England and other parts of Europe ; that they travelled in bodies high in the air is also proved, because the domes of St. Paul's and other lofty churches were covered with them ; they stayed for a time and then disappeared. In some seasons wasps, in others beetles, in others flies of specific kinds, become perfect pests from their numbers. All our extensive blights, from those which are visible as insects, to those which can hardly be seen with a magnifying glass, make the same uncertain visits. And what is more remarkable, it has been found that pestilence is more prevalent in seasons which are marked by an unusual quantity of insects ! Do we not read of the same thing in ancient times, when the plague of flies, the plague of darknes — doubtless atmospheric — the plague of locusts, the plague of blotches and blains, the murrain of beasts, and the blight producing famine in corn, all visited Egypt in close succession ? I could relate numerous examples of this kind which have happened in various parts of the world. What is there like contagion in all this ? But this question leads naturally to another, namely — What is meant by contagion ? For some persons would explain contagion, and even the' specific effect of animal poisons which reproduce their own peculiar matter, to the sudden invasion of insects who seize 8 on any body in contact with the one which they occupy, and colonize it ! On this supposition indeed, we might in some measure reconcile the double mode by which Epidemics, in some cases, seem to be propagated. For if pestilential animalcula come in the air and fix on the bodies of living beings, their subsequent escape to neighbouring persons might well be facilitated by proximity or contact. However, this part of the hypothesis is unnecessary ; for positive facts are all against the notion that Epidemics are at all dangerous to those who approach infected persons ; otherwise than this, that if the malaria still remain in the space round the patient whom it at first infected, any one who invades it may become a prey to its malignity, merely from entering either into a current, or a confined volume of morbific air. There is yet another notion respecting contagion which is still more absurd, namely, that it can be communicated in goods, letters, and parcels of paper, to distant parts. The simplest calculation of probabilities is sufficient to show, that if this were the case, the world must have been almost depopulated by this time, from the universality of such communications. This doctrine would indeed make Mercury a messenger of woe, and convert the blessings of the post into a propaganda of pestilence: the idea too is hardly credible, even on the assumption that insects are the cause of disorder, and that they lodge themselves in the article said to convey the disorder ; and I confess, after much research, that I cannot find well authenticated cases of disorder propagated in this manner. When fortune casts her lot of chance, coincidences will happen which are mistaken for causes ; but beyond this, there is nothing but imagination in the opinion alluded to. Persons in the Levant have been known to wear, with safety, the old clothes of those who have died of the plague. The direct proof that we possess that electric changes 9 produce symptoms of disorder in some instances, does not militate against the supposition that in others, specific disorders are produced by insects ; because it is known that the generation of most tribes of them is closely connected with winds, weather, and electricity. If a blight suddenly coming over with a scowling eastern breeze, shall leave particular species of plants in our gardens, and even particular parts of them, a prey to specific vermin, I ask — Would not analogy lead us to expect that where peculiar states of weather affect parts of our bodies, it might also be through the medium of similar animated agents ? Full nature swarms with life, and the microscope has opened to the view of the naturalist, myriads of hitherto unknown tribes of animalcula inhabiting every variety of texture of the human body, and every morbid secretion from its vessels ; and proving that in the boundless distribution of animal life, from the whale or the fabled behemoth to the smallest ephemera, nature abhorring a vacuum of life and intelligence, has peopled every particle of matter with animals. I shall pursue this curious subject no further, nor stop to enquire — Whether the dry epidemic cough, for example, of last midsummer, was occasioned by particular insects which made choice of the glottis ? — Whether it was caused by an air impregnated with some particular effluvia, which had a chemical affinity with that organ ? — or, Whether it resulted from some electric quality in the air itself, which had a specific action on certain organs ? I know that direct proofs are wanting to solve these questions; and I therefore content myself with the conclusion that whatever may be the nature of the agent, it was external, and came in the air ; that it attacked hundreds at once in different places, and was not communicated from one person to another, but subsided after a limited period, in a manner and from causes quite as obscure as those which originally produced it. And I assert the same, on the strength of long experience and research, of every other epidemic with which I have become acquainted. The speculative opinion put forth about insects may however 10 serve to suggest some new sanatory regulations, such as the rubbing of the skin with camphor, oil of cajeput, and other drugs, known to be repulsive to insects, and also the use of smoking tobacco, and the employment of many other powerful fumigations. But beyond this, speculation is rather hurtful to the practical man, by enticing him away from his object, into the wide but delightful fields of philosophical enquiry. My object is to overthrow, by the force of well established facts, the dangerous doctrine of contagion, a doctrine calculated to frighten selfish man away from his duty to his fellow creatures, and, in minds not possessed of uncommon fortitude and principle, to render abortive all those precepts of charity which teach us to live for our neighbours as for ourselves. In furtherance of the above desirable object, I will submit to any reader capable of reasoning, whether the following facts are not wholly incapable of being explained on the principle of contagion; and whether they do not evidently belong to that class of phenomena, of which the occasional or the periodical vicissitudes of the atmosphere which surrounds our globe, are admittedly the causes, however obscure may be the manner of their operation ? The origin of epidemics, if not derived from the air, is unknown ; as on the supposition of specific contagion, it would remain a desideratum, — what gave rise to the first case !? The effects of Epidemia are infinitely varied. I remember at Oxford, some years ago, seeing a case of an Epidemic, which consisted in the mortification of the thumb to the first joint, and attacked nearly a whole village. Being at Melun in France, in July, 1822, I witnessed cases of an epidemic croup, which had attacked nearly all 11 the children in the neighbourhood at one time for miles round, and of which many had died. There is scarcely a disease which has not at some period or other become epidemical ; nor is there a part or limb of the body that epidemia has not selected as the seat of disease. Cholera Morbus is only one of a numerous train of biliary and other fevers, which have been epidemic at some period or other, its origin being like theirs, obscure, its course various, and its subsidence uncertain. Authentic instances of its being imparted to attendants, from the patients, are actually wanting, and the belief in such alleged facts can only be ascribed to that sort of delusive credulity by which men of ignorant and mystifying minds are induced to give credit to talismans and charms, or to believe in the effects of sorcery, incantation, and witchcraft. I have examined the reports from India, Russia, Prussia, Poland, and Austria, and cannot find one case that in the least favours the silly doctrine of contagion.* Dr. Albers, head Physician to the Prussian Medical Commission, in March last, reported that at Moscow, in many houses, it happened that one individual attacked by Cholera was attended indiscriminately by all the relatives, none of whom caught the disease, and all the nurses remained free from it. The Moscow Committee reported that " at the opening of bodies of persons who had died of the Cholera, to the minute inspection of which four or five hours a day, for nearly a month, were devoted, neither those who attended at these operations, nor any of the assisting physicians, nor any of the attendants, caught the infection, though scarcely any precautions were used." * Dr. Maclean relates of the plague in Turkey, that those who attend the sick never catch it, if only fresh air be admitted into the chamber during the interview. 12 M. Searle, an Indian practitioner, who saw the disease on an extensive scale in the East, and suffered from it himself, went to Moscow, and lived in the hospitals there. He declares his conviction that Cholera is not contagious. All, or almost all, cordons and quarantines have been abolished in those countries where the Cholera has been witnessed, and the disease is not now half so much dreaded at Hamburgh, where it prevails, as it was when it was no nearer actually than Moscow. When I was at Paris last September, I presented to the Conseil Sanitaire there, my larger work on Epidemics ; and I am glad to perceive that the opinion has been adopted in that capital that Cholera is not contagious, and that the sanitary cordons are useless. When a patient has been enabled to change the air by removal, the cure has frequently been almost instantaneous. These are convincing proofs that Cholera is not contagious. I could adduce many others, but I shall go on with an analogy with which I will wind up the great presumptive evidence of the atmospherical nature of this as well as other epidemics. There appears to be a gradation of similar disorders affecting, on different occasions, all the tribes of plants and races of animals, as well as the generations of men. Certain features are common to all these cases ; and while we cannot allow contagion to be the cause of such diseases among plants, we cannot anywhere draw the line between two approximating cases all the way up, through every variety of amimal to man himself. This is a circumstance of great importance in the history of pestilence. In the course of the subjoined examples, it will be seen that I am backed up by authority, both ancient and modern, for the view I have taken of the causes of the epidemic disorders in question. 13 Plants appear to be affected by peculiarities of the atmosphere during Epidemics, and hence it happens that famine, as well as pestilence, murrain of beasts, inordinate increase of vermin and insects, and other such things, have occurred together, or in succession,- in Epidemic periods, as was the case in the plagues with which Pharoah was anciently visited in Egypt. Obscure qualities of the air affect plants alone on other occasions. In the summer of 1810, almost all the roughbarked plane trees, Platanus occidentalism became diseased in the neighbourhood of London, and for many miles round ; very few of which, in comparison with the whole number decayed, recovered ; while the smoothbarked plane trees, Platanus orientalis, and sycamore trees, Acer pseudoplatanus, remained healthy. The same fact was noticed also in distant countries. The season was not either remarkably hot or very particularly dry ; but there were all those circumstances alluded to above, as denoting an unusual state of the atmospherical electricity. I can relate many cases of other trees being so affected, and of particular species of plants which have been as it were selected as victims of the individual season. I have found that in nursery grounds some classes will be cut off, and others escape, in one year, and yet on another occasion the converse shall take place. This may be in part connected with modifications of electricity, and perhaps their appropriate insects. In proof of this, I may observe that I have found hail and snow, so generally the vehicle of electricity, to be more conducive to early vegetation than a warmer air, in a dry spring, or one which was attended by much unwholesome non electric rain. The learned Abbe Bertholon goes further, and asserts that plants growing near to conductors of atmospherical electricity flourish better than those that are distant from them ; and he relates one remarkable instance in France in which some jasmin shrubs were planted against the side of a house, down the side of which was carried a metallic conductor of lightning. Of these jasmins, those 14 which grew near the insertion of the metallic rod acquired three times the size of the others, and extended so high as to reach the upper windows. Another proof of even the periodical influence of the atmosphere on plants, analagous to the ephemeral symptoms in human beings, is what is called Flora's Dial, a circular piece of ground planted with certain species of flowers, regularly arranged according to the particular hours of the day or night at which they are known to open and close their blossoms, so as to enable us to learn what is o'clock, by a sort of botanical horologe. Epizootic comes next to be considered ; by which flocks and herds are suddenly carried off or diseased by atmospherical pestilence. A few years ago, in Essex, prevailed a mortality among cats, which carried off considerable numbers. And the well known history of the cats who died of parotitis felina, about Haywood, in Staffordshire, including the whole of a fine breed of Persian cats, is related by Dr. Darwin, in his Zoonomia. A similar pestilence once prevailed extensively in Holland, which destroyed this useful animal very extensively. The mange is said to be contagious ; but if this be the case, it is one of those disorders which, arising from unknown causes in a great many animals at once, may be afterwards propagated by contagion. The same mode of reasoning seems applicable to the glanders of horses, to scabies, and to many other distempers of cattle. The whole history of epizootic, the murrain of beasts, and indeed all the pestilences which have befallen kine, of which history has recorded numerous instances, are illustrations of the effect of peculiar conditions of the atmosphere acting in an occult manner on the animal machine and inducing, at different times and seasons, very various and dissimilar morbid phenomena. Many cases of the kind will be found in the " Electricity dcs Meteors" by the Abb 6 Bertholon, 15 Lyons, 1787. Animals, too, show that, like men, they are immediately sensible of the electric and other changes of the weather, as our popular prognostics prove. These indications are, well known to the husbandmen in all countries. I have collected a great many in my Illustrations of Atmospheric Phenomena, which are popular in our country, and I have collated these with the remarks of the old Greek and Roman writers, in Notes to the Diosemeia of Aratus. Epizootic is often shortly followed by Epidemia, as was noticed by the Greek writers. Homer in one book of the Tliad, sings of pestilence in a very remarkable passage, wherein he describes it as the arrows of Apollo, first fixing on mules and dogs, and then on men. Oyprjaj f/,ev vpoorov evooxsto yjx\ xuvaj otpyovs The plague of Aegina, according to Ovid, Met. vii. 528, was a remarkable exemplification of the atmospherical cause of pestilence : it began with a long continued south wind, an air full of dark vapours and electric phenomena, the great abundance of serpents followed, and a disease which destroyed birds, dogs, and other domestic animals, and lastly human beings, by thousands. The author has described the symptoms very accurately, as following the state of the air. Principio coelum spissa caligine terras Pressit et ignavos inclusit nubibus aestus. The plague, he says, first began with birds and cattle, and then attacked man, as is frequently the case. Strage canum prima, volucrumque oviumque boumque Inque feris subiti deprensa potentia morbi. Concidere infelix validos miratur arator Inter opus tauros, medioque recumbere sulco. Lanigeris gregibus balatus dantibus segros Sponte sua lanaeque cadunt, et corpora tabent. 16 Acer equus quondam, magnseque in pulvere famae, Degenerat : palmas veterumquc oblitus honorum, Ad prsesepe gemit, morbo moriturus inerti. Non aper irasci meminit ; non fidere cursu Cerva ; nee armentis incurrere fortibus ursi. Omnia languor habet : Silvisque, agrisque viisque Corpora foeda jacent. Vitiantur odoribus aurse. Miraloquor. Non ilia canes, avidseque volucres, Non cani tetigere lupi : dilapsa liquescunt, Afflatuque nocent ; & agunt contagia late. Pervenit ad miseros damno graviore colonos Pestis, et in magnse dominatur moenibus urbis. Viscera torrentur primb ; flammseque latentis Indicium rubor est, & ductus anhelitus segre. Aspera lingua tumet, trepidisque arentia venis Ora patent ; aurseque graves captantur hiatu. Non stratum, non ulla pati velamina possunt ; Dura sed in terra ponunt prsecordia : nee fit Corpus humo gelidum, sed humus de corpore fervet. Nee moderator adest : inque ipsos sseva medentes Erumpit clades ; obsuntque auctoribus artes. Quo propior quisque est, servitque fidelius segro ; In partem leti citius venit. Utque salutis Spes abiit, finemque vident in funere morbi ; Indulgent animis : & nulla, quid utile, cura est : Utile enim nihil est. Passim positoque pudore, Fontibus, & fluviis, puteisque capacibus hserent : Nee prius est extincta sitis, guam vita, bibendo. The plague of Rome of the year anno. R. 281, described by Dionysius Hallicarnassensis, came on quite suddenly, was very limited, and as suddenly disappeared, like the plague of Athens, described by Thucydides. Some modern plagues have been equally rapid in their course. There are some circumstances concerning the plague which followed the battle of Salamis worth noticing. A comet, and a violent eruption of Aetna, preceded it ; and it led 17 to an enquiry, founded indeed on the then general belief that comets rouse the fire of volcanoes, and also bring violent heats and pestilence in their train. The pestilence alluded to carried off most of the remaining army of Xerxes after the said battle. Greece was anciently less subject to epidemics than Italy : nevertheless when Greece has been visited by pestilence it has been often very violent. Rome has been remarkable for its numerous epidemics, and it was in one of them that St. Aloysius perished in the flower of his youth, in the year of our Lord 1581, early in the morning of the 21st of June. The Campagnia di Rome still continues the frequent seat of terrible influenzas and fevers, particularly towards the close of the summer. The following lines, said to be preserved by Baronius, show the almost proverbial unhealthiness of Rome in ancient times. Roma vorax honrinum domet ardua colla virorum ; Roma ferax febrium necis est όberrima frugum. The famous lake Avernus, in Campania, was so unhealthy in its vapours that even birds avoided its banks, and the ancients from its pestilence feigned it to be the way to hell. It was the state of the air in Rome so ill adapted for carrying off odours that gave rise to the cloaci, and sub sequently to the feigned goddess Cloacina. At Rome the festivals of the Lectisternia were instituted to appease the gods during the pestilence of V. C. 353. In the 1 2th book of Livy is a most vivid description of a pestilence that began among cattle in U. C 576, which soon extended to men. Febris now seemed to trample every thing before her, even bulls, dogs, and all sorts of domestic animals ; the highways were strewed with dead carcases so offensive that the vultures left them untouched to decay, and Libitina being overdone with unwonted labours, and un- c 18 equal to her office, the air, itself in a state of pestilence already, was still further loaded with the stench of disorganizing mortality. Numerous birds left the suburbs of Rome, during this plague, as they had formerly done during those of Athens. This desertion of places infested with the more violent forms of pestilence, which is a fact well known in natural history, is worthy of particular notice, as it shows that the whole air is infected, and disproves the silly notion that pestilence owes its spread to contagion. To which we may add, that the vaporized atmosphere prevalent during the time of plagues often produces, by its peculiar refracting properties, those crowns of light, parhelia, and luminous arches, described by historians as signs of destruction. The bow seen to cross the temple of Saturn in the time of the above plague was probably one of this sort. Thirty or forty similar instances are on record of plagues that have happened in Italy, in Egypt, and in Asia Minor, which have been accompanied by extraordinary lights in the sky, and which have ravaged the earth and inhabitants to so prodigious a degree as to leave do doubt on the mind of any reasonable man that they must have been powerful agents in the work of desolation and ruin, to which ancient empires have been subject. Besides occasional pestilence, it seem that there is some peculiar influence exerted on the body in particular parts of the world, in consequence of which, in certain countries, particular diseases will always become prevalent, which may be ascribed to some local peculiarity of the atmosphere. Lucretius, who was an accurate observer of nature, thus describes occasional, as well as established local epidemia, and endeavours to account for the former as follows : — Nunc ratio quae sit morbis, aut vnde repente Mortiferam possit cladem conflore coorta Morbida vis hominum generi, pecudumque cateruis, 19 Expediam. Primum multarum semina rerum Esse supra docui, quae sint vitalia nobis j Et contra quae sint morbo mortique, necesse est Multa volare : ea guam casu sunt forte coorta Et perturbarunt coelum, fit morbidus aer. Atque ea vis omnis morborum, pestilitasque Aut extrinsecus ut nubes nebulaeque superne Per coelum veniunt, aut ipsa saepe coorta De terra surgunt, vbi putrorem humida necta est Intempestiuis pluuiis, et solibus icta. Again, in allusion to the latter or local epidemia — Est Elephas Morbus gui propter flumina Nili Gignitur Aegypto in media, neque praeterea vsquam. Atthide tentantur gressus, oculique in Achaeis Finibus : inde aliis alius locus est inimicus Partibus ac membris ; varius concinnat id aer. Virgil, the imitator of Lucretius, observes :—: — Hie quondam morbo coeli miserandi coorta est Tempestas, totoque Autumni incanduit aestu, Et genus omne neci pecudum dedit, omne ferarum, Corripuitque lacus ; infecit pabula tabo. Of the above local Epidemic, history furnishes abundant examples, which I forbear to quote as being superfluous. It is probable that there are different conditions of atmosphere perpetually moving about, which act as specific stumuli and excite corresponding peculiar diseased nervous actions, which actions are still further varied in each individual case, by the predisponent or state of constitution of the patient, and I think it probable that many colds and lesser diseases, though unsuspected, are in fact obscure epidemics. Parts of the world are visited by the plague at very short intervals, while the same disorder appears more rarely in 20 other places. The small pox rages for a time throughout whole tracts of country, but the symptoms of this epidemic are different in one season from what they are in another : which proves some external cause of variety. The pious processions and prayers which have of late been offered up in many Christian countries to God, to avert the Cholera, are the remains of a very ancient usage, founded on the belief that these disorders were scourges, as they were demonstrable not contagious; and while religious men were ascribing them to Heaven ; the astrologers set them down to the influence of the stars and comets. It may be remarked that some of the ancient Christian hymns and orations, used in times of epidemic pestilence, were prayers that the sidereal influences might be repressed. Thus, in the petition to our Lady, beginning " Stella coeli extirpavit, qua lactavit Dominum" &c. we have the words, " Sidera cotnpescere." I must now mention a fact of which I have received numerous and authentic accounts, because it proves beyond everything else the atmospherical origin of epidemics. Before the breaking out of pestilence, particularly in the East, an unusual obscurity of the atmosphere, accompanied with strange coloured refractions of the sun's light, has been repeatedly observed ; besides luminous meteors and other phenomena referrible to the state of the air. Ancient authorities also concur in this remark ; and the plague of darkness which visited the Egyptians during the Jewish Captivity is justly considered by a late American writer as a case in point. I shall allude again to this circumstance, when, at the close of this section, I describe the phenomena that have accompanied the spread of the present Cholera Morbus, to which I invite the reader's particular attention. 21 In the mean time I will proceed to examine a few more cases in point, taken from an ample store of historical records, which I have long been gathering on the subject of pestilence. I might go as far back as the famous plague of Athens, described by Thucydides, which was preceded by darkness and extraordinary electrical phenomena ; or, descending to more recent times, I might instance the prodigies that forerun the great plague of Florence, so eloquently described by Boccacio. Who is ignorant of the portentous appearances of the sky, which occurred before the great pestilence about B. C. 44, and which the superstitious flatterers of princes in those days regarded as prophetic of the death of Caesar ; when, as Virgil says, Sol etiam extincto miseratus Ctesare Romam, cum caput obscurd nitidum ferrugine texit, or as Ovid more aptly has it, Phcebi quoque tristis imago Lurida sollicitis probabat lumina terris. At the same time we are told Nee dirwhich began about A. D. 169, was characterised by a loathsome gangrene of the feet, probably similar to the mortification of the thumb which I saw in Oxfordshire. It is well known that during the dreadful plague of flies in A.D. 117, earthquakes were so frequent that Trajali passed a law to limit the height of the houses, in order to prevent danger. * When we recollect the fact above stated, it is not hard to discover the reason why similar complaints have apparently been cured by different practitioners by remedies of the most opposite character; a fact so notorious, that it has often cast a slur on the boasted utility and importance of the profession. The fact is, that changes of atmosphere really exercise a much greater influence over health than is usually imagined; and thus during the slow and tiresome course of medicine to which patients frequently submit, it happens in the natural order of things that obscure changes in the qualities of the atmosphere take place, which in reality effect the cure, and that, too, just in time to save our credit as physicians. 40 The pestilence which carried off Pope Pelagius about A.D. 590, was marked by a tendency to disturb the brain, and to make the patient see phantoms of hideous shapes, as Procopius and Evagrius relate.* This epidemic was sudden and universal.! A long period of near half a century followed, in which various epidemics of different degrees of malignity infested almost every part of Europe, accompanied at times by extraordinary visitations of locusts, and other insects.^ It is asserted by Echard that St. Gregory instituted a procession at Rome at this time in consequence of the plague, and that during its solemn progress upwards of 80 of the persons composing it, fell down dead in the streets. According to Paulus Diaconus, and others, this plague in some countries produced death with great rapidity, often on the first attack. In some persons sneezing was immediately followed by death, which gave rise to the custom of saying " God bless you" when one sneezed. In others, gaping was a mortal prognosis ; hence the custom still preserved in some places, after gaping, to make the sign of the cross. || See also that inimitable code of ancient learning, the " Vitae Sanctorum" and " Butler's Lives of the Saints," vol. iii. under March 12. In the year 717, the plague destroyed 300,000 persons at Constantinople only ; it returned in 725 with a remarkable vapour from the sea. The pestilence of 810 fell chiefly on animals, and the loss of cattle in France was immense. In 1230 so destructive a blight occurred in vegetation that 20,000 people died of famine ; during which a plague raged in Italy. * In my larger work "on Epidemic Disorders," all the authorities for these, and numerous similar facts* will be found quoted. f Procopius, and Evagrius. |) Paul. Diac. lib. 4. Mag. Cent. 6, 13, &c. \ August, hist. 1157. 41 In 1848 the Cholera Morbus occurred and produced frightful ravages in Denmark, as I have alluded to in another place ; it was called the Sorte Diod, and the clergy and all persons of sedentary habits suffered most : it was marked by that blackness from stagnation which distinguishes the present Cholera. The symptoms of the epidemic of 1389 were like dysentery, but without the blackness. In 1373, insanity visited the people as an epidemic ; no one could call this contagious ! and yet it spread as disorders do which are vulgarly called infectious. This epidemic determined the blood in such violence to the brain as to occasion the delirium often ending in madness ; and it may be remarked that this disease prevailed while the volcanic eruptions of the next year were gathering. In 1483, first appeared the celebrated epidemic, called the Sweating Sickness, which carried off great numbers from time to time. This disorder attacked those who fed well and were in high health. About the same time the plague changed its character according to authors, and it is said to have resumed its former character a century afterwards. Scotchmen escaped the sweating sickness from their more prudent way of feeding : it recurred, says Webster, in 1506, 1528, and 1551. Another epidemic soon broke out in England called the Falling Sickness, a kind of epilepsy. In 1510, the influenza prevailed in Paris; and it caused people to wear a particular costume against cold, called the Cocoluche or Catarrhal Cowl. In 1545, the symptoms of the epidemic were very peculiar, and caused it to be called the Troup Gallant. Charles, Duke of Orleans, died of it in a religious house at Abbeville. 42 In 1548, a pestilence whose symptoms were indescribably loathsome, suddenly prevailed all over Saxony. Between 1557 and 1570 sore throat, cough, quinsy, and spotted fever, all appeared in succession as epidemics, and all fatally so ! In 1710, the strange symptoms of the " Dunkerque Rant" occurred and were often fatal. Early in 1740 set in the celebrated long frost which lasted till March ; and what is remarkable, in the other hemisphere a similar winter prevailed the following year. The whole period was very unhealthy. The hooping cough, spotted fever, and small pox, raged in succession till the end of 1741. Ireland lost 80,000 persons by famine and by dysentery. Don Ulloa says, that the Black Vomit, as it was called, was first observed in Guayaquil, this year. In the summer of 1780 occurred the extraordinary epidemic called the Breakbone Fever in America, and during its prevalence Europe suffered from great vicissitudes of weather. The hybernal season this year was cold. On St. Hilary's Day, Jan. 14, the thermometer, according to Fahrenheit's scale, fell to o—90 — 9 or 9° below 0, at Hartford, in America :it had been as low as o—26°0 — 26° on the 11th. But I mention the 14th as a particular day, because it is the average coldest day of the year.^ The thermometer fell at Glasgow, to o—46°,0 — 46°, a cold almost incredible for Scotland. At Walthamstow it was 17°, which is no great cold. The spring was cold, and the plague raged at Smyrna. During the Festival of Guardian Angels, Oct. 2, a violent hurricane desolated the Leeward Islands, and on the 11th, the Windward Islands were laid waste. * It was on this day, in 1820, that the thermometer fell in the night to o— loo, at Hartwell, near East Grinstead. 43 In 1795, and during the scarcity of bread in Europe, a species of headache with vertigo became epidemic in America, and it also observed regular diurnal periods, beginning about eleven in the forenoon and going off by degrees after two o'clock, which was the time of its crisis. Neither bleeding, opiates, nor aperients, had effect on it. The next year Cholera occurred in America, but it attacked only children ! If the reader can see contagion in the above accounts, v he must be differently constituted from me. But I must now solicit particular attention to the following account of the disorder of the present year. After carefully examining the accounts of different persons who have described the Cholera Morbus of the present period, I find no one which appears so accurate in detail as that drawn up by MM. Barry and Russell, physicians, which I shall therefore subjoin. The editor of the Lancet, from whose pages I take the following account, observes, that it is a most useful document, though extracted from a very insignificant pamphlet, published by the Board of Health. After reading the extract, I shall compare the symptoms and course of the present Cholera with those of other epidemics which are recorded in history. The memorial from which the following extracts are taken, appears to have been drawn up at St. Petersburg, from actual observation. "St. Petersburg, 27, or O.S. 15 July, 1831. — Although there can be no doubt that the disease now prevailing here is strictly identical, in all essential points, with the epidemic Cholera of India ; and although there are many descriptions extant of that malady, much more ably and accurately drawn up than any which we can pretend to give ; yet we are induced to believe that a short account of the symptoms which we ourselves have actually witnessed and noted at the bedside in some hundreds of cases, since our arrival here, may be useful, — first, because we are not aware that any description by an eye witness of European Cholera has yet been addressed to the British 44 government ; secondly, because the disease, as it has shown itself in this capital, when closely compared with the Indian Cholera, appears to have undergone some modifications ; thirdly, because, having now studied the disease in all its stages, our description, however imperfect, will at least assist towards establishing a standard of comparison with other local epidemics of Cholera in Europe, and may, perhaps, enable those who have not seen this disease, to recognise it with more certainty than they would otherwise be able to do. "The Cholera Morbus of the north of Europe, to which the Russian peasants have given the name of " chornaia colezn" or black illness, like most other diseases, is accompanied by a set of symptoms Avhich may be termed preliminary; by another set which strongly mark the disease in its first, cold, or collapsed stage ; and by a third set, which characterise the second stage, that of reaction, heat, and fever. "Preliminary Symptoms. — We have but few opportunities of witnessing the presence of all these symptoms, some of which precede the complete seizure by so short an interval, that the utmost diligence is scarcely sufficient to bring the patient and the physician together, after their occurrence, before the disease is fully formed. Diarrhoea, at first feculent, with slight cramps in the legs, nausea, pain, or heat about the pit of the stomach, malaise, give the longest warning. Indeed, purging, or ordinary diarrhoea, has been frequently 4tnown to continue for one, two, or more days, unaccompanied by any other remarkable symptom, until the patient is suddenly struck blue, and nearly lifeless. Often the symptoms just mentioned are arrested by timely judicious treatment, and the disease completely averted. When violent vertigo, sick stomach, nervous agitation, intermittent, slow, or small pulse, cramps, beginning at the tips of the fingers and toes, and rapidly approaching the trunk, give the first warning : then there is scarcely an interval. Vomiting or purging, or both these evacuations, of a liquid like rice water or whey, or barley water, come on ; the features become sharp and contracted, the eye sinks, the look is expressive of terror, wildness, and, as it were, a consciousness on the part of the sufferer that the hand of death is upon him. The lips, the face, the neck, the hands, the feet, and soon the thighs, arms, and 45 whole surface, assume a leaden, blue, purple, black, or deep-brown tint, according to the complexion of the individual, varying in shade with the intensity of the attack. The fingers and toes are reduced at least a third in thickness ; the skin and soft parts covering them are wrinkled, shrivelled, and folded ; the nails put on a bluish pearl white ; the larger superficial veins are marked by flat lines of a deeper black ; the pulse is either small as a thread, and scarcely vibrating, or else totally extinct. The skin is cold, and often damp ; the tongue always moist, often white and loaded, but flabby and chilled, like a bit of dead flesh. The voice is nearly gone ; the respiration quick, irregular, and imperfectly performed. Inspiration appears to be effected by an immense effort of the chest, whilst the alae nasi in the most hopeless cases, and towards their close, instead of expanding, collapse, and stop the ingress of air. Expiration is quick and convulsive. The patient asks only for water, speaks in a plaintive whisper, the • vox Cholerica,' and only by a word at a time, from not being able to retain air enough in his lungs for a sentence. He tosses incessantly from side to side, and complains of intolerable weight and anguish around his heart. He struggles for breath, and often lays his hand on his stomach and chest to point out the seat of his agony. The integuments of the stomach are sometimes raised into high irregular folds, whilst the belly itself is violently drawn in, the diaphragm upwards and inwards towards the chest ; sometimes there are tetanic spasms of the legs, thighs, and loins ; but we have not seen general tetanus, nor even trismus. There is occasionally a low suffering whine. The secretion of urine is always totally suspended, nor have we observed tears shed under these circumstances ; vomiting and purging, which are far from being the most important or dangerous symptoms, and which, in a very great number of cases of the present epidemic, have not been profuse, generally cease, or are arrested by medicine easily in the attack. Frictions remove the blue colour for a time from the part rubbed ; but in other parts, particularly the face, the livor becomes every moment more intense and more general. The lips and cheeks sometimes puff out and flap, in expiration, with a white froth between them, as in apoplexy. If blood be obtained in this state, it is black, flows by drops, is thick, and feels to the finger colder than natural. Towards the close of this scene, the respiration becomes very slow, there is a quivering among the tendons of the 46 wrist ; the mind remains entire; The patient is first unable to swallow, then becomes insensible; there never is, however, any rattle in the throat, and he dies quietly after a long convulsive sob or two. " The above is a faint description of the very worst kind of case, dying, in the cold stage, in from six to twenty four hours after the setting in of the bad symptoms. We have seen many such cases just carried to the hospital from their homes or their barracks. In by far the greater number, vomiting had ceased, in some, however, it was still going on, and invariably of the true serous kind. Many confessed that they had concealed diarrhoea for a day or two ; others had been suddenly seized, generally very early in the morning. "• From the aggravated state which we have just described, but very few indeed recover, particularly if that state has been present even for four hours before treatment has commenced. A thread of pulse, however small, is almost always felt at the wrist, where recovery from the blue or cold stage is to be expected. Singular enough to say, hiccough coming on in the intermediate moments, between the threatening of death and the beginning of reaction, is a favourable sign, and generally announces the return of circulation. " In less severe cases, the pulse is not wholly extinguished, though much reduced in volume ; the respiration is less embarrassed ; the oppression and anguish at the chest are not so overwhelming, although vomiting and purging and the cramps may have been more intense. The coldness and change of colour of the surface, the peculiar alteration of the voice, a greater or less degree of coldness of the tongue, the character of the liquids evacuated, have been invariably well marked in all the degrees of violence of attack which we have hitherto witnessed in this epidemic. In no case or stage of this disease have we observed shivering ; nor have we heard, after enquiry, of more than one case, in which this febrile symptom took place. " Fever, or Hot Stage. — After the blue cold period has lasted from twelve to twenty-four, seldom to forty-eight hours or upwards, the pulse and external heat begin gradually to return ; headache is complained of, with noise in the ears ; the tongue becomes more 47 loaded, redder at the tip and edges, and also drier. High-coloured urine is passed with pain and in small quantities, the pupil is often dilated, soreness is felt on pressure over the liver, stomach, and belly ; bleeding by the lancet or leeches is required ; ice to the head gives great relief ; in short, the patient is now labouring under a continued fever, not to be distinguished from ordinary fever. A profuse critical perspiration may come on from the second or third day, and leave the sufferer convalescent ; but, much more frequently, the quickness of pulse and heat of skin continue ; the tongue becomes brown and parched, the eyes are suffused and drowsy, there is a dull flush, with stupor and heaviness about the countenance, much resembling typhus ; dark sordes collect about the lips and teeth ; sometimes the patient is pale, squalid, and low, with the pulse and heat below natural, but with the typhous stupor ; delirium supervenes, and death takes place from the fourth to the eighth day, or even later, in the very individual too whom the most assiduous attention had barely saved in the first or cold stage. To give a notion of the importance and danger of Cholera fever, a most intelligent physician, Dr. Reimer, of the merchant hospital, informs us, that of the twenty cases treated under his own eye, who fell victims to the disease, seven died in the cold stage, and thirteen in the consecutive fever. " The singular malady is only cognizable with certainty during its blue or cold period. After reaction has been established, it cannot be distinguished from an ordinary continued fever, except by the shortness and fatality of its course. The greenish or dark, and highly bilious discharges produced in the hot stage, by calomel, are not sufficiently diagnostic, and it is curious that the persons employed about these typhoid cases when they are attacked, are never seized with ordinary fever, but with genuine cold blue Cholera. Nothing, therefore, is more certain, than that persons may come to the coast of England, apparently labouring under common feverish indisposition, who really and truly are suffering under Cholera in the second stage. " The points of difference between the present epidemic and the Cholera of India, when the two diseases are closely compared, appear to us to be the following : — 48 •* First, The evacuations, both upwards and downwards, seem to have been much more profuse and ungovernable in the Indian than in the present Cholera, though the characters of the evacuations are precisely the same. " Secondly, Restoration to health from the cold stage, without passing through consecutive fever of any kind, was by far more frequent in India than here, nor did the consecutive fever there assume a typhoid type. " Thirdly, The proportion of the deaths in the cold stage, compared with those in the hot, was far greater in India, according to Dr. Russell's experience, than here. " Fourthly, The number of medical men and hospital attendants attacked with Cholera during the present epidemic, in proportion to the whole employed and to the other classes of society, has been beyond all comparison greater here than in India under similar circumstances ; twenty five medical men have been already seized, and nine have died out of two hundred and sixty four. Four others have died at Cronstadt, out of a very small number residing in that fortress at the time the disease broke out there. Six attendants have been taken ill at a small temporary hospital behind the Aboucoff since we wrote last. It is certain, however, that in some Cholera hospitals, favourably circumstanced as to size, ventilation, and space, very few of the attendants have suffered. "Of these facts we are likely to receive accurate statements in answer to the written questions which we have submitted to the medical authorities through the government here. •* Convalescence from Cholera has been rapid and perfect here, as is proved by the following fact : — The Minister of the Interior had given orders that all convalescents, civil as well as military, at the General Hospital, should be detained fourteen days. We inspected about two hundred of these detenus some days back, with Sir James Wylie, and found them in excellent health, without a single morbid sequela amongst them. 49 ¦" Relapses are rare in this epidemic, nor have they been often attended with fatal results : hospital servants seem to have been most liable to them. One physician had three attacks, the second severe, in which he states that he derived great benefit from the magisterium bismuthi." It seems by report also that on an average, out of 272 cases, 108 died and 164 were cured. After reading the above authentic account, it is lamentable to turn to the unintelligible farrago published by our Boards of Health, and to perceive how much France is before England in everything that is rational and scientific in medicine. I will not quote from the productions which I allude to, for it would be a useless waste of time, while delicacy prevents me from commenting too severely on the productions of men who, no doubt, have done their best. On a subject, however, of such importance, it is our duty to expose the fallacy of recommendations that could only have resulted from the most narrow, and, to say the least, mistaken views of the nature of disease. In the next section I shall show that the vexatious restrictions of quarantine, and still more the internal regulations for removing the sick from the care and consolations of their healthy relatives, even if the councils had any power to enforce them, which luckily in a free country they have not, are not only useless, cruel, and ridiculous in the extreme, but are calculated to do the most serious mischief, by exciting fear, that great predisponent to disorder, by which thousands of human lives may be sacrificed ; and by presenting obstacles to external commerce, and to that free interchange of the product of local manufacture, by which alone human industry is rendered an available medium of national wealth. If the Boards of Health are desirous of advancing the interest of the Board of Excise, which is the only plea for E 50 the observations on the danger from smuggling, which we have lately seen in print ; they had better find some mode of exploring the means by which contraband boats can introduce diseases of the gall bladder into England, than by propagating the exploded doctrine that the cork of a Dantzic brandy bottle, or piece of Turkey carpeting, can bring the Cholera or the Plague to this country ; or that an incautious dispatch from Warsaw, or from Petersburg, can carry a mortal pestilence from the Polar regions to the Equator ! There is, unfortunately, such a mixture of ignorance and imbecility in all that belongs to the healing art in England, that one is prepared for a certain quantum of what is honestly called humbug, in all medical effusions, but there is at the same time an extent to which folly cannot be carried without producing its reaction. That this may be the case in the present instance is my sincere wish ; for, as Dr. James Johnson very ably hints at in his excellent letter on Cholera, the promulgation of a doctrine that spreads morbific alarms, and at the same time tends to sever the finest bonds of mutual charity by which men are held bound to succour each other in sickness, must, to any humane and reflecting person, appear a serious public evil : I, for my part, feel it to be so, and am convinced that those who do not, as well as those who do agree with me on the subject of contagion, will allow at least that no effort, however humble and limited, can be useless, which leads to the solution of this important question. Sect. 3. — Of the Treatment of Cholera Morbus and other Epidemics. We shall find by examination that among the many occasions of disorder to which the mortal fabric of man and animals is subject, two principal classes of causes claim our particular notice — the excitant and the predisponent, so that 51 by diminishing the influence of either of these we shall materially break down the force of the complaint. Hitherto this essay has related to the specific excitant of these lamentable diseases, which I have proved to be atmospheric, and beyond the reach of our control ; but the predisposing circumstances in the constitution and habits of life, which as it were lay out for and forecast the disease, are nearly all of them within the range of medical power, and may, by ordinary prudence, be so lessened, that the disorders which we aim at controlling, may be reduced almost to an epitome of their original virulence. In order to give the clearest notions of such curative means as Nature has left within our reach, I shall divide the treatment of it into three distinct considerations :—: — 1 . The treatment of the human body, whereby we can remove many of the predisponent causes, and by strengthening and tranquillizing the constitution, render it unfit for the reception of the malady. 2. The removal of all those circumstances about our habitations which would be favourable to the disorder ; such as fetid odours, and filth of all kinds. 3. The introduction of such fumigations as time and experience have shown to be capable of counteracting the effects of the expected malaria. This third precaution may be regarded as the counterpart to the second, and when all three are acted on collectively, we have done all that human ingenuity has hitherto been able to effect, in order to place society in a state of defence against the coming evil. Ist. Of the Mode of Preparing the Body. — Hislory 52 7 proves that not only in less virulent epidemics, but even in the more violent attacks of Cholera and even the plague itself, when the epidemic constitution of the air has been at its height, certain persons totally escape its attacks ; and these are the temperate and regular, who have that sort of secure and tranquil health in store, which is called stamina, from its being capable of bearing up against the incursions of disease. This sort of real soundness of constitution, the invariable result of due temperance, exercise, and regularity, is essentially different, both from the high, florid, and artificial health which comes of repletion, on the one hand ; and the weakness and debility of an impoverished habit of body, resulting, from debauchery, neglect, and bad food, on the other. The persons whose health enables them to resist, in the most perfect degree^ the effects of disease, are those who have been temperate for a length of time. In times of certain sorts of pestilence, a little additional stimulus may be necessary, but it cannot be too often repeated, that it is the previous habits of the individuals which lay the foundation of their power to repeal diseases. The first object will therefore be to point out the Rules of Health to be observed, which I endeavour to compress into a small compass, as follows, dividing the subject into Rules and Observations : — Rule I. — Quantity of Food. — Observe that you never eat more food than is necessary to satisfy the demands of Nature ; since whatever is eaten superfluously acts injuriously on the stomach and bowels. It is not what we eat, but what we digest, that nourishes us, and the leajst surplus proves a source of disease. Observations. — By digestion is meant that process by 53 which the- food is separated into the nutritive fluids that replenish the daily waste of the body, and into the fnecal matter or residue. Any thing which interrupts this process is hurtful, by causing dangerous chemical changes to take place in the aliment which lays unconcocted in the stomach and bowels ; hence headaches, weakness, and predisposition to disease, in consequence of the sympathy that exists between the digestive organs and other parts of the body. Rule 2. — Quality of Food. — Eat nothing known to disagree with you. Beef, mutton, game, and poultry, and a due proportion of well boiled vegetables, are the best ; a small portion of ripe fruit is also good, as it promotes the natural action of the bowels : but pork, and young meats, fish, pastry, and other things liable to fail in digestion, are to be avoided. Wine and beer in very small quantities, and only after meals : spirits to be avoided. Observations. — The exceptions to this rule are persons who cannot eat animal food at all ; and those who cannot digest vegetables. Idyosyncracies should be consulted ; and any thing known to disagree carefully avoided. With regard to avoiding strong spirits it may be observed, that by not exhausting the system with habitual stimulus, we shall allow its susceptibility to increase, and then a little cordial, or good brandy, will have double effect, when the time .comes, to give the constitution every possible strength. Rule 3.— Periods of Meals.— Breakfast, dinner, and a very light tea or supper, are enough for anybody ; those who dine late ought not to eat supper at all, and those who dine early would do better without it. But it is a golden rule — never to eat between meals — nor to have your meals come nearer to each other than the interval of six hours at least : after meals always rest quiet for a short time to allow the food time to digest. 54 Observations. — By walking or working after dinner the food is shaken about in the stomach, when those energies, which are intended to be employed in digestion, are spent in the muscles, to the injury of the stomach. As I recommend smoking, perhaps a pipe or two after dinner might ensure, to the patient, the necessary stillness. In weak, very young, or very old people, sleep is advisable afterwards, a siesta being, of all other things, the most restorative of the strength. Scholars, particularly children, should be allowed two hours of play out of doors before dinner, and one of quiet recreation after it : labour would become easier the rest of the day. Children often suffer dreadfully at schools, for want of enough air and exercise. Rule 4. — Exercise. — Rise early, and take the morning air on an empty stomach, whenever the weather will permit, nor ever pass a day without exercise, if possible. Observations. — The old proverb which recommends getting up with the lark is founded on good sense, and has received the sanction of a long experience in its favour. Whether it be that certain active persons, constructed at all events to be long livers, have got up early from the native activity of their constitutions; or whether early rising actually possesses the healthy influence that is ascribed to it, facts are wanting to determine ; but certain it is, that of an enormous catalogue of persons who have attained to a great age, of very dissimilar habits in other respects, a very large proportion have been early risers. There are few persons who cannot take early exercise before breakfast. Rule 5. — Ventilation — Never stay or sleep in close rooms, but always have fresh air, either by means of ventilators, or some contrivance of parallel utility. 55 Observations. — If few persons know the advantage of exercise, still fewer understand the benefit of fresh air. Ventilation of rooms, too, is apt to be neglected, particularly in winter. The flywheels, called ventilators, are good things for close apartments. The diseases of manufactories and gaols are in a great measure produced by foul and stagnating air. Many suffer from lying in close bed rooms, and I have often recommended a small portion of the upper part of the window to be kept open, with great advantage, to those who are weak, or are liable to headaches in the morning. Rule 6. — Sleep. — Seven hours sleep will be sufficient for grown persons, but children and old persons require an hour or two more. Observations. — I have before noticed the use of sleeping an hour after dinner, and it is particularly advisable for those who have much mental as well as bodily labour. Rule 7. — Digestive Functions. — Take care to have motions at least once every day, and watch narrowly for any symptoms of disorder in the digestive organs, and correct it by the means of alterative and mild medicines, Observations. — Although we soon become acquainted with the disordered state of our digestive organs in some cases, by the pain and uneasiness they occasion, as for instance in stoppages, in colic, and in inflammation ; yet there are other and less obvious disorders of those organs, which frequently escape the notice of the patient, till they have gone on sufficiently long to occasion great mischief in the animal economy. For this reason I shall here endeavour succinctly to point out to the notice of the reader, certain signs of disorder in the stomach, bowels, and liver, 56 by attending to which in time, we may often prevent the occurrence of diseases of greater magnitude. When the tongue be white or furrowed on its upper surface, or where there be a bitter or otherwise unnatural taste in the mouth in the morning before breakfast, we may rest assured, however well we may think ourselves, that the stomach, either from indigestion or some other cause, is irritable and out of condition. I know of no more certain sign of a disordered stomach than this. Persons who have the care of a family should observe the surface of the children's tongues the first thing in the morning, particularly when they are in the least degree indisposed, as some trifling indigestion, always indicated by the state of the tongue, is frequently the beginning of very serious disorders. By remedying this incipient evil in its early stages, by small doses of opening medicine, I believe many children might be saved from tedious and often fatal diseases. The next symptom of disorder to which it will be proper to allude, is that feeling of uneasiness in the stomach after eating, which really arises from indigested food. This symptom usually, but not always, accompanies the one before described, When the meal has been too copious, or the food of a quality which does not agree with the patient's particular constitution, this sensation is generally experienced, and is often followed by nausea. We ought to take notice whether all food produce it, or whether the sensation pnly .occur after eating particular kinds of aliment, in order that in the latter case the obnoxious article of diet may be avoided. When the stools are not of a natural colour and consistency, it indicates the defective performance of the subsidiary processes of digestion ; the most important perhaps of all these is the function of the liver- If the 57 excrements be not duly coloured of a deep yellowish brown, we should regard some defect in the bile as the cause of the discolouration, and should have recourse to small doses of mercury, or of calomel and aloes. For it is by the bile that the feces are coloured : colourless or pale feces, therefore, show that the secretion of bile is deficient, while green, black, and other discoloured stools, indicate an unnatural secretion of that fluid. In either case, the state of the liver becomes the object of attention, and, as the most distressing symptoms frequently arise from a disordered liver, so may we often, by the timely application of simple remedies for the disorders of that organ, avert calamities of the most important nature, both mental and bodily. I believe that in cases of Cholera the liver ought always to be •particularly attended to, as that disease, as its very name implies, affects the secretions of the liver in a remarkable degree ; and on a due discharge of the vitiated or redundant bile, the case seems often to depend.* When any of the abovementioned signs of defective. or yitiated bile appear, five grains of the blue pill may be taken every alternate night, and a draught, next day, of one ounce of infusion of gentian, tivo drachms of infusion of senna, and one drachm of tincture of cardamom. This is an excellent stomachic in most cases of indigestion. In case of this draught not agreeing with the patient, any substitute may be employed which custom has reconciled to the constitution ; as cascarilla, and so on. In many cases vegetable diet drinks, even the simple infusion of balm, of sage, horehound, and other herb teas, will prove beneficial, by tranquillizing the irritability of the stomach. Rule 8.-— Periodical Abstinence. — Observe one day of abstinence at least in every week, and do not omit * See Medicina Simplex ; or a Guide to a Healthy Life and Happy Old Age, with Family Prescriptions. Price 2s. 6d. 58 to observe fasts and abstinence, anciently prescribed by the catholic church, if already accustomed so to do. Observations. — -If our fasts had been ordained by a council of physiologists, they could not have been better timed and adapted to the necessities of the case, than they are at present. The days of abstinence prescribed by the church, in each week, will by all be admitted to be wholesome ; occasional abstinence is known to be better than habitual low feeding ; it affords to the stomach a useful alterative from our customary heavy food. As the abstinence practised by some persons in Lent is a useful alterative in spring, so is the little fast of Advent a good substitute for the old silly custom of bloodletting again in autumn. It prepares us likewise for the feasts of Christmas and the New Year, just as Lent does for those of Easter and Whitsuntide ; and we enjoy the return to the festive circle round the wassail bowl, ten times more than those do who have no change. When Sir Isaac Newton was writing his Principia, he lived on a scanty allowance of bread and water, otherwise he would not have achieved his undertaking. Rule 9. — Ease of Mind. — Take care not to let your mind be occupied by laborious employment, nor with irritating thoughts about the time of meals: otherwise indigestion will ensue. Observations. — Music and light amusement after dinner are on this account desirable. There is no doubt that the custom of sitting in convivial society after meals, arose from the knowledge of the fact that pleasurable sensations after eating promoted digestion. 59 Rule 10. — Aphrodites. — Avoid all occasions of the exhausting and debilitating passions : which in reality weaken the body, dispose it to disorder, and shorten life. Observations. — The experience of Europe in the present Cholera Morbus has proved that all persons addicted to debauchery, and particularly sexual indulgence, fall the earliest victims to the disorder. Rule 11.— Bathing. — Use the Bath wherever it be practicable. Observations. — The disuse of bathing in northern climes has proved a great evil, and is no doubt one cause why cold climates, which are comparatively healthy, have been so severely visited by pestilential disorders. I should strongly recommend daily ablution of the whole body. Those who are used to the warm bath will continue this practice with advantage. If our Councils of Health would establish public BATHS, they would render a very essential service to society. These are the general rules of health to be observed ; and in furtherance thereof I shall subjoin a list of prescriptions at the end of this work, which will facilitate the application of those means which have been recommended in order to guard the body against the introduction of Cholera or any other epidemic. 2d. Removal of Filth. — The principal rules to be laid down here are such as common sense will suggest. Clear out drains and ditches, empty cesspools, draw off stagnant water, promote currents of fresh water, where it can be done; remove dirty rags and every sort of chiffons from your houses and streets, and every thing of a putrid or offensive nature; above all, observe personal cleanliness, as 60 regards washing, and also apparel. It has been Found that those who have most frequently changed their under garments, particularly where they be woollen, have been less severely attacked. 3d. Fumigations and Washes. — On the supposition that insects are the cause of disease, persons have recommended washing the body with solutions of camphorated spirit mixed with the water. I have not much faith in this. Fumigations however are good, such as tobacco, and for this reason / would encourage the poor to smoke in their cottages of an evening. Various other fumigations are useful ; but particularly the watering the floors of the chambers with solutions of chlorate of lime and of chlorate of soda ; which are so well known to disinfect all odorous places. =& This plan has been adopted with success on the Continent, and is found to be a very great addition to household comfort. I am aware that some persons discard this precaution ; but of its good effects in many cases I have no doubt. Remedies.— When the disease comes, I trust that physicians shall be prepared with remedies, but in the meanwhile, I will not refrain to submit to the public some of those gentle precautions which the Board of Health have adopted as likely to be useful, reserving all further means which experience or study may have placed in my power, till the arrival of the complaint, which, after all, may never come. It is right, however, to be prepared for it, as the labour of the certain preparation is trifling when compared with the possible importance of the issue. I must, however, observe, that I have been forced to omit other of their rules as likely to prove more mischievous than good. * It is necessary to ensure good drugs on ihese occasions, and as I wish my patient to be well supplied, I recommend the Chlorides, made by those excellent and philosophical manufacturers MM. Beaufoy and Co, South Lambetb, which are to be had at all Chemists and Druggists. 61 " It is evident that the most urgent and peculiar symptom of this disease is the sudden depression of the vital powers : proved by the diminished action of the heart, the coldness of the surface and extremities, and the stagnant state of the whole circulation. It is important to advert to this fact, as poi tfing out the instant measures which may safely and beneficially be employed where medical aid cannot immediately be procured. All means tending to restore the circulation and maintain the warmth of the body should be had recourse to without delay. The patients should always immediately be put to bed, wrapped up in hot blankets, and warmth should be sustained by other external applications, such as repeated frictions with flannels and camphorated spirits : poultices of mustard and linseed (equal parts) to the stomach, particularly where pain and vomiting exist ; similar poultices to the feet and legs, to restore their warmth. The returning heat of the body may be promoted by bags containing hot salt or bran applied to different parts of it. For the same purpose of restoring and sustaining the circulation, white wine whey, with spice, hot brandy and water, or sal volatile, in the dose of a tea spoonful, in hot water, frequently repeated, or from five to twenty drops of some of the essential oils, as peppermint, cloves, or cajeput, in a wine glass of water, may be administered ; with the same view, where the stomach will bear it, warm broth with spice may be employed. In very severe cases, or where medical aid is difficult to be obtained, from twenty to forty drops of laudanum may be given, in any of the warm drinks previously recommended." In addition to the above, I must observe that one of the most important facts in the cure of Cholera, seems to have been left out in the above directions, namely, the utility of bringing away copious discharges of bile, and feculent matter from the bowels, early in the disease, for it having been found extensively in the North of Europe, that those patients who, in the natural course of the disorder discharged much bile, generally got well, the employment of artificial means to effect the same was naturally suggested, and was attended with good effects. On the same principle we shall see the utility of employing occasionally those 62 gentle cholagogues and alterative medicines as bring away bile, and keep the secretions in a healthy state, such, for instance, as the Pill No. 20, of the list of prescriptions subjoined. The following plan may be acted on in the absence of immediate medical advice, on the spur of the occasion, as soon as symptoms of real Cholera appear: — Give the Pill No. 20, and then put the patient into a warm bath* — Vapour Bath if possible ; after which put him to bed in a room warmed by tire, but well ventilated, and then repeat small doses till the bowels be emptied and biliary discharge produced. In violent and sudden attacks, where it is necessary immediately to allay nausea and sickness, cajeput oil dropped into water has been advised : in some such cases sometimes a pill of Opium gr. j. Calomel gr. i. and Antimon. Tartariz. gr. \. have been found useful ; but the hot baths should never be omitted. * In Cheltnsford there is no excuse for not using the baths, as there are excellent accommodations for bathing in the centre of the town. DOMESTIC PRESCRIPTIONS. NO, DRAUGHTS. 1. R. In/us. Gentian comp. oz. j. In/us. Senna, dr. jj. Tinct. Cardamom, comp. dr. j. M. A draught to be taken an hour before dinner, as a stomachic in cases of bad digestion, where there is also slight costiveness. Take with it Pill, No. 14, at night, now and then with advantage. Where there is no constipation of bowels, the senna may be omitted or diminished in quantity. 2. R. In/us. Rosarum. oz.j. Sulphat. Magnes. dr. j. Syrupi. q. s. M. A cooling and rather opening draught, to be taken once or twice a da.y in fever, on an empty stomach. This draught is assisted by Pill, No. 14, taken every other night. 3. R. Decoct. Sarsaparilla comp. oz. ij. A draught to be taken twice a day on an empty stomach, in cases of eruptions of the skin, of boils, of nervous irritability, and many others. Its effect is powerfully increased as an alterative by 5 gr. of blue pill, taken at night, No. 19. 4. R. Mistur. Camphor, oz.j. Spirit JEther nitr. dr. j. Carbonat. Amman, gr. vii. M. A very useful draught taken once or twice a day in cases of corrupt states of both, of oedematous swellings, incipient dropsy, with Pill No. 22. 5. R. Vini. Ipecacuanha, dr. j. Antimon. Tartariz. gr. j. Aquce puree, oz. j. M. A safe and certain emetic. 6. R. Pulveris Rhei. gr. xv. Potassce Sulphat. gr. xiii. Aquce Cinnamomi. oz.j. M. This draught will effectually clear the stomachj and is a good and safe purgative ; its effect will be rendered more complete, if Pill No. 20, be taken the preceding night. 7. R. Soda Tartarizat. dr. y. Soda Carbonat. scr. j. Put the above powder in a glass of lemonade, and take it in a state of effervescence ; it forms a most grateful and cooling aperient in cases of feverishness. 8. R. Infus. Senna, oz. j. Tinct. Jalap, dr. j. Potass. Tartar, dr. j. Cum aliquo Syrupo. M. The above may be taken as a strong clearing draught, instead of No. 6, where the patient cannot keep rhubarb on the stomach, but it is not near so certain. And I advise that Pill No. 14 be taken with it, if not beforehand, to increase the effect if required. 9. R. Potassa Subcarbonat, gr. x. Infus. Gentian, comp. oz. j. Spirit JEther. comp. dr. ss. Tree Cinnamom. dr. j. M. A diuretic draught. To increase it, take over night Pill No. 22. 10. R. Misturcs Camphor, oz. j. ss. Liquor Amman. Acet. oz. ss. Liquor Antimon. Tartar, mm. x. Tinct. Opii. mm. vi. M. Diaphoretic draught, to be taken at night, in cases of violent cold, and cutaneous obstruction. Open the bowels previously with Pill No. 20. POWDERS & PILLS. 11. R. Pulveris. Antimon. gr. iij. Calomel, gr. j. — Fiat Pulvis. A powder very useful for children suffering from colds with disordered digestive organs. 12. R. Calomel, gr. j. Pulv. Scam- monice. gr. iv. A useful powder to give children who suffer from overloaded bowels, or where excrements appear dark or otherwise of an unnatural colour. 13. _R. Sulphat. Quinnineί, gr. iij. Twice a day in ague and other intermittents after the bowels have been well evacuated with Pill No. 14 or No. 20. 14. R. Calomel gr. j. Extr. Aloes. gr. ij. Rhei. gr. ij. — Pill. The most efficacious Pill for ordinary occasions. 15. R. Extr. Aloes, gr. iij. Rhei. gr. ij.— Pill. 16. R. Extr. Aloe's, gr. iv. Saponis, gr.j.-Pill. 17. R. Extr. Aloe's. Extr. Colocynth, comp. Rhei. Of each gr. j. — Pill. Those who are subject to constipation of bowels, may make choice of any of the above three Pills, to be taken periodically and frequently as occasion requires. 18. R. Pit. Calomel comp. gr. v. 19. R. Pil. Hydrarg. gr. y. Commonly called Blue Pill. May be taken every alternate night in cases of defective action of liver, and for an alterative ; assisted by draughts No. 1, No. 2, or No. 4, according to the case. See those numbers. 20. R. Calomel— Extr. Aloes— Extr. Colocynth — Rhei. aa% gr. j. — An- timon. Tartariz. gr. £. — Fiat Pil. A good Pill for clearing the bowels previous to giving quinnine for ague. 21. R. Camphora. gr. ij. Pulv. Antimon. gr. iij. Opii. Purif. gr. j. Confect. Arom. q. s. — Pill. 22. R. Calomel, gr. j. Pulv. Scilla. gr. iij— Pill. At night to assist draughts Nos. 4 and 9. 23. R. Infus. Gentian, comp. oz. j. Liquor Potassa Subcarb. dr. j. Tinct. Cascarilla. dr. j. M. 24. R. Infus. Cascarilla. oz.j. Some prefer the above draughts to No. 1. A necessary precaution ought to be mentioned at the close of this paper. Wherever cases of Cholera Morbus occur, it should be distinctly understood, that fresh air must be admitted into the apartment of the patient, wherever attendance is required. For though the disorder is not contagious, yet at a time when we are involved in malaria, additional danger would result from the infectious air of close apartments. Erratum.— ln page 6, line 24, for "lunar" read "human." CHELM6FORD: PRINTED BY MEGGY AND CtlALtt.