THE CHOLERA AT MALTA IN 1837; 

I'IKiM THE ITALIAN OF GIUSEPPE STILON, M.D.. Ac, fte. 

««» 

PHYSICIAN TO THE CHOLERA HOSPITAL IN VALLETTA. 

1$V 

fSETH B. WATSON, D.M., st. John's college, and formerly onk of the 

PHYSICIANS OF THE HOSPITAL AT OXFORD. 

TO WHICH IS PREFIXED 

ALET T E R 

KUOJ] 

SIR JOHN STODDART, LLD. 

THEN CHIEF JUSTICE; OF MALTA. 

ImprovUa Lathi Vis rapuit, rapietque Gentes.- 

LONDON: 

JOHN CHURCHILL, PRINCES STREET, SOIIO. 

MDCCCXLVIII. 



~~v Q( •—} OS 1 S4« 

fi/L-w Me . q-«b^ I\o> & 







CONTENTS. 

riductory Letter . . . . Page 1 Table A.— Weekly Deaths by Cholera in Malta 37 Table B. — Deaths by Cholera in Malta, and Gozo 38 

Table C. — Meteorological Table . . . . 39 

Table E.— Comparative Effect of the Plague of 1813 and the Cholera of 1837, in Malta, andGozo 40 

CHAPTER I. 

Physical causes predisposing to Cholera 

46 

CHAPTER 11. 

Physiological causes predisposing to Cholera 

58 

CHAPTER 111. 

61 

Pathological causes predisposing to Cholera 





CHAPTER IV. 

Pathology of Cholera 

ill 

CHAPTER V. 

Of the Premonitory Symptoms of Cholera 

70 

CHAPTER VI. 

Observations on the most remarkable symptoms of Cho- 

lera 

85 

CHAPTER VII. 

Of the presumed cause of Cholera existing in the air 101 

CHAPTER VIII. 

Methods of different physicians in the treatment of Cholera 

112 

CHAPTER IX. 

Treatment in the first stage of Cholera 

118 

CHAPTER X. 

Treatment in the state of collapse 



CHAPTER XL 



Treatment in the third stage, or reaction 

4 





CHAPTER XII. 

Of Prophylactics 

143 

Table containing the names of the Cholera Patients received into the Hospital of the Normal School, and the quantity of calomel in grains taken by each ... 15G 

5 









TO 

DRD R - SETH B. WATSON. 

My dear Sir, 

IV.S I resided many years at Malta, and 5 there during the whole time of the >lera in 1837, you desire to know my nion of Dr. Stilon's pamphlet on that demic ; and also whether I can give you r additional information of the circumnces which attended the course of the 3ase. I shall endeavour to satisfy you both points. 

I! knew Dr. Stilon well, and had the hest opinion both of his abilities and of 

n 



a 

his honourable and benevolent character: and greatly indeed do I lament to have to speak of them in the past tense ; for since I left the island, he has terminated his earthly career — an irreparable loss, not only to his family and friends, but to his profession and to the public ! He was a native of Calabria, but entered, at an early age, into the British service, in the medical department of the navy, in which he attained the rank of surgeon, and eventually settled in Malta, with the degree of M. D. as a physician. In that capacity he was employed by the governor, by Mr. Hookham Frere, and by many of the principal families of the place, my own included, and his reputation among all ranks was deservedly high for ability, zeal, and humanity. He was therefore, when the cholera broke out in the island, most properly chosen by the then governor, Sir Henry Bouverie, to take the direction of the Cholera Hospital in Valetta. Nobly indeed did he discharge that arduous duty, which, added to his ex tensive private practice, required and founc 



3 

in him almost superhuman energy. If the result, estimated by the proportion of cures to cases, was less favourable than might have been hoped, and considerably so when Inpared with those in the naval and miliy hospitals, this is easily to be accounted by causes, on which he has slightly iched in his pamphlet, and to which I ill presently advert more at large — causes ich, far from implying in him any defincy of skill or exertion, only serve to cc in a stronger light his persevering ;rgy in contending with and overcoming iculties apparently insuperable. 

|>o much for his public character ; but I >t not close this short tribute to the nory of a most excellent man, without itioning, that in the course of my official es, I had occasion to learn circumices in his private conduct, which evinced •erne kindness of disposition, most active evolence, and in serving others a total egation of self. Of the merits of his lphlet, in a professional view, I cannot ;end to judge ; I can only say, with the 

b 2 



4 

I most confidence, that implicit reliance ty be placed on his statements of fact. 3 was of too candid and straightforward nind to dress up, or colour a case, to make suit a preconceived theory. He sought nestly for the truth, and honestly rerded the event of his search. 

I proceed to your second question. I have had occasion to observe that the situation and circumstances of Malta are known so indistinctly in England, that you must excuse me, if my statements appear rather pedantically minute. The Island of Malta is in the line of its extreme length, running south-east and north-west, about eighteen British statute miles, and in its greatest breadth (crossing that line at right angles) about nine miles. It is indented, especially on the north-east side, with numerous bays and inlets, of which the most remarkable form the great harbour and the quarantine harbour, separated by a promontory, on which stand the city and strong fortress of Valetta; whilst on the east side of the great harbour are the three united cities of 



5 

Cospicua, Vittoriosa, and Senglea. The ancient capital of the island, Citta Vecchia, now comparatively deserted, stands on an elevation near the centre of the island, and to the westward of it are some hills a little higher, but none which can projjerly be called mountains. The greater part of the island is nearly plain, with gentle undulations. There is little foliage, or herbage, and no pools or running water, and consequently few spots troubled in any degree with malaria, the fertile cause of epidemics in most other w r arm countries. Opposite the north-west end of Malta, at a distance of three miles and a half, is the Island of Gozo, about ten miles long, by four and three-quarters broad ; and between them intervenes the small Island of Cumino, about two miles long and one broad. Gozo is more hilly than Malta, but in other respects very similar: it is deemed, however, more healthy. These two islands (for Cumino has scarcely any inhabitants) contained, just before the breaking out of the cholera, a total population of 119,878 souls, viz., in 



6 

Malta, 103,344, and in Gozo, 16,534. Of the inhabitants of Malta, very near one-half were contained in Valetta, (with its suburb Floriana,) Cospicua, Vittoriosa, and Senglea, all which together may be considered as forming the capital of the island, the seat of government, of trade, and of the chief military force. Here consequently were, on the one hand, the best means of guarding against illness ; and, on the other, the greatest temptations to excess, and the worst haunts of misery. The remaining portion of the inhabitants was spread among casals and villages, containing from five or six thousand souls to a few hundreds each. This rural population was chiefly employed in husbandry, living very simply, working hard, and the great majority of them wretchedly poor ; and in all these particulars they were resembled by the people of Gozo. The various calculations of the area of the three islands differ very widely : that which appears to me to be upon the whole most correct, makes it about one hundred and eighteen and five-sixths square miles, 



7 

I which about one hundred square miles i capable of cultivation. The population therefore, far more dense than in any ler part of Europe, being in 1837 nearly 00 persons to a cultivable square mile, is, and the other circumstances to which aye adverted, must be taken into account, en we speculate on the progress of an demic in such a country. 

The cholera had begun to move from Asia into Europe so early as 18*29. In that year, the late Sir John Malcolm predicted that it would make the whole tour of Europe, and from his experience of its slow and insidious progress, he thought it would not accomplish the whole of that course in less than eight years. The last year of this term had arrived in 1837. The cholera had visited Russia in 1830, and England in 1831 : it had ravaged Marseilles in 1835, and had appeared in Naples and Sicily in the spring of 1837. Still the governing authorities of Malta had made no preparations for its reception. A flattering delusion prevailed with some, (which I for one 



8 

II not share,) that Malta being a small and, fifty miles distant from the nearest in land, this epidemic would be unable cross the channel, or would pass by witht touching the Maltese shores. On the :h of May, the Malta Government Gate, printed at that time under the absoe control of the public secretary, congratulated its readers on the freedom of the island " from cholera, plague, earthquakes, and the grippe," " though it had for a long time past been surrounded, and pretty nearly too, by one or other of these visitations." The very next day, however, a startling fact occurred. No less than forty of the crew of H. M. Steamer Medea were licked with influenza. The disorder biased : several hundred men of the squan became affected by it, as were some sons on shore. Still the editor " hoped t the complaint w y as trivial" But, alas ! the 9th of June several cases of unlbted cholera at once broke out in the nziOy an asylum containing about seven ldred and fifty aged and impotent persons. 



9 

This building was situated in a damp part of Floriana, a suburb of Valetta ; and being near to the Protestant burying-ground, probably received from thence noxious inhalations. The disorder spread rapidly among the inmates ; so that in ten days no less than two hundred of them had died. Still the Government Gazette writer argued that this circumstance " furnished no general ground of despondency to the rest of the population." The governor, however, soon became sensible of the gravity of the occurrence. His first step was to remove the whole establishment of the Ospizio to Fort Ricasoli, an insulated building, on an airy spot at the mouth of the harbour. Orders for that purpose were given on the 13th, but from some misunderstanding the unfortunate individuals were subjected to a very injurious delay in carrying those orders into effect. When they were at length fixed in the fort, a new difficulty presented itself. The deaths increasing rapidly, the ordinary gravediggers refused to perform that office. It became necessary to employ the con- 



10 

Its ; but these men, finding themselves smpt in a great degree from control, used ir temporary freedom for the perpetralof unbridled atrocities. Another un-3seen obstacle occurred. It was scarcely sible to obtain medical assistance for the "erers. With one or two exceptions, long whom was Dr. Arpa, whom I shall c occasion to mention more particularly eafter,) the native Maltese physicians conceiving that the cholera was a kind of plague, and communicable by contact, absolutely refused to approach a cholera patient. I must not, however, be understood to impute to the medical gentlemen of Malta, on all occasions, either physical or moral cowardice. There have been times when they have exhibited calmness and courage in the last extremity of danger ; and I cannot omit to mention the instance of the police physician at the time of the plague in 1813. This worthy man having exposed himself to infection, in the discharge of his duty, took the disease, which terminated fatally. An English surgeon of 



11 

my acquaintance was present at his dissolution ; and to him the sufferer said, with the utmost coolness and resignation, " You see these black spots on my arm ; they warn me of the near approach of death : in two hours I shall be no more." The backwardness of the Maltese physicians during the cholera arose less from timidity than from ignorance. Had the government, years, or even months previously, taken proper means to enlighten them on the nature of the disease, which was so manifestly approaching, they would doubtless have been as ready as Dr. Stilon himself was, to to combat the malady, when it first ap- 

peared. 

|3n the 19th of June the governor adopted a asure, which might indeed have been more leficially undertaken before the appear- of the epidemic, and in anticipation of all but certain arrival ; but which was the proverb says) " better late than er." He appointed a central committee line gentlemen, English and Maltese, for supervision of cases of cholera, amongst 



12 

whom were the physicians of the Naval and Military Hospital, and of the Police. This committee immediately drew up a report containing many judicious suggestions, which either for want of means, or for other reasons, unfortunately remained in part without effect. They advised that a large and well-arranged hospital should be provided for each of the country districts ; but the only hospital answering that description, that I heard of, on the civil establishment, was the Valetta Hospital, of which Dr. Stilon has so ably given the details in his valuable pamphlet. Indeed, if such hospitals had been opened throughout the island, it would have been difficult, if not impossible, to find medical men to perform the requisite duties, for the reason which I have before stated. The central committee next recommended the formation of local committees in all the casals, of which the members were to be approved by government. If this measure was anywhere carried into effect, I at least am not aware of any utility derived from its operation. The 

5 



13 

central committee was invested by an ordinance of the government, with authority to issue orders, if confirmed by the governor, and with power to enforce those orders by compulsion. How far they availed themselves of the provisions of this ordinance I cannot pretend to say. They discharged with great zeal and regularity the duties imposed on them till their dissolution on the 26th of August ; but it was understood that their suggestions were not always so readily attended to as might have been wished. On one very material point, however, the governor fully agreed with them ; and that was in impressing on the public mind the doctrine that cholera is not contagious. In confirmation of this, they published the authoritative opinions of the physicians and surgeons of the hospitals of Paris. Various useful recommendations for guarding against the approach of the disease were also issued from time to time by the committee. Among these were the cleansing and whitewashing the houses in the Manderaggio, the filthiest part of Valetta, which was carried 



14 

into effect under the direction of the police. The governor set on foot a voluntary contribution for the relief of the poor during the prevalence of cholera. He headed the subscription himself, and was liberally seconded by all the wealthier part of the inhabitants, both English and Maltese. The relief, however, consisted chiefly in the distribution of soup, which, I am afraid, was in Ine cases rather injurious than beneficial, disturbing the action of the digestive fans in persons not accustomed to such a triment. The governor, from an early •iod of the disease, made one regulation ich, in my own opinion, was very judius. He caused to be published daily a nerical list of new cases and deaths, ich, while it prevented exaggerated alarm, ved to keep public attention alive to the I extent of the danger. 

irhe Gazette notices it as a "provident asure " on the part of his Excellency, t certain medical men had arrived from )raltar, by his invitation, on the 28th of y. On that day, however, the disease 



15 

had raged above seven Aveeks ; it had carried off near three thousand victims, and was already on its decline ; and the measure would surely have been more " provident" had it been adopted on the day of the first attack ; in which case, the Gibraltar surgeons might have reached Malta by steamers, before a dozen lives had been lost, exclusive of the inmates of the Ospizio. After all, the great, I may almost say the only practical, measure of material benefit to the population, was the establishment of the Cholera Hospital in Valetta, and the placing at the head of it a man so skilful, and, above all, so energetic, zealous, and -persevering, as Dr. Stilon. When I nien-111 one good man, however, who was enjed in this great work, I must not forget )ther, whose self-devotion ought to ren• his memory dear to his countrymen, am every friend of humanity. There was a man Catholic priest, a Maltese, namei UMA, who no sooner heard that there s a large hospital opened for the recep-11 of cholera patients, many of whon 



16 

would infallibly die, than spurning the danger of contagion, in which most of his countrymen firmly believed, he took his bed with him into the hospital, and there remained, day and night, so long as the epidemic lasted ; for the sole purpose of administering to the dying those sacraments, which smooth with them the awful entrance into the valley of the shadow of death. Whether this heroic man has since been recompensed by any earthly distinction, I know not; but surely he may expect the infinitely higher reward — " Well done, thou good and faithful servant ! Enter thou into the joy of thy Lord !" 

I After speaking so freely as I have done the public proceedings at Malta, in relan to the cholera, I should not advert to a vate matter, in which I am myself conned, but that I think a knowledge of the cumstances may be useful, in particular lations, even in England. On the west c of the quarantine harbour, in an airy lation, about a mile distant, by sea, from letta, there is a village named Sliema, 



17 

much resorted to for country lodgings by persons in easy circumstances from the city. In 1837, about thirty poor families resided there, who were employed in agriculture : the number of other inhabitants it was not easy to ascertain, as many of them were mere temporary lodgers ; but taking all classes together, the average number of individuals, during the period in question, may be estimated at four hundred and fifty. Six or seven of the better class of residents, English and Maltese, formed in this village a voluntary committee. They began by establishing a night-boat, to transport any persons who might be attacked in the night to Valetta, either for conveyance to the hospital, or to obtain the advice of the best physicians there, as they might wish. They procured a cataletto, a sort of bier, on which patients are usually earned to hospitals, in serious cases ; and as nobody chose to receive into a private house this melancholy vehicle, they built a small hut just large enough to contain it. They then proceeded to engage a physician, at a monthly salary, 

c 



18 

in the village. By good fortune they succeeded in engaging the above-mentioned Dr. Arpa, who, though a Maltese, having pursued his medical studies at Naples, had more enlarged views than most of his countrymen, and was not alarmed at the contagious character ascribed to cholera. A house was taken for him in the centre of the village : it was properly supplied with medicines and utensils; at the door were fixed a night-bell and lamp, and near the latter a board, inscribed, " Advice and medicine gratis, at all hours, for the cholera." But the principal and most material stipulation was, that the doctor should walk through the village morning and evening, inquire into the state of health of every family, and if any premonitory symptom appeared, should immediately apply to it the proper remedy. With regard to the poor, the committee determined to relieve them, by giving, not soup, but bread, with a proportionate quantity of any kind of food to which they were most accustomed ; only taking care that it should be digestible, 



19 

wholesome, and sufficient ; and Dr. Arpa kindly undertook to superintend the distribution every morning. In an English gentleman's family, as the Maltese servants are usually kept on board wages, and mess together, as they think best ; the master contributed something to their mess, to insure its being substantial and wholesome ; and instead of the ordinary wine, which they drink mixed with water, and which by its acidity might have provoked diarrhoea, he issued daily to them a proper quantity of brandy and water ready mixed. After all these precautions for the body, the Maltese members of the committee, well knowing the anxiety of their countrymen for those last sacraments which they deem essential to the repose of the soul, applied to the bishop to make their little chapel a sacramental one, and appoint to it a duly qualified priest. A whole month elapsed before these objects could be attained ; but at length a capuchin friar arrived, a man of much simplicity, mildness, and piety ; and from that moment all the inhabitants of the 

c 2 



20 

village looked without apprehension to the progress of the disease. Thus the committee obtained the two great ends it had in view ; namely, to calm those apprehensions which so often enhance the danger of an epidemic ; and to secure the earliest possible attention to symptoms easily counteracted in the outset, but rendered fatal by even a short neglect ; and all this was done ftout any expense whatever to the gotment, by the voluntary contributions of inhabitants. 

I such being the circumstances of Malta, 1 such the means, public and private, >pted to deliver it from the dreadful urge of an epidemic, which had ra;ed so many countries, I come now to ice the results of the measures pursued, render my observations on this head re easily intelligible, I subjoin four taar statements, marked A. B. C. D. The t contains a statement of the deaths in different cities, casals, and villages of lta alone, from the 9th of June to the i of September, in twelve columns, each 



¦21 

containing the deaths of a week, except the first, which comprehends twelve days, and the last only four. The second table contains the remaining deaths in Malta, and all the deaths in Gozo, (without distinction of casals, &c,,) till the termination of the epidemic on the 4th of October, and compares the whole number of deaths with the whole number of cases of attack. The third is a meteorological table of the state of the winds, and of the atmospheric temperature as indicated at its lowest and highest degree, each day, by Fahrenheit's thermometer. And the last table presents a comparative statement of the number of deaths occasioned by the plague of 1813, and those caused by 'the cholera of 1837. The reducing of statements of fact to a tabular form is doubtless of great use in facilitating the general comprehension of a subject; but as my old friend, the late Sir Humphrey Davy, once observed to me, they should be regarded at best as mere approximations to the exact truth. There will always be, in a given number of observations or experiments, 



22 

some difference in the careful attention to, or precise notation of the facts, some omission of minute circumstances in one case, or exaggeration of them in another. All that can reasonably be expected is that they should be conscientiously framed, with as much accuracy as the means possessed by those who draw them up will enable them to observe. This rule I have endeavoured to follow in framing the tables above mentioned ; and the inferences which I draw from them will be found, I believe, pretty near the truth, with that fair allowance which the nature of the case demands. 

I have mentioned that during the prevace of the cholera, daily reports were publed, by the governor's order, of the new es of attack, and of the deaths, in all ts of the island, except the small village Vfelleha, which w T as altogether free from Lck. These reports, however, were only tinued with the same minuteness till the . of September, after which the disorder reased so rapidly, that it was only 



23 

deemed necessary to state the numbers as applicable to the two islands of Malta and Gozo, without further distinction. It is perfectly clear from Appendix A., that with the exception of the Ospizio, the disease began in Malta with a small number of victims, gradually advanced to a much greater, and then gradually subsided. In twelve days, from June the 9th, there were but five deaths, in a week, from the 12th of July, seven hundred and seventy-four, and in four days, from the 30th of August, fifteen. And so it was in almost every separate' district ; for instance, in Senglea it rose from two to one hundred and four and declined to five ; in Zeitun from one to seventy-eight and fell to six. When I say that it is perfectly clear that there was a gradual rise and a gradual fall, I do not mean to say that these figures exactly indicate the ratio of the variations in each district. It is impossible, at this distance of time, to ascertain how many of the sufferers, that died in the hospital of Valetta, may have been attacked elsewhere ; and this circumstance precludes a strict 



24 

Imerical accuracy of comparison ; but of c point we may be certain, that there Lst have been a very marked and rapid rease, and a gradual declension in the iths, and consequently in the intensity of epidemic, in almost every district, and st obviously so in the instances above ntioned of Senglea and Zeitun. 

This table, (A.,) too, seems pretty clearly to indicate, when compared with the map of Malta, that the cause of cholera, whatever it may be, does not depend either on personal contact, or on local proximity; for Birchircara and Balzan are within half a mile of each other, connected by the high road to Valletta, and the inhabitants are in daily communication. Yet in Balzan no death appears to have occurred till the week after the epidemic had reached its utmost height in the island, and the whole loss of lives was seven, while in Birchircara (a place indeed of much larger population) the deaths began in June, and the whole loss was one hundred and seventy-three. So Curmi lost one hundred and thirty-seven, Attard, about a mile distant, 



25 

(and with a fourth of the population,) only eight. The table (A.) is framed so as to show at once (subject to the above remarks) the great or small number of deaths in each district, and by reference to table (C.) it will be seen, so far as the latter extends, that the deaths bore no assignable proportion to the population in the respective districts ; for instance, Vittoriosa, with between four and five thousand inhabitants, lost one hundred and forty-five lives ; Sliema, with a tenth of that population, only two. In point of fact, Sliema lost but one of its inhabitants, a lady who refused to submit to Dr. Arpa's medical treatment ; the other death being that of a labourer who was accidentally employed on a field in this district, but belonged to Birchircara, and consequently had not the advantage of the distribution of food which was made to the poor of Sliema. 

I Che table (B.) shows that there was in zo the same gradual rise and decline in intensity of the epidemic as in Malta, , a rise from eight deaths in a week to 



26 

ninety-three, and a decline to seven. The proportional effect on the population of the two islands was, however, very different. The civil population of Malta being (as shown in table D.) 103,344, and the deaths 3,784, the proportional loss of life was one in about twenty-seven and one-third. Tn Gozo, on a population of 16,534, the deaths being 368, the proportion was only one in forty-four and eight-ninths. To what causes this difference may be ascribed I know not. Some difference of circumstances may be pointed out. Gozo was attacked twentyseven days later than Malta. The island is smaller; and is generally esteemed more healthy. It has no large city or port, the seat of luxury, dissipation, and immorality, and the resort of mendicants and profligates of the lowest class. It has few soldiers and no sailors, except the native fishermen, and those regularly employed in the passage to and from Valetta. Though the majority of the inhabitants are poor, their exclusive occupation in agriculture, joined to their simple and regular habits of life, may perhaps 



27 

harden their constitutions against epidemic attacks. They are not so closely crowded together in their dwellings as is the case in the cities and larger casals of Malta. It is true that they had, during the cholera, little medical assistance ; but in this respect they were not worse off than the inhabitants of most parts of Malta. There were indeed physicians in both islands, but physicians who would not come near a cholera patient. From one source of misery Gozo was free. None of the sufferers were thrust, at the last extremity, into a Cataletto, transported for miles through a broiling sun, and laid down at the hospital door in a dying state, as Dr. Stilon shows to have been more than once the case in Valletta. 

I fable C seems most clearly to prove that ther the direction of the wind, nor the tperature of the atmosphere, has anyig whatever to do with the introduction, manence, increase, or diminution of this larkable malady. Of the winds which vail at Malta, those which blow from the th and west are indisputably the most 



28 

refreshing, and in ordinary cases the healthiest : yet out of the one hundred and eighteen days that the disorder lasted, (omitting four, when there were calms, or variable airs,) the proportion of the more to the less salubi'ious winds was as seventyone to forty-three : and in the very week, ending the 18th of July, when the deaths were at the highest, viz., eight hundred and lee in the two islands, the winds ranged ilusively from north to north-west. The iations of temperature exercised as little luence on the intensity of the disease, ring the same week, when the deaths re at eight hundred and three, the temature ranged only from seventy-four to hty-four; whereas, in the week ending 15th of September, it ranged from enty-eight to eighty-six, and the deaths re only fifty- two. Nor was even the lastntioned height of temperature extraordiy in Malta ; for on the sth of September, 28, it reached the point of ninety-one. 

Ehave added the table D. rather as a ter of curiosity than as throwing any 



29 

important light on the subject of the cholera. The two diseases were not only essentially distinct in their operation on the human frame, but they differed as widely in all the circumstances which marked their course at Malta. The plague was generally believed, on very strong evidence, to have been introduced into the island by some infected goods, and to have been communicated by contact alone. The cholera was, on equally good grounds, believed to have arisen from the state of the atmosphere, and not to have been communicable by mere contact. The former seized the patient without warning : the latter was preceded by premonitory symptoms, always manageable if attended to in due time. The actual loss of life was spread in the plague over nearly nine months, and amounted to 4,668 deaths: the cholera, which lasted little more than three months, destroyed 4,152 of the civil inhabitants. In the first case, the loss was about four and a quarter per cent, of the population, in the latter not 



30 

quite three and a half. The consequential injury inflicted on the island by the plague was incalculably greater than that occasioned by the cholera : it broke up the commerce of the island, impoverished the inhabitants, burthenecl the government with expense, and obliged it to resort to a loan at an interest of twelve per cent. ; none of which circumstances attended the cholera. To extirpate the plague demanded all the energy of so able and resolute a man as Governor Maitland : the cholera ceased of itself, without necessitating a resort to any violent or costly measures on the part of the government for its suppression. In the interval between these two visitations, an increase of nearly ten thousand souls had taken place in the general population of the islands ; and is presumable that this augmentation bore somewhat of a like proportion in each district. I know indeed that this was not exactly the case in 1827, on which I have founded the approximative estimates for 1813 and 1827 ; but these cannot be far 



31 

Ei the truth, on the whole, the excess in c instances being compensated by the ciency in others. 

I fou will not expect me to discuss the erent methods pursued for the alleviai or cure of cholera in Malta. That ild require a degree of scientific informai which Ido not possess. I may, howr, observe on the open and obvious inmces to be drawn from a comparison of number of cases which occurred with t of the deaths which ensued. 

In the civil hospital in Valletta, the cases c five hundred and forty-eight, and the ths three hundred and six, or about fifty - per cent. 

fa Malta at large, the cases which are ed to have occurred in the civil populawere 7,672, and the deaths 3,784, or ut forty-nine and a quarter per cent. 

In Gozo, the cases were eight hundred . eighteen and the deaths three hundred sixty-eight, or about forty-five per t. 

In the Naval Hospital, the cases were 

5 



32 

sixty and the deaths twenty, or thirty-three and a quarter per cent. 

In the Military Hospital, the cases were 3e hundred and three and the deaths enty-one, not quite twenty-three and a f per cent. 

Now these statements alone, however plain on the face of them, can lead to no distinct judgment on the merit of the treatment followed in the respective classes referred to. Dr. Stilon has clearly shown that it was impossible not to expect numerous deaths in the Civil Hospital, where many patients were brought in at the point of death, and expired soon after admission ; and the only wonder is that he was enabled to rescue so many as forty-four sufferers out of one hundred in states so desperate. Probably this could not have been done by means less powerful than those which he employed; for he appears to have administered to two of his patients in successive doses a thousand grains of calomel each ! and both of them recovered. 

In Malta and Gozo generally, it would be 



33 

In to look for anything like a systematic de of treatment. Nearly one-half of se who were attacked fell victims to the ease ; the others generally owed their overy to the strength of their constituis, or to the comparative purity of the losphere in which they dwelt, and which haps the Gozetan enjoyed in greater ity than the Maltese. 

I Both the Naval and Military Hospitals re under the care of most able, zealous, and inane physicians. The Naval Hospital nds in a most airy situation, admirably It, well ventilated, and kept as clean and jet as any private house can be. Whether re was any difference in the practice foled there from that of the Military Hospital low not. Probably the cases sent to the ncr were of a less favourable nature than se received by the latter, which may acnt for the greater proportion of deaths he one establishment than in the other. 

Kne circumstance relating to the military ents I must not omit to mention. The ichment of artillery suffered, in relation 

i) 



34 

I their numbers, more than the other part the garrison : and yet I was informed by lir colonel that some of the victims were ong the finest, and most temperate young nin the corps. I infer from this circumnce, that their liability to the disease was owing to the damp, confined, or ill-ventilated state of their barracks. Coupling this fact with that of the first appearance of the disease in the Ospizio, an ill-placed and crowded building, I am led to conclude that the cholera virus, or miasma, whatsoever it may be, is rendered much more intense in damp places without sufficient ventilation, and where the air is already corrupted by the respiration of many persons in the same apartment by night as well as by day. Indeed, I do not see how T we can explain the other remarkable fact, that while the military, who all live in barracks at Malta, furnished 303 cases, and seventy-one deaths, there occurred among the other English inhabitants a very few serious cases, and only two or three deaths, and even these latter were of individuals of intemperate 



35 

habits, or under the weakening influence of terror. 

After all, I am deeply convinced, that preventive measures are far the most important that can be taken during the prevalence of such an epidemic as the cholera, of which at Malta almost every person felt at times some premonitory symptoms. Though at Sliema, as I have said, there were only two deaths, and indeed only two cases, which Dr. Arpa thought of sufficient gravity to report them to the government, there were at least forty, which he arrested in early stages, and which therefore gave the individuals comparatively little trouble. Every one of these might, and most of them perhaps would, have led to collapse, with a tfreat probability of death, but for the system of constant medical surveillance, which the worthy physician carried into effect. I am aware that it would be morally impossible to practise such a system in a vast metropolis like London ; but there are many country parishes in Great Britain, where, with the countenance and aid of the resident 

D 2 



36 

gentiy, and especially of the clergyman, an active physician or surgeon would have no difficulty whatever, in preventing the cholera from producing any fatal effect. 

1 am, my dear Sir, Your faithful friend, 

John Stoddart. 

Brompton Square, October, 1848. 



37 

TABLE A. Veekly Deaths by Cholera in Malta from June 9th to September 2nd, 1837. I Total. Valletta . .. 32 186 193 179 144 71 20 20 8 6 2 761 Ospizio, &c. 232 158 44 9 2 445 Senglea . .. 2 19 66 104 74 51 11 7 H 5.. 350 Cosnicua . •• 1 13 47 48 78 40 30 20 7 6 1 291 Zeiten . . . 1 19 37 78 64 32 21 6 4 6. . 268 Zebbug . .. 1 13 31 53 37 42 22 8 7 5 1 220 Lia .. ~. 1 7 26 15 22 15 9 12 9.. 176 Birchircara . . 6 15 24 39 43 29 10 4 2 1 . . 173 Floriana . 3 7 23 33 21 18 20 16 6 2 12 5 166 CittaVecchia .... 1 1 15 31 25 26 15 25 13 2 154 Vittoriosa . • . 4 10 25 26 35 29 15 4 2 3 . . 145 Curmi 2 10 38 37 31 13 4 1 1 .. 137 Zurrico 7 25 25 18 13 7 1 .... 96 Zabbar ... 1 2 8 25 21 16 6 4 2 1 .. 86 Siggeui 1 15 28 14 8 2 1 2 .... 71 Asciak 5 10 16 11 6 1 .. 1 .... 50 Musta 26 9733 2 32 Tarscien 1666541 29 Nasciar 8 3 24 33 121 27 Luca 2 7 8 1 . . . . I . . . . 19 Gudia 7 1 2 2 2 14 Micabiba 2 3 4 2 . . 1 1 1 . . 14 Gargur 1 2 4 4.. 2.. .. The Lazaret, !•* &c. . 2 1 2 2 2 2 1 12 Pieta . .. 1 1 2 2 1 1 8 Attard 1.. 2 1 1 2 1.... 8 lialzan 2.. 1.. 3 1.. 7 San Giuliano 1 3 1 1 6 Crendi 1 2 . . 3 Chircop 1.. 1 2 Safi 1 . . 1 2 Sliema 1 . . 1 * Milit. Hospit. . . 4 13 24 13 14 2 . . 1 71 Naval Hospit. .. 1 5 1 8 1 3 1 20 Tot. per Week # 237 222 276 580 774 698 462 246 130 99 80 +15 3,819 1 2 3 4 5 6 7 8 9 10 11 12 * 12 days. 1 4 days. 



38 

TABLE B. 

Deaths by Cholera in Malta and Gozo. 1. In Malta, from June the 9th to September the 2nd, 1837, (sup. App. A.) ..... 3,819 ? from September 3rd to September sth . 12 ,11 ? 12th • 16 ? ? ». ». I!Hh • 15 2. In Gozo, from July the Bth to July the 12th . 8 19th . 2!) 2(ith . 93 August 2nd . 57 9th . 34 I6th . 17 ? 23rd . 83 30th . 411 September 6th . 25 11th . 10 18th . 13 3. In Malta and Gozo from September 18th to 27th . 13 to October 4th . 7 Total deaths from June !)th to October the 4th . . 4,243 Deduct for Military and Naval . • 91 Deaths of the civil population . . 4,152 Deaths in Malta . 3,784 Deaths in Gozo . 308 The total number of cases was .... . 8,853 viz. in Malta . 8,035 viz. in Gozo . 818 Deduct cases in the Military Hospital . 303 ? Naval Hospital . . 60 Cases of the civil population . . . 8,490 viz. in Malta . 7,672 viz. in Gozo . 818 



39 

I TABLE C. METEOROLOGICAL TABLE, During the prevalence of the Cholera at Malta, 1837. I JONH . JULY. AUGUST. SEPTEMBEK. OCTOBBR. Hid. Therm. Wind. Therm. Wind. Therm. Wind. Therm. Wind. Therm. > N. 74-70 WNW. 77-80 S. 83-86 ESE. 7174 SE. 73-79 NE. 78-81 S. 83-85 N. 707:5 NNE. 76-81 ESE. 7680 S. 82-86 SE. 6971 Variab. 75-82 N. 7579 S. 81-85 ENE. 6771 SSW. 7883 W. 77-80 NJJW. 7833 W. 78-84 NW. 76-81 ESE. 79-84 N. 75-83 NNW. 77-82 WNW. 79.85 E. 7682 NW. 78-82 SW. 72-76 (iO-74 SE. 78-82 E. 78-8.5 NW. 75-77 ¦'> <)778 S. 78-83 E. 79-83 WNW. 73.76 ¦• 69-79 S. 76-81 WSW. 77-81 WSW. 76-77 ¦¦ 7«"8O N. 79-84 Calm. 77"82 SW. 76-78 ¦ 75-80 NW 74-82 NNE. 78-83 SW. 7982 Be. re-88 nnvv. 74-79 n. 78.83 sw. 77-80 77-81 NW. 75-88 E. 79-84 NW. 7479 If. 76-84 N. 74-78 E. 79-83 N. 75-7!) ¦ W 76-83 NNW. 75-79 SW. 79-84 NE. 7578 ¦ 78-85 NW. 77-80 NW. 7683 N. 74-77 ¦»'¦ 76-84 WNW. 76-81 ESE. 77-81 N. 74-77 ¦/. 77-82 NW. 74-79 NE. 79-82 WSW. 7478 ¦NE. 75-79 WNW. 74-77 N. 77-84 WSW. 7477 ¦E. 75-78 W. 73-78 N. 78-84 SSE. 7378 ¦HE. 70-7'; NW. 73 77 Calm 76-82 ENE. 73-77 ¦ < 7075 E. 73-76 W. 77-83 SSE. 72-76 ¦/NW. 72 75 W. 74-77 WNW. 78-83 NNW. 7274 P^ 71-76 NNW- 7578 NW. 76-81 W. 7175 ¦ 7277 NNE. 75-77 NW. 78-82 WNW. 7175 ¦BE. 72-77 E. 76-78 W. 77-82 N. 73-76 ¦ NE. 7478 E. 7779 WNW.7B'B4 S. 7476 ¦/NW. 76-80 ESE. 77-80 SW. 78-83 NNE. 7275 Calm 76-81 S. 81-85 



40 

TABLE D. 

Comparative effect of the Plague of 1813 and the Cholera of 1837 in Malta and Gozo. 18 C 1 & Population, Deaths by Population, Deaths by 1813. Plague. 1837. Cholera. CospicuaCity .. 9,303 12 10,293 291 Zeitun 5,287 11 5,848 268 Birchircara .... 5,275 281 5,835 173 Zebbug 4,690 691 5,190 220 VittoriosaCity.. 4,095 33 4,530 145 Curmi 3,849 642 4,339 137 Musta 3,583 32 3,963 32 Zurrico 3,299 6 3,649 96 Zabbar 3,269 44 3,616 86 Siggeui 3,140 9 3,473 71 Nasciar 2,815 9 3,113 27 Luca 1,306 42 1,446 19 Lia 1,188 4 1,258 176 Tarscien 980 1 1,091 59 Gudia 961 6 1,063 14 Attard 861 2 952 8 Micabiba 758 7 838 14 Sliema Village . . 250 3 450 2 Malta 94,258 4,572 103,344 3,784 Gozo 15,243 96 16,534 368 109,501 4,668 119,878 4,152 N.B. The population here stated for Malta and Gozo in 1837 i faken from the official return in June, 1837, just before the breaking out of the cholera. All the other statements of population here made are approximative, with reference to former returns. 



41 

In describing the symptoms which characterize cholera in its different stages, I thought it rather advisable to study brevity, tn to indulge in a lengthened comment, which, after all, would produce only bable hypotheses, and furnish matter for atisfactory dispute. 

I According to the report of the central nmittee on cholera, dated 22nd of July, 37, it appears that the number of cholera tients admitted into the Military Hospital Malta, from the 17th of June to the 18th July inclusive, and who were all treated ;h calomel in large doses, amounted to E), and of all these the deaths, notwithiiding some pre-existing indisposition, re only 58. 

tthe civil hospital, which was provilly erected for cholera patients, in the 



42 

building belonging to the normal school, 548 individuals were received, but in these the effect of the calomel Avas not entirely so advantageous as had been hoped ; but it could hardly have been so, if we take into Isideration the following circumstances. s well known how strong an antipathy erally exists among the common people, inst the hard necessity of applying to a pital for the cure of any disease. To > prejudice, at the breaking out of the demic in Malta, another and much ater prejudice was unfortunately added, umour prevailed that the object of transporting the sufferers to the hospital, was to cause their death by a poison called calomel ; this wicked calumny, suited only to I nds the most obscure, and malignant, preled so far with the lower classes, that in early part of the disease, few cholera ;ients were brought to the civil hospital til almost expiring ; and in fact some of m actually died on their way thither, my also of those who arrived in a state )able of cure, perished through an invin- 



43 

Kle obstinacy, in refusing every succour of medical art. 

I Again, of the patients who were sent to 3 hospital, many were of a very advanced c ; almost all of them were in the most serable condition, ill-clothed, and worse 1. Often, too, they came from a distance the country, and most of them, in a joury of several hours, were necessarily exsed to the burning rays of the sun, not- Jistanding that all possible care was taken preserve them from this inconvenience : m all these causes, no doubt, the progress the malady was greatly increased. 

Ihi the military hospital the case was very ferent ; the patients sent thither were, for i most part, individuals suffering only from ! earliest stage of the disorder ; they did ; partake the prejudices, which had so lentable an effect among the country >ple ; they readily submitted to any treatnt which their medical advisers directed ; y were brought from places very near the spital itself; their age in no case exsded 50 years ; all of them had been well 



44 

thed and supplied with abundant food, sequently they were in every sense more able of resisting the deadly impression he poisonous miasma. 

In my own private practice I attended •259 persons in different stages of the malady ; of these 36 were in severe rigor, and 14 of them died, a reaction having occurred to six, which took the typhoid form. Out of the 2*73 in whom the disorder had not yet reached the state of rigor, there was only one to whom I found it necessary to administer five scruples of calomel, in order to arrest the disorder; to a few others I gave two scruples, but in almost all the cases a single scruple was sufficient to arrest the malady. 

I Although it had been feared that the omel, even after having cured the epidec, might produce consequences injurious the animal economy, I can positively sert that of all those individuals, who der my care were cured by means of canel, no one has to this day suffered the ist inconvenience from the effects of that 



45 

remedy ; on the contrary, some of them enjoy a better state of health than they did previous to the attack ; and it is a circumstance particularly remarkable, that of the immense number of cholera patients who were cured by calomel, not more than 40 underwent salivation, and even of these very few suffered it to a serious degree. 



46 

CHAPTER I. 

PHYSICAL CAUSES PREDISPOSING TO CHOLERA. 

I Many authors have written on the cholera, t though I have studied most of them y carefully, I have not been able to meet :,h any one who has fully satisfied my nd, as to the primary cause, which directly lerates so formidable a disease. And as ;ure has many recondite secrets, we may sonably doubt, whether we shall ever sued in withdrawing the veil, which hides m us so desirable a discovery. 

Kome are of opinion that the cause is to attributed to a malignant fluid, which :ed by a current of the atmosphere with 



47 

which it is mixed, produces this disorder in those countries, and lands, which it reaches. Strongly convinced of this opinion, they will not allow that the disease may be communicated from one person to another by contact. 

The natural philosophers, who treat of aerial fluids, furnish us only with hypothetical notions, which lead to little else than intricate and doubtful discussion. Hence it is that we are still unable to say, whether a particular condition of the atmosphere cither alone, or combined with other circumstances, is the efficient cause in the case of many epidemic maladies so different from each other, as, for instance, scarlatina, small It, influenza, measles, and the whole train miasmatic diseases ; or whether there is eculiar combination acting as the cause sach one. 

IVlr. Wilkinson, in his elements of galvam, holds it for certain, that the electrical te of the atmosphere exercises a powerful uence on the human body ; from the eximents which have been made, he main- 

7 



48 

tains, that the deficiency of electric fluid produces that remarkable relaxation of strength, which causes that general debility of the human functions which is experienced in countries where the sirocco prevails. Mr. Orton goes on to establish the doctrine, that the cholera has, as its remote cause, an insufficient quantity of positive electricity of the atmosphere. The arguments which he adduces in support of this opinion, though not altogether without weight, cannot be said to resolve entirely the serious doubt in controversy; without dwelling further on this point, it would be sufficient to refer my readers to page 237 of his wort : for the sake of brevity I shall also pass over several similar theories which, as I think, do not amount to a clear ascertainment of the remote cause which produces cholera — but that it is derived from some principle existing in the air, (whatever that may be,) and which is circumscribed by certain atmospheric strata, has been sensibly demonstrated, by the evidence of the following among many other cases, which have occurred. 



49 

Lieutenant Macillwain, of the British navy, in a conversation with me on the cholera, assured me that when he was serving in 1832 on board the frigate Liny, which was then stationed in India, and was anchored a few miles from the shore, the cholera broke out in the ship. Information having been transmitted to the admiral, he gave orders that the frigate should imme" diately proceed to sea, and this command being promptly obeyed, and the frigate consequently being removed to a distance from the seat of the epidemic, the progress of the disease was immediately stopped, and no new cases broke out ; but of those who had been attacked in the infected locality, ten died in the course of a very few hours. 

I Miss Wallis, the daughter of an officer of 45th regiment of the line, was proceed, in the year 1832, from Trincomalee to ,dras on board a vessel, which fell into a rent of air infected with cholera, which i short time caused the death of several he crew ; the captain, in his anxiety to serve the persons on board, thought it 

E 



50 

Ist to alter the course of his vessel to an posite direction ; the expedient proved ective, for the disease immediately ceased. it as he could not reach his destination ;hout passing again through the seas he 1 quitted, he no sooner arrived at his mer latitude, than the crew were again acked by the same disease, and a great it of those who fell ill the second time, re individuals who had not been attacked the former occasion. 

The Rodney, a British man-of-war, was assailed by the cholera when at a short distance from Malta, where the disorder then prevailed ; wishing to escape from the evil, the commander ditected his course towards Sicily, but the disease still continuing, either because the navigation pursued the same atmospheric strata which was impregnated with the choleraic miasma, or from some other cause as yet unknown, the vessel finally returned to Malta in order to land the patients for the Naval Hospital. Departing again, and directing its course towards Sardinia, it was observed that at a 



51 

certain distance to the westward of Malta, the malady made no further progress, and those sailors on board, who had been attacked after leaving the port began to get 

Iriie Bellerophon, another man-of-war beiging to the English squadron, stationed the Mediterranean, on its return from a lize on the coast of Barbary, approached ilta with the crew in perfect health ; but i commander, finding that the island was Fering from cholera, and being anxious to ird against the infection, caused the vesto anchor at the mouth of the harbour, I kept it there in most rigorous quaran-3: useless precaution ! the malady quickly ike out in the vessel. 

IL'hese events, so uniform iv effect, and strong in their evidence, confirm at once reasonableness of the opinion, that the )lera takes its rise from a malignant fluid sting in the atmosphere, and at the same c show, that the disease has not the proty of being transferred from one person another by contact alone. 

c 2 



52 

I The truth cannot be better known than considering the effects which produce, in r opinion, indisputable evidence, so as to tnpel me to dissent altogether from the ctrine of those, who regard cholera as a utagious malady : if they had examined i effects which manifested themselves in ilta, and had conducted the examination those simple principles, which usually lead to a reasonable conclusion, as to the origin of any given malady, which presumably is brought from another country, they would certainly have been compelled to acknowledge, in spite of themselves, that the Asiatic cholera, however it might be thought contagious in its nature, could not be communicated by mere contact. Before they Initted a doctrine founded only on probaties and vain conjectures, they should ler have observed, that in this island all sels proceeding from countries infected, in the neighbourhood of infection, are versally subjected to a rigorous quaran-3; the quarantine is performed in places >gether separated from inhabited spots, 



53 

and that it is constantly watched by the most accurate observation, that persons are severely prohibited from approaching these places, and that those under quarantine are not even permitted to speak to others, except at a certain fixed distance, and under the watchful observation of guards. The gentlemen who rely on conjecture, might also have easily recalled to their memory, that notwithstanding there were, at the beginning of June, 1837, in the ports of this island many vessels, which had arrived from countries suffering under severe cholera, their crews did not exhibit the least symptoms of that malady, and yet for the greater precaution, they were compelled to undergo that quarantine, which the careful foresight of the sanitary committee had respectively decreed to them, and which they had not accomplished, till some days after the cholera had already exhibited itself in the 

t^.nd even if any of these vessels had on I'd persons, who after their arrival exited symptoms of cholera, which, thank 



54 

|)d ! did not happen, the first who must ye received the fatal contagion, would doubtedly have been those, who acted as arantine guardians, and others would m them have received the disease proissively by contact, — but none of these ional inferences were verified in fact. 

Evidence of this kind, strongly circumstantial, and resting upon facts publicly known, ought, one would think, to have disabused the contagionists of their hypothetical notions regarding the Asiatic cholera. But deep-rooted prejudices are not easily eradicated from obstinate minds, more especially when they have taken the form of a system. As soon as it was known that the cholera had broken out in a kind of almshouse called the " Ospizio de' Poveri," a large insulated building in the suburb of Floriana, to which few persons resorted except the public officers, and where the inmates were mostly predisposed to disease by age, and consequently were the first victims, the contagionists loudly declared that the malady had been intro|;ed 



55 

into that place, by means of some icles susceptible of infection. Shame-5 fabrication ! thus they excited a most raring fear in the minds of that large part ;he population least cultivated by educa-1; so that they would have shortly iken up all the bonds of relationship and iety, if they had not been actively op>ed by those, who with the clear argunts of experience, day by day refuted se fables. 

|[n further support of the arguments, by ich I endeavoured to dissipate the alarms these poor people, I feel it a duty to ntion several observations, which occurred me from time to time, as the cholera bene more aggravated, and which finally inrmed beyond a doubt, in my mind, the inions which I had formed from speculan and study. All the cholera patients, m the moment they were admitted into ! temporary hospital, established, as I ye before observed, in the building belging to the normal school, were treated th the most intimate familiarity, and yet 



56 

out of sixty individuals, who were employed in the service of that establishment, only six were attacked, four of whom were persons notoriously addicted to the excessive use of spirituous liquors. The attendants gathered together the clothes of the cholera patients, and laying them in a place covered with cloth, reposed or slept on them when not upon duty. The medico-chirurgical assistants readily bled those patients who required it, and it often happened that when the blood did not flow freely, I myself bled the individual in the other arm. The caesarean operation, when necessary, in case of death, was not omitted, nor did I hesitate, when the circumstances required it, to give the female patients assistance in case of miscarriage. The post-mortem examinations were not performed at first for want of the necessary accommodation ; but when the hospital was transferred to another building, the house of industry, many examinations were made ; in one of which, for the sake of a more minute inspection, I persevered for three whole hours, and on that 



57 

occasion the gentleman who assisted me in laying open the smaller intestines, which were found full of a whitish pulpy matter, wounded one of his fingers, and yet there followed neither to him, nor to any of us the least symptom of contagious cholera. Many lier experiments of the same kind, which Malta were spoken of as extraordinary deities, were also practised in the military 1 naval hospitals, with the same success in various foreign countries. 



58 

CHAPTER 11. 

PHYSIOLOGICAL CAUSES PREDISPOSING TO 

CHOLERA. 

I When the epidemical cholera prevails in country, it is generally considered that ) causes predisposing to it are not only ; external agents, but the differences of ?, of sex, and of natural temperament, treme poverty, continued hard labour, and s various professions, and arts, which reire toilsome exercise, excite in an indiiual such a state of body, as renders him her more liable to receive infection. 

I Several writers have laboured to esta;h the opinion, that adults are the most disposed, but my observations showed 



59 

I it the advanced periods of life, were by means less exempt from it ; for in the spital above named, out of a total of 548, ire were 1 56 between the ages of 60 and years, and of these the greater part, as II be seen by the annexed tables, died, those cases, the reaction passed into en)halitis and apoplexy. 

In regard to sex, it may be taken as certain that females are more predisposed to it than males; this appears clearly from the numbers contained in the official reports of the police physician. 

Irhere is no doubt, but that among the ierent temperaments natural to the human :ly, the bilious is that which most predis>es to cholera. In fact, the greater part the choleraic patients, who were admitted the hospital, were of that temperament; vever, several were received who were of crofulous habit, and these were generally nd the most difficult of cure. 

Eehement and ill-regulated passions of mind, such as terror, rage, anger, and alarming fear, which often seizes on 



60 

persons at the first appearance of this terrible malady, are moral agents which easily dispose the individual to be affected by it. It is thought that any labours or duties, which require excessive exercise, as they tend to debilitate the body, dispose it also to receive cholera. This opinion, which is very reasonable, is also demonstrated by the great number of the patients, who belonged to the class of the very indigent, or of those employed in very laborious occupations. 

I Finally, some think that certain profesns occasion a susceptibility to cholera ; my part, however, after the most diligent nervations that I have been able to make? m of opinion that in pursuing any prosion with proper moderation, we shall not ur a predisposition to the malady, unless i locality is either too humid, insufficiently itilated, or not kept with due cleanliness. 



61 

CHAPTER 111. 

PATHOLOGICAL CAUSES PREDISPOSING TO 

CHOLERA. 

Having reviewed the physical and physiological cause of cholera, I proceed to lisider the pathological causes, — a knowge of which is of no less importance with 3ience to the malady in question. We >w that by means of pathology, we enter j the most minute investigation of the ;gular functions of the human body, and isequently to the clearest possible per)tion of its sufferings, of their differences, sasions, and effects. In order to judge 11 of any disease, we must diligently exale the constitution of the patient, measuring 



¦> 

it attentively in its relation to the normal and abnormal state. To give a mere passing thought to this examination, which can never be too careful, would be, in fact, to encounter a thousand inevitable, most serious, and most dangerous errors, in the choice of the method to be followed in treating the disease. To know how to stop the advance of an approaching infirmity, how to remove it when formed, how to diminish its effects, to overcome some of its symptoms, before we can entirely remove the disease, is a kind of knowledge which, if well analysed, leads, by the most certain, and secure steps to the discovery of those remedies, which the most skilful practitioners, after long and most accurate experience, would indicate as the most conducive to the ends 

KVfter a full consideration of these mani; truths, I have been enabled to satisfy self that the principal pathological causes of cholera were such as follow : viz. all acute or chemical inflammations of the mv cous membrane lining the stomach and in 



63 

testines — the presence of worms in the in r testines — the effect produced by drastic purges, or by acids organic or inorganic, used in such a quantity as to keep up a continual irritation in the prima via, hypoehondriasis, or any of those particular modifications of the gastro enteric viscera, which often remain after hepatitis, or chronic pulmonary disease. 

The examination of these pathological causes tending to cholera, has not been mentioned with a view to impress those, who are not affected by them with the idea that they may therefore consider themselves exempt from its danger. For this would be a flattering but fallacious comfort. My intention was rather to advise those, who find themselves subject to these inconveniences, to be the more cautious in their mode of living, especially when that particular condition of the atmosphere prevails, which is believed to generate cholera. 



64 

CHAPTER IV. 

PATHOLOGY OF CHOLERA. 

IFhe different accounts, which have hitherbeen published of the post-mortem exanations of cholera patients, are so uni•lll in their statements, as to leave no όbt that the principal seat of the malady, in the mucous membrane of the stomach d intestines. 

I (The author, after having cited the statents of the sectiones cadaverum performed India by Messrs. Orton, Annesley, Kelly, rrell, Whyte, and Craw ; those in Europe Mr. Mackintosh, by the French surgeons, 

and by the Italian anatomists, proceeds to 

5 



65 

mention such as were executed at Malta, as follows) : — 

The " necroscopic " observations, which result from the post-mortem examinations of the different bodies of those who died of cholera in the civil, and military hospitals of Malta, exhibited nearly all of them, the same pathological appearance. 1 abstain for the sake of brevity, from transcribing all the particulars registered, and shall give the description of one only, which may serve as a model for the understanding of all the others, and will be sufficient to show that t pathological state of those, who died of lera in this country, was the same ;is reed from the autopsia in other places. 

E[aria Cassar, 60 years of age, died in state of rigor, 20 hours after the attack, was dissected 14 hours after her death. 

External appearances, 

I 'he skin of the arms, hands, legs, and ;, was of a livid colour, with blackish ts on various parts of the superficies of 

i- 



66 

Cavity of the Skull. 

The cavity of the skull, overflowed with a bloody fluid, coming from the incisions of the membrane made in opening the skull. In detaching the encephalon from the cranium, and in dividing the medulla oblongata, a quantity of very transparent serum escaped from the opening of the vertebral column ; on examining the external surface of the encephalon, the arteries and veins were found turgid with black blood resembling liquid pitch ; the interior was in like manner gorged with blood of the same quality ; the ventricles were almost full of bloody serum ; the plexus choroides was nearly black. The interior surface of the fomix was of a reddish hue, the substance of the cerebellum was tougher than usual, and its colour was dotted with black, grunious spots, which arose from the vessels which had been divided. 



67 

Tlie Thorax. 

The right pleuro pulmonalis adhered to the costal pleura ; this was evidently occasioned by an old morbid affection of the lungs ; the superficies of the lungs were of a yellowish white colour, smeared with an unctuous liquid ; the blood-vessels were replete with black blood, which presented to the view a black arborescence, very promilit; the parenchyma of this organ was ged, and in making incisions into it, a intity of thick black blood issued. The it auricle of the heart and the corrending ventricle were full of curdled od having thick fibrine in the centre, eh prolonged itself to the interior of the monary artery ; the left ventricle was in natural state, containing black blood, liquid ; the aorta, the veins, and coroy arteries were full of black blood. 

Abdomen. 

The mucous lining of the cardiac aperture 

f2 



68 

of the stomach was so soft that it could be with the greatest ease detached from the muscular tunic ; this viscus and the small intestines were of a rose colour on the external surface ; the mucous membrane of the duodenum was reduced to a pulpy substance, which could be separated easily with a slight movement of the finger, that of the jejunum of the same nature, exhibited on various points spots of ecchymosis, and particularly in the duodenum, which contained seeds of melon and earth-worms ; the large intestines were injected, and were of a reddish brown colour, their mucous Imbrane greatly relaxed and easily dehed; the transverse colon was full of j ; the liver was in its natural state, but vessels, like those of all the other organs, s turgid with black blood ; the gall blad• was full of bile, very black and dense ; pancreas was in its natural state. The een was soft and flabby, and its external face was of a blue colour. The parenma was macerated, the bladder was void 



69 

of urine, and wrinkled up towards the symphysis of the pubes. The neurilema of the pneumo gastric and of the great sympathetic was injected, and of a brown colour nearly the whole of its extent. 



70 

CHAPTER V. 

OF THE PREMONITORY SYMPTOMS OF CHO- 

LERA. 

The above-described appearances being derived merely from post-mortem examinations, were not sufficient to lead to an adequate conclusion in respect to the true seat I the pathological condition of cholera. I nk, therefore, that we cannot come to eh a conclusion with the greatest pos>le probability of accuracy, without addj those circumstances; which are learnt by ?ans of a sensation of uneasiness in the aecordial region : from disturbance in the »mach and intestines, from a disagreeable 



71 

bitterness in the mouth, from the continual rumbling in the abdomen— symptoms which were felt by almost all the inhabitants of countries where the cholera prevailed. The knowledge of these, added to that of the other symptoms which manifested themselves in individuals, after the cholera had developed itself, suffice pretty well, when considered together, to furnish reasonable conjectures ; for holding it as certain that the virus which the cholera engenders, obtains primarily, or secondarily its power in the stomach and intestines ; from no other principle, than from such a virulent impression on those organs, could so many and such various morbid phenomena be produced, as were observed in the course of this fatal disease. To convince ourselves the more of this truth, the knowledge of the following symptoms will be sufficient. 

Symptoms of thejirst stage. 

Ehe quality of these, varies according to vidual temperament, idiosyncracy, or r particular predispositions. In some 



72 

I "sons, this disorder was preceded by a ling of languor, a dryness of the palms of the hands, and the soles of the feet, frequent eructations, accompanied with a sense of fulness of the stomach, and by slight colic. In other persons it was preceded by nausea, fulness of the lower stomach, followed by pains, continued desire to evacuate, and painful heat in the prsecordial region. Some persons there were in whom the first symptoms were only cold shiverings over the whole surface of the body, connected with sensations of terror, and w 7 ith noise in the intestines ; others, again, were only premonished by a singular sense of anxiety in the stomach, by pains intense, though of short duration, in the abdomen, by diarrhoea, at first, of a natural colour, sometimes bilious, or greenish, but in its progress, white, like water slightly tinged with milk, or by weak pains in the head, and frequently by tinnitus aurium ; all these observations are collected from accounts nearly uniform, which w r ere published in Nuremberg, Moscow r , Edinburgh, 



73 

Id other countries, and which agreed with -i observations, which I had the melanoly opportunity of making here in Malta, ny if these symptoms, which at first sight mid seem to be of slight importance, re disregarded by any individual in a untry visited by the cholera, they cernly would lead in a short time to the ;ond stage, and so become almost incu)le and hopeless. 

To what eventual evil did such a thoughtlessness lead ! How many fewer victims would not the cholera have destroyed, if the doctrine of its being contagious had not been spread through the public mind ! This opinion, alarming to those who had blindly embraced it, induced them to bear in injudicious silence the approaches of the evil, which might then have been very easily overcome. It is now an indisputable rule, established by all modern practitioners of great reputation, that the cholera is of easy cure, whenever a physician is immediately consulted on the premonitory symptoms ; and, on the other 



74 

hand, this is almost always incurable if these symptoms are followed by others more violent, which characterize it as having passed inio the second stage. 

Symptoms in the second stage. 

This stage, which is also commonly called the stage of collapse or rigor, never occurred, as far as my observations extended in this island, unless the diarrhoea had previously manifested itself for some time. The duration of this profuse evacuation, differed according to the different constitutions of the persons attacked. In some les it was observed, that before the seid stage came on, the individuals had fered diarrhoea for as much as twenty s ; whilst, in other cases, it had lasted y a few hours : the danger in this period 5 generally in the direct ratio of the ater, or less evacuation of the liquid 

The symptoms which showed that the cholera had passed to the second stage were these, — the skin began at the extremities 



75 

to assume a livid colour ; this colour sometimes soon spread over the whole surface of the body, and sometimes was confined to the extremities, which appeared always wrinkled and withered; the colour of the nails became blue ; there were also cases in which the surface of the body, or of some particular portions of it, was marked by white spots on a dark blue ground ; in these instances the malady was almost always fatal. The whole circumference of the body, except the anterior part of the trunk, was generally cold, and bedewed with a light sweat, very cold and unctuous, presenting to the touch a disagreeable sensation, like that which is felt in handling frogs taken out of water ; the smell exhaled by this sweat was very nauseous, and impressed itself so strongly on the memory, that whoever had once handled persons attacked with cholera in this stage, was easily able, from this circumstance alone, without any other examination, to distinguish the malady in any person really suffering from it. 



76 

Notwithstanding the skin of the cholera patients was extremely cold, they were yet unwilling to bear any warm bodies touching them ; on the contrary, they preferred stretching themselves on the stone pavement, naked, to lying covered in bed ; the countenance was much depressed, haggard, and drawn ; the forehead was abundantly covered with cold sweat ; the eyes were glassy, and very deeply sunken, and surrounded with a halo of a livid colour, very characteristic of cholera; the eyelids half closed, the nose sharp, the lips of a dark violet ; tingling in the ears ; the tongue generally white, always cold, drawn into a round form, and its edges of a red colour. 

I [lie thirst of these patients was so great L constant, that it was impossible to inch it by frequent imbibition ; the voice ame so weak, hoarse, and, as it were, inguishing itself in the glottis, that it ; almost impossible to distinguish the ient's words. 

Ehe matter vomited was white, exactly lar to the dejections in colour; it 



77 

took place without any effort of the patient to expel it ; and oftentimes both the vomit and the intestinal evacuations occurred with great vehemence at the same moment. 

Even though the evacuations in the first stage had been feculent, in the second stage, however, they became watery and very like rice-water, or water mixed with a small quantity of milk, and still more offensive to the smell, than the sweat above mentioned. These were the characters of the evacuations observed in the majority of cases in the second stage ; still there were some instances, in which the evacuations resembled water something turbid, and containing small flakes, such as have been previously mentioned; in others, they were slighty tinged with blood, blackish, or like the crust of red wine ; sometimes lumbricales, and sometimes grains of hardened 

llcces. 

Irhere was a great and often irresistible esmus, sometimes accompanied with ns of the abdomen, and sometimes with snse of burning in the anus. The quail- 



78 

IV of liquid lost at one time, varied accord* to the constitution of the patient, and i intensity of the attack ; in some, the acuations were accompanied with a reirkable quantity of gas; with the vomit ,s generally felt a great burning in the igastrium, which formed a symptom so narkable in this malady, and is commonly called the praecordial cingulum. 

The secretion of urine was entirely suspended, and yet a continued and increasing desire to make water was felt ; the pulse at the beginning was rapid, and very weak ; in the majority of cases, however, it was thready, in others, it was entirely suppressed in one arm, and scarcely distin- Ishable in the other, or altogether with; motion in either arm ; notwithstanding it the action of the heart was so rapid, 1 comparatively so strong, that it seemed if it wished to free itself, from the black od it received from the veins : as the lady progressed, the action of this organ .dually diminished, until its entire cessa- 

7 



79 

The blood which was drawn from cholera patients by phlebotomy, flowed with the greatest difficulty, and was thick, black, and deprived of the natural appearance, which it has in the normal state, when, if left to itself, it remains semi-fluid, and separates into the crassamentum and serum. In some cases the circulation was so slow, that if you pressed your finger on any subcutaneous vein, you observed for some time the vacuum occasioned by the pressure. In the beginning the respiration, though weak, was nevertheless natural, but in the progress of the malady it became difficult and oppressed. This was the effect cf the quantity of blood, which having been deprived of a great part of its serum, inasmuch as that substance was evacuated from the mouth, and intestines, could not, therefore, circulate in the lungs, except with great slowness, and consequently became engorged there, so as not only to compress the small air-vessels, but to close also the minute branches of the bronchi; such a disturbance of the natural operations must 



80 

no doubt have impeded the ingress, and egress of the portion of air, necessary to oxygenate the blood. 

The cramps which generally accompanied the cholera in this stage, were of all symptoms the most remarkable ; they took place in different parts of the body, but particularly in the muscles of the extremities, superior and inferior, and still more observably in the muscles of the gastric I (ion. The palms of the hand, the soles the feet, and the flexors of the fingers and !S, sometimes also in the thorax. 

iVhen the progress of the malady had died this state, the patients were much icted, and disquieted, continually turning niselves from one side to the other in the bed ; nevertheless, in the midst of all fs pain, the intellectual faculties were but c weakened, and the patient was geney able to give a clear account of everylg he felt, or that was passing around him. 

Klthough the patients in this stage, were arently in a state of great weakness, seemed quite incapable of voluntary 



81 

motion, nevertheless some of them before death exhibited strong convulsions. 

If all the symptoms above mentioned, continued obstinately in the same degree, death invariably followed, and the cure was always found to be impossible, if the patient could not pass from this state to another, which leads to the third stage of the disease. 

Third stage, or state of reaction. 

In the state of reaction, the skin, from having been livid, began to return toward its natural colour ; the surface of the body, from having been entirely cold, became gradually warmer, and the perspiration, from being cold, fetid, and unctuous, became warm, lost its factor, and reassumed I natural state ; the countenance was more mated, the dark circle around the eyes dually disappeared, the lips and cheeks ssumed their natural colour, the tongue :ame clearer, and from having been nd and cold, was warm and dilated; the •st diminished, the voice became stronger, vomit ceased, the diarrhoea was less 

Q 



82 

Ijquent, and the evacuations, instead of ing quite watery, showed a consistence, d a colour tending towards green. The dominal pain diminished, the secretion urine began to show itself, but very >wly, the pulse was stronger and fuller, 3 respiration was no longer difficult, but sy and natural ; the sleep, which in the mer stage had been entirely suspended, w returned, and became placid and tranil, and the cramps entirely ceased. 

Such were the symptoms, which were generally observed in the state of reaction, but in many instances the event was not so fortunate ; for when we thought that the malady was on the eve of cessation, suddenly a new train of symptoms presented itself, which showed that the patient was still in great danger. 

i[n such cases the warmth of the body reased beyond its natural degree, comnicating to the touch a particular and agreeable sensation; the pulse became [, often manifesting all the symptoms, ich characterize typhus. The conjunctiva 



83 

was injected, the strength prostrated, the tongue dry, and red; tremor in the limbs, difficulty of answering, continued delirium, which terminated in lethargy, and so in death ; in others, the secretion, as it increased, took the form of encephalitis ; in these patients was observed great headache, increased heat, pupils sometimes contracted, and sometimes dilated, furious delirium, propensity to sleep, contraction in the flexors, muscles, &c, &c. If to the encephalitis was added meningitis, then besides the symptoms above described, there were almost always convulsions. 

ILgain, if the reaction took the form of tro-enteritis, it began with simple nausea vomit, then diarrhoea, the substance of evacuations being bilious, mixed frently with blood ; the pulse small, and [iient; the heat augmented, the face , the conjunctiva tinged with yellow, the covered with a yellow fur, and red ;he edges ; burning thirst ; abdominal is ; difficult respiration ; palpitation of heart ; these symptoms corresponded in 

G 2 



84 

degree to the greater or less violence of the attack, and to the individual constitution; we must not omit to observe that sometimes when the symptoms of rigor seemed to cease, and a slight reaction to take place, followed by some revival of the former strength, from whence it might have been thought that the patient was out of danger, nevertheless, on a sudden, the pulse began to fail, the vomit to reappear, together with the evacuations Iculiar to cholera. The blue colour manited itself, and finally such a debility >k place as to lead to the death of the 



85 

CHAPTER VI. 

OBSERVATIONS ON THE MOST REMARKABLE 

SYMPTOMS OF CHOLERA. 

[s diarrhoea was in Malta, the primary most remarkable symptom of cholera, must begin from that point our obserons. 

Irhe symptoms of the cholera patients, o were received in the hospital at the mal schools, before the other symptoms the second stage presented themselves, re always preceded for a greater or less gth of time by diarrhoea ; some of those ients, when asked how long they had f'ered it, answered from fifteen to twenty 



86 

liys, whilst others had felt it but a few >urs before ; but after having taken indistible food, at first they felt slight pains the abdomen, and other symptoms which aracterize indigestion ; these were folsved by diarrhoea, which, being neglected, d reduced them to the state in which ?y were. Others said that they had not fFered for any length of time, but that the cretion of watery matter in that short riod had been very copious. 

RWe learnt that in the cases of all those, 10 had suffered the watery diarrhoea, in consequence of feeding on figs, melons, Impkins, apricots, and some of them on h — more especially fried — the diarrhoea jreased so rapidly as to produce in a very ort time all the symptoms indicating the ite of rigor; in these cases the quantity liquid ejected above, and below, was so undant, that it was difficult to understand wit could have been supplied ; the indiluals so circumstanced, exhibited a body a short time so faded, and transformed, it a man young and athletic looked like a 



87 

ithered, and failing old man ; all this innes me to believe that so sudden a metajrphosis, should be attributed to the rapid js of so copious a quantity of the serous rt of the blood. 

Cingulum pr<Bcordiale. 

I The stomach, and small intestines, and >re particularly the duodenum, being ich affected, communicated by the vicinity the parts to the caeliac and solar plexus greater or less degree of irritation, which, ded to the pain that the affection of these fans produced, constituted that continued lse of pressure which is known by the me of cingulum piae cordial c. 

Vomit. 

I Che vomit, another symptom which acnpanies cholera, did not always present ;lf, in the first stage of the malady, but tever failed to appear in the second ; and may be laid down as certain, that when 5 symptom supervened with any degree activity, the state of collapse was quickly 



88 

I er wards manifested. Whether it was that s cholera virus, by its elective faculty, acted the exhalants, or on the mucous follicles, on both at the same time, it is evident it an irregular function manifested itself oughout the gastro-enteric mucous merame, from whence was derived that imderate ejection of the serous part of the •od, which was thrown out by the patients the vomit. 

It was observed, that all medicines of a nulating nature, whenever they were inluced into the stomach, almost always asioned vomiting. 

Circulation of Blood. 

I A the serous part of the blood was thus inished, it followed that the globular ; remaining of the same quality as be, this fluid consequently became thicker, eh impeded the circulation in such a mer as necessarily to cause a want of ition, innervation, and healthy secre- 



89 

Tlte Urine. 

IFhe blood having become thick, so that could not well insinuate itself into the }illary vessels, and consequently could t produce the composition of the several rts, it inevitably caused a suspension of s secretions, and the innervation. Theree it happened that in persons attacked cholera, when they reached the stage of or, the secretion of urine ceased. Neverless, the patients, although the bladder s entirely empty, felt a continued and nful desire to make water, which some- Les we were able to calm by the introducn of a catheter into that organ. 

Cramps. 

I 'he cramps were observed in the state of r generally, but not in all cases ; their c was very various, for in some persons r consisted only in slight contractions, in others they were so violent as to reble the paroxysms of tetanus. The ips in a special manner attacked the 



90 

Iperior, and inferior extremities, nor was c trunk altogether spared ; in grave cases, lich soon terminated in death, the cramps companied the alvine evacuations ; how- Br, there were some cases in which very )lent and acute cramps took place together th the evacuations, and yet the patients 

Among the causes which produced cramps, may be reckoned the irregular action of the nervous centres — some gastro-enteric irritation, or some particular pathological state of the disordered intestines ; the irregular in nervation appeared to be occasioned, by the diminished nutrition of the great sympathetic, or by some irritation in that nerve, which disturbing its organic motion, rendered it incapable of exercising its functions properly. The irritation of the stomach, and bowels, may have been caused by some irritating stimulant, which operating on them, disturbed their action. 

Eo prove that an irregular innervation, intestinal affections usually produce ips, the following instances may be ad- 



91 

Iced. When sufficient blood is taken m an individual to produce syncope, it is served that if the person be placed vertilly, cramps immediately take place with >re or less violence, according to his parular susceptibility. 

I A patient of mine being troubled by a nia, I, in order to deliver him from so όblesome an inmate, prescribed for him lecoction of the root of the pomegranate ; er he had taken it for some days, he obned from it the relief which I had excted; but wishing to ascertain his case >re perfectly, I recommended him to use ! same decoction a few days longer, but prescription could not be employed, for enever he drank it, he was immediately Eicked with violent cramps in the extre- 

I\. few years ago I prescribed to a patient mine suffering under bronchitis, a solu-1 of tartar emetice, which produced grave istinal irritation, accompanied by alvine cuations, and at the same time, with >ng cramps not only in the extremities, 



92 

but also in the muscles of the trunk, to overcome which it was necessary for me to recur to the expedient of full doses of morphine. 

Another patient of mine was attacked by cramps in the lower limbs whenever an accumulation of faecal matter took place in the intestinal tube. Knowing the cause, he had recourse to a purgative, but its action increasing the irritation, contributed to the violence of the cramp; when the action of the purgative, however, ceased, the cramps altogether disappeared, and did not return, till a new accumulation of faecal matter was formed. 

There is no doubt but that the cholera virus acting primarily, or secondarily on the mucous membrane of the stomach and bowels, must be deemed the occasion of a more or less intense irritation, which, combined with the other symptoms before mentioned, is the cause, which produces the cramps. 



93 

Tlie Cholera Countenance. 

The appearance of the face in cholera patients was so marked that I may almost say that the diagnosis of the malady might be determined by that appearance alone, — a certain drawing doAvn of the features, a dark circle surrounding the eye, which was sunk deep in its orbit, a glassy appearance of the cornea, the eyelids half closed, the nose pointed, and the cheeks dried up, were the signs in the countenance of patients, which indicated cholera. We must believe that these symptoms were derived from the greater or less loss of serum in the blood, occasioned by the vomit and the diarrhoea. 

Cyanotic appearance. 

I The cyanosis or blue tint of the skin is emarkable symptom of this malady, and s common to almost all the persons in s disease, who had recourse to the hosal, as well as to many others in my prie practice; as to the cause which proses tKis colour, it seems to me that as the 



94 

I "dilation of the blood became slow, and 3 arterial blood, for want of a perfect tiguification, was converted into a colour arly similar to venous, the capillary ssels of the skin, being injected with 311 blood, must necessarily present a more less livid appearance, beginning with >se processes which are most distant m the centre. 

Diminution of Heat. 

As physiologists are not agreed as to the origin of animal heat, it is somewhat difficult to determine accurately, the true cause of its deficiency on the surface of the body of a cholera patient. Dr. Crawford and his followers think that the arterial blood has a greater capacity for caloric, than the venous blood, and that the former only differs from the latter in possessing a less quantity of carbon ; they, therefore, in explaining the calorification, say that the venous blood coming as it were into immediate contact with the atmospheric air, and the oxygen of the air combining with the carbon of this 



95 

|>od, a carbonic acid is produced, and is the venous blood becomes arterial, and Lsmuch as the arterial has a greater capay for caloric, therefore that which deve•es itself while the oxygen combines with ! carbon, is immediately absorbed by it, 1 transported by means of the circulation, the various parts of the body. 

The chemical physiologists embrace the same theory, though with considerable modification. In consequence of the experiments of Mr. Edwards, who having caused various animals to respire in gas altogether deprived of oxygen, observed that a great quantity of carbonic acid was then formed, they found themselves constrained to admit, that the inspired air was absorbed by the blood, and transported to the capillary vessels, in which the oxygen combining with the carbon forms the carbonic acid ; and from this union a quantity of caloric developes itself in the parts where it is necessary. The carbonic acid thus formed, unites with the blood, to which it communicates the dark colour, and from arterial it thus 

5 



96 

i;omes venous, then being transported by : veins again to the lungs, it gives out the •I onic acid, and appropriates to itself sh air. 

Others say, that the venous blood in the act of respiration becomes changed into arterial by appropriating to itself the oxygen alone contained in the atmospheric air, and that afterwards passing into the parenchyma of the different organs, it is transmuted from liquid to solid, in order to contribute to nutrition, and by such a change of s^ate developes a considerable quantity of caloric, which maintains our temperature at a greater or less degree of elevation, even though we should be in a temperature less than our own. If this theory were correct, the calorification should necessarily augment itself, in the direct ratio of the quantity of oxygen, which combines with the blood. This circumstance, however, is contradicted by not a few facts, amongst which we may reckon that, which happens in those diseases of the lungs, when the greater part of that viscus is found to be so disorganized, 



97 

as to admit only a very small quantity of air into the air-vessels, and yet the heat of the individual is greatly increased, ana at a certain period of the disease, may be said to be intermittent. It has often happened to me to attend persons affected with consumption, who before their death were, so to speak, burnt up with heat, and yet after death, on their dissection, the lungs were found entirely destroyed, so that not merely a small quantity, but the least possible quantity of oxygen could unite with the blood ; and although it may be sail 1 that a slight portion of the organ remaining intact might be sufficient to perform sanguification, it certainly must have been incapable of producing so great an augmentation of heat. 

15 ir B. Brodie, observing that the calori/tion is not effected in a paralyzed limb, under certain states of the mind, or 3re there exists any diminution of inneron, has inferred that the calorification is duced solely by the nervous influence. 

It would be foreign to my purpose to 

II 



98 

ttatiate further on the various theories of production of animal heat. I therefore ifine myself to saying that it takes place ;he capillary vessels, but cannot be prosed without arterial blood and nervous uence. 

In the cholera, in consequence of the thickness of the blood, the circulation in the lungs is so slow that it prevents the formation of a perfect haematosis, (vide page 1,) consequently the arterial blood being deficient, there follows a want of nutrition in the parts, and consequently a defect of innervation of vital force and heat ; we may also add in relation to this subject, that the stopping of the blood in the internal vessels, in consequence of the pathological state of the stomach and intestines in cholera, produces not only a want of heat on the surface of the body, but a sense of internal heat, of which the patients without intermission complain. 

Cold Sweats. 

In almost all serious maladies in the 



99 

stomach, and intestines, the skin is observed to be covered by a cold sweat; if we wish to have a certain proof of this, we have only to prescribe to an individual a strong dose of tartar-emetic, or a purgative which acts on these organs ; we should then immediately perceive the surface of the patient's body to exude a large quantity of cold sweat. Now as the disease of cholera causes an excessive disturbance of the E)-enteric passages, we may confidently that the cold sweat of cholera is occa-1 by the same cause. 

Thirst. 

I The thirst, which is a most constant nptom of cholera, and is so great and Lent that draughts of water seem scarcely lessen it, most of the patients were so ich tormented with it that they desired have constantly in their mouths pieces of i ; there is no doubt, that the above-deibed state of excitement in which the imach and intestines continued, and the ,nt of the serous part of the blood, occa- 

H 2 



100 

sioned both by the excessive fluid ejection, and diminished absorption, was the cause of this symptom. 

Diminished action of the Nervous System. 

When the stage of rigor had reached a high degree, it was observed that the action of the nervous system in the patients, gradually diminished ; in this state they exhibited a general lassitude ; they seemed to care for nothing, and to be insensible to all that passed around ; nevertheless, whenever any questions were put to them, they did not hesitate to give, though with some difficulty, appropriate answers ; from this it is clearly to be believed, that the activity of the nervous system, both in consequence of the action of the cholera virus, and a want of nutrition, occasioned by the causes above set forth, was greatly deteriorated, and consequently a diminution of its functions en- 



101 

CHAPTER VII. 

OF THE PRESUMED CAUSE OF CHOLERA EX- 

ISTING IN THE AIR. 

I Since the cause, and origin of cholera m subjects of great controversy among dical writers, and since they who seem deserve most credit, maintain that it ists in, and is communicated by, the air, which a miasmatic virus exists, though yet it cannot be properly named, or deed, we must not omit to examine at least s instrumentality, by which this virus is roduced into the system, and the manner which it acts, when so introduced, on the ng tissues. 

We know that there are only four ways 



102 

in which a virus can attack the animal economy — just when it is in contact with the surface of the body, — and in this case the medium through which it acts is the skin. The second is when, being mixed with the air, it insinuates itself into the body, and then the easiest mode is that of respiration, but also through the pores of the skin ; the third is of the digestive tube, and this happens, w r hen it is swallowed in the food, or drink, and then it is imbibed substantially ; the last is, when it makes an impression on the tissues, by means of a disruption of con- 

I doctors Addison, and Morgan, think that different kinds of virus, when they enter 5 the current of the circulation, exercise ir action on these nerves, which are dis>uted on the internal membrane of the od-vessels, that after this first impression y lose altogether their injurious nature, ich is communicated to the nerves, and ;ses from them to the brain, whence it is ected on other organs, which are thereby icted in a secondary manner. 



103 

I But this opinion has not obtained the union suffrage ; that which is more genely embraced is, that certain kinds of virus roduced into the circulation pass on with it changed, or but slightly modified, to the rticular organ, on which, by their proper ality, they have the specific pow r er of 

In support of this theory, there concur many experiments, of which, for the sake of brevity, I shall mention only the following. If we observe various substances which are received into the torrent of the circulation, we see them combined with the different secretions of the body; again, others are perceived to have had only their elements separated, and those particles of their composition, which are of a virulent character remain, as injurious as they were, previously to their decomposition. There are also some substances which, after having circulated, together with the mass of the blood, through the animal economy, have the faculty of fixing themselves for some time in a particular tissue j this happens to the 



104 

libia tinctorun, which attaches itself to the iseous tissue of those animals who feed on From these sensible effects we may asonably conclude that the different tises of the animal economy, on which differit kinds of virus act, are of a nature presposed to receive the impressions of cern agents, which come in contact with 3m ; but it may be asked, are all parts of 3 animal economy subject to the impres>n of the same virus, or rather different ids of virus, which have the property of ;ing on one part rather than another. 

In order to answer these questions, we must refer to what physiology, and pathology teach, as to the different parts of our body ; from these sciences we learn that the different parts, are affected by stimuli peculiar to them. The retina is not acted upon by the undulations of sound, nor the acoustic nerve by the rays of light ; again, the secretions contained in the bladder, and the excretion of the intestine, cause no injury to the parts which contain them. But if by any extraneous cause these tis- 



105 

Is should communicate to each other ir respective contents, the result would dangerous, for gangrene would shortly ervene. These manifest truths may ye to persuade us, that the different partshe body on which particular kinds of virus jctly act, are so organized, or modified to be subject to the impressions of those nts, with which they come in contact. 

liuch appears to me to be the reason why skin and mucous membrane of the airsages, although the most exposed to the lediate contact of the virus, which proes cholera, do not appear to be partiirly affected by it ; certainly they would the first to receive impressions from it, heir organization had been so predis- 

Irhe contrary takes place with the gastroeric mucous membrane. This, as in the lmer it appears always to be in a state considerable excitement, either on ac,nt of the quality of the food taken ) it, or for other reasons, is therefore posed to receive with more facility the 



106 

cholera virus, which is diffused through i by means of the poisoned atmosphere cir dilating through it, mixed with the all ments introduced into the stomach ; the ac tion of both of which causes becomes more or less energetic according to the greater o less predisposition of the parts, and of the individual constitution, to which they are applied. 

iίut although we may believe that the ac n of this deleterious principle is exercise( mediately on the nerves of the gastro teric mucous membrane, we must, never theless, admit that these nerves transmit th impression received, to the nervous centre and occasion in them very grave disturbances. The encephalon, however, is not equally affected ; this organ continues regularly to proceed in the exercise of its functions ; it has been already said that many individuals, under the most violent affection of cholera, nevertheless remained conscious. From thence it may be well argued that the encephalon, though weakened in its energy for want of nutrition, in 



107 

Inseqnence of the diminished circulation, es not appear to be so far affected, as to ike us believe that it has any organic 

I The before-mentioned examinations would rtainly not be sufficient, if we did not ,o know the mode, in which the cholera us exercises its action on the mucous srabrane of the stomach, and bowels, and nld not indicate some medicine, which ustant experience has proved to be the •st likely to effect a cure. 

IWe have said that the different kinds of is, when they are mixed with the circula-1, and so brought in contact with those parts the body on which they are capable of ing directly, nevertheless do not exercise t action otherwise than either as stimuts, sedatives, or irritants, according to ir nature. To this last class, according >ome writers, belong the various kinds of ,smatic virus, and consequently that crating cholera ; but others who regard i latter as stimulant, have in their favour fact of the abdominal pains, which are 



108 

symptomatic of this malady, and also the lesions of the intestines, which are found on the post-mortem examinations. 

In comparing, however, these opposite opinions, we do not find any argument so strong as to induce us, without fear of mistake, to hazard a judgment in favour of one or the other ; for I have often had occasion to observe, that the cholera began its attacks on some individuals, without any pain, or other symptom inducing me to suppose that there was a phlogistic action in the stomach or intestines. Such was the case amongst others of a lady named N., of about sixty years of age, in whom the first symptom which she observed was nothing more than a gradually increasing swelling of the abdomen, which compelled her to loosen all her clothes; and as she observed that this swelling continued to augment, she applied to medical advice, but before the physician could arrive, the vomit and alvine excretions had already manifested themselves to an alarming degree, and these were followed by coldness to the touch, copious 



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sweat, ardent thirst, and, in short, the whole lamentable train of symptoms which characterizes the state of collapse. 

I Should we not be justified in inferring im such a case, that the nature of the virus lich produces cholera, by operating on 3 mucous membrane of the stomach, and wels, had paralyzed the vascular network, m whence followed a free effusion of the •ous part of the blood ; consequently great elling of the abdomen, and, finally, the icuation of the intestines ? 

Some persons, however, relying on the examination of those symptoms of the malady, which distinguish its progress in the different stages, and also in the results of different dissections, maintain that the action of the virus in cholera, is of a stimulating nature ; they say that coming in contact with the mucous follicles, as well as with the surface of the membrane, which covers the intestines, it excites them so as to impel them to a super-secretion, from which is derived that whitish liquid, which is so characteristic of the cholerose evacuations. 



110 

Whichever of these three opinions we may embrace, with regard to the nature of the action of the virus producing cholera, there can be no doubt, but that it is directly effected by some operation on the mucous gastro-enterica. The morbid appearances observed in the different stages of the malady, always distinctly proved, that the membrane was the first to be affected by it ; with the difference, however, as to greater or less intensity, according to the temperament and predisposition of the individual. All the authors that I have consulted on this subject, agree in stating, that patients in every part of Europe, attacked by cholera, first suffered a diarrhoea, and that this continued for a longer or shorter time before the stage of collapse took place. The many instructive accounts which I met with on this point were unfortunately but too fully confirmed, both in the private and public practice, which it was my lot to exercise so long as the cholera raged in this island. 

Brom the fullest evidence we may with ainty conclude, that a great part of the 

7 



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serum of the blood being effused from the mucous membrane, the blood becomes consequently thicker, and is therefore retarded in its circulation ; first in the capillaries, then in the vessels of greater diameter, as the serum continues to be separated ; and this cause continuing to increase, the stage of collapse naturally succeeds. Having thus shortly described the observations resulting from a rigorous examination of that strange disturbance, which is usually occasioned in the animal economy by cholera, it will now be proper to turn to those considerations, which may enable us most sagaciously to discern the best method of cure ; otherwise the remarks hitherto made would be mere lost labour. 



112 

CHAPTER VIII. 

METHODS OF DIFFERENT PHYSICIANS IN THE 

TREATMENT OF CHOLERA. 

If it be an indispensable canon of medical science that we ought to control the first symptom, which announces the presence of any malady in the animal economy — in the case of cholera the practice of this action is so indispensable, that even a few moments passed in neglecting its first symptoms, have been proved by experience, sufficient to render the disease most dangerous, incurable, mortal. It is therefore an act of charity in every physician, and required for the honour of his profession, to render as public as possible a maxim so highly important, 



113 

and which, if once universally embraced, will greatly contribute to render less fatal the attacks of this formidable disease. After having recommended, above everything else, an attention to this most indisputable rule, I proceed to explain, with the requisite brevity, and in the best manner that I can, the different methods which different authors have published, and which I have kept in view during my practice in treating the cholera, both among my private patients, and in the hospital which was placed under my direction. From the time when this alarming malady began to pass from Asia into Europe, one of my principal, and most assiduous occupations, was to study its nature. From that period I endeavoured, as far as was in my power, to procure the books which treated of it : after reading them successively, as they came to my hands, I reconsidered the various doctrines which they contained. I endeavoured to learn the nature of a disease, characterised by the symptoms, which they described ; I observed the method of treatment 

i 



114 

I lowed in the cure, but in this respect I md the most manifest discordance, notthstanding that all the writers very nearly ncurred, in their opinion of the symptomaogy; for some of them recommended a sthod absolutely antiphlogistic, others preibed all the therapeutical means of a mulating nature, and lastly, some adopted uethod partaking of both kinds of treat- 

Dr. A. F. lays it down that the only efficient method is to employ calomel and opium combined, tincture of opium and brandy, stimulating frictions, &c. Orton, at the beginning of an attack of cholera, trusts wholly to opium, in doses of three, or four grains ; and if the desired effect is not produced, he reiterates the same in smaller doses, taken every three, four, or six hours. This gentleman asserts that he found the effects of stimulants in general very dangerous in this malady, and more particularly those of brandy, aromatic tinctures, camphor, essential oils, blisters, nitric acid, &c, and particularly of calomel and venesection. 



115 

I. G. H. Bell insists strongly on the prac-3of venesection. Therefore, after having )ken of the danger, which stimulating meines may produce on the stomach, if adlistered whilst this viscus is in a disor•ed state, he advises, rather to administer omel combined with opium and camphor, owed by a draught of brandy-and-water ; 1 if the vomiting ceases, he prescribes the lowing mixture : — 

Q. jEtheris Sulphuric. 

IHXXX. 

Tse. Opii 

>Nx, 

Mist. Camph. 

3J. 

M. fiat haust 

Ibe taken every quarter of an hour, acding to the urgency of the case : finally, recommends cold drinks, and rubbing by nulating substances over the whole body, ie acid externally applied, blisters, and apisms. 

There are also authors who wrote shortly after having observed, and treated cholera in India ; as far as I have been able to collect from reading their works, I have found them 

i 2 



116 

v 

disagreeing but little, from the mode of treatment practised by those above mentioned ; limiting themselves to contend with the symptoms, they administered every sort of medicine, which seemed to them efficacious in overcoming the symptoms, with which they meant to contend ; those among them who thought that the malady depended on a disturbance of the nervous system, made use of opium, camphor, sulphuric ether, nitric ether, confection of opium, and aromatics. They who held that the malady was derived from a morbid state of the stomach, gave emetics of mustard, ipecacuanha, sulphate of zinc, or of copper, and antimonial preparations; others, in order to expel from the intestines that substance, which they regarded as the proximate valise of the irritation producing the morbid affection, prescribed purgatives of castor oil, rroton tiglii, or jalap. 

Eome who thought that this disorder was ved from a debility of the nervous sys, prescribed the combination of opium l camphor, or with other stimulants, such 

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Ejrandy, compound tincture of cardamum, of peppermint, and cajeput oil. But for • of too much debilitating the stomach, V forbade the drinking of water. 

The authors who studied cholera in Europe alone, in treating it, made use of a similar method, with the exception of those who added to it powdered charcoal and supercarbonated salts — these persons thinking that the virus of cholera had its seat in the venous capillaries of the lungs, whence arose the state of collapse, endeavoured to neutralise it by introducing carbonic acid into the circulation ; there were also others who prescribed oxide of bismuth, ipecacuanha combined with opium and calomel, galvanism, cold baths, warm and vapour, and hot air baths ; and, finally, the injection of saline solution into the veins. 



118 

CHAPTER IX. 

TREATMENT IN THE FIRST STAGE OF THE 

CHOLERA. 

I When a physician is requested to give i assistance of his art to a cholera patient, svill be his first duty to make the most jurate examination of the patient himself. Lose appearances which are distinguishle by the senses, and indicate a morbid inge as having occurred in the animal momy, will guide him in inferring the ssence of the evil, and the true state of case ; consequently the investigation of modifications, which in the cholera are sented in the face, in the beat of the se, in the nature of the evacuations, the 



119 

quantity of the food taken before the attack, the precise time, at which the first symptom appeared, — these are all particulars, which merit the greatest attention of a physician, who undertakes to heal the disease. Having made these researches with the most serious diligence, he must next apply himself to understand the temperament of the individual, interrogating him whether he has been subject to complaints of the viscera, and whether he suffered any such at the approach of the cholera; from a diagnosis well understood, it will be easy to decide what have been the symptoms, which declare the incipience of cholera, and consequently to render the physician more sagacious in applying those particular remedies, which he may deem most efficacious to over- 

iVhen this island was first attacked by lera, instructed as I was by the perusal he authors previously consulted, I began treatment by prescribing a purgative of barb and calcined magnesia, or castor I sometimes caused these remedies to be 



120 

Imbined with opium, in greater or less doses, circumstances seemed to recommend, endeavoured to assist the action of these xlicines by drinks of a slight decoction of momile, rice, or barley ; this method in me patients, where the disease was but •ently developed, succeeded well enough arresting its progress ; but when the apcation to medicine had been too long glected, so that the alvine evacuations had come frequent and more watery, this renen not rarely accelerated the stage of 

Irhe experience I acquired, in the progress the epidemic, induced me to prescribe, itead of the medicines just mentioned, the mediate use of calomel in large doses, m which I always obtained fortunate re- 

frhe oxide of bismuth, w T hich having been atly recommended by various German fsicians, and for that reason used by me i few cases, never produced the effect for :ch it w r as so much extolled. On the trary, it often occasioned intestinal pains, 



121 

I rich greatly annoyed the patient ; and alaugh it sometimes delayed the appearance the state of collapse, it never succeeded stojiping the diarrhoea, a circumstance so sirable in cholera. 

Among the purgatives of which I prescribed the use, at the first appearance of the cholera in this country, I found, I must candidly confess, that those of an oleaginous and saline nature were very hurtful. To a lady suffering an attack of pleurisy, I ordered bleeding both local, and general, the effect of which was to lessen, but not to eradicate the accompanying pains. Wishing to obtain this effect, I proposed for her a purgative of castor oil ; but this, in the course of the succeeding night, having acted excessively, augmented to such a degree the evacuations, which at the same time had become watery, that the state of collapse shortly afterwards supervened, and in a few hours she died. 

I^his case, together with some others, all which were remarkable, rendered me, v my own experience, very careful not administer oleaginous, or saline purgatives 



122 

during the prevalence of the epidemic. I had for many years employed in my practice, and almost always with a fortunate result, the use of calomel in large doses for the cure of dysentery; a constant experience had convinced me that this medicine, far from increasing the alvine evacuations, rather contributed to their sensible diminution, and instead of occasioning great irritation, which they who are ignorant of the laws of medical action falsely suppose, produced, on the contrary, a remarkable calm. By its use the pains of the abdomen were stopped, the alvine secretions changed their appearance, and finally the disagreeable tenesmus, always present when the rectum is attacked, entirely gave way. 

I laving diligently compared these obserions of mine, with the statements respectthe dissections performed in other couns, and with the knowledge of the sympis, which I noticed in the first stage, I ught myself justified in concluding that action of the cholera virus is principally the stomach and intestines; relying on 



123 

Is criterion, I immediately determined to at cholera in the same manner, which ne authors had recommended, but in difent doses, and I therefore began to prac-3 it in the early stage of the disease as 

After having formed to myself the diagnosis, I administered to the patient 20 grains of the chloride of mercury, that is to say, calomel, mixed with an equal quantity of sugar, reduced to an impalpable powder. Having observed in practice that calomel given in pills was often rejected by vomiting ; I thought it expedient to administer it in powder; but I shortly perceived that given even in that manner, it adhered to the papillae of the tongue, and that so tenaciously, that it could not be entirely removed, either by frequent vomiting, or by continued drinking. In order to obviate this inconvenience, I exhibited it rubbed up with sugar, in the same manner as I had been accustomed to give it to infants. Being thus mixed, and consequently enlarged in volume, I caused it to be placed on the tongue of the patient, and 



124 

made him immediately take a draught of water, which contributed to propel the medicine into the stomach, before it had become attached to the tongue, and mucous membrane of the fauces. If, after this application, the diarrhoea continued, evidencing the escape of serum, I repeated, after three hours, this medicine, in an equal dose, and reiterated the practice until the evacuations became more dense, less frequent, and of a greenish colour. When all this had been obtained, I suspended the use of the calomel, and after a day or so, prescribed a purgative. This mode of treatment succeeded in overcoming, in 223 individuals, the symptoms which usually precede cholera; though without such a system these persons would probably have passed into a state of collapse. In these 223 cases I found it necessary to repeat the calomel to only one individual five times, to some others three times ; but in the generality of cases a single dose was sufficient. Many of my patients, under other guidance, had previously taken oxide of bismuth, but not having received 



125 

from this any great advantage, they were advised, under my direction, to have recourse to calomel, which soon relieved them. 



126 

CHAPTER X. 

TREATMENT IN THE STATE OF COLLAPSE. 

Ist. As to Mild Collapse. 

For the better understanding of what I shall have to say respecting the state of collapse, it is important to consider it in two different relations, namely, Ist, as to the milder, and 2nd, as to the graver form. 

In the stage of mild collapse, the loss of serous part of the blood not being very siderable, there may be some hope of cting a cure. When I commenced my ies at the hospital, I first administered in i stage, successively, all the remedies, eh the authors of the different works suited by me had most strongly recomiincled; 



127 

experience, however, taught me it the patients rejected all medicines of a uid nature, consequently as they were not ained in the stomach, it could not be isonably expected that they would proce any benefit. 

i\gain, medicines of a stimulating nature, iduced very painful sensations in the uth, and pharynx ; so that the patient, after ing them once or twice, generally refused m. 

IWe had recourse then to medicines of the id class, which it was supposed would, na their nature, remain longer on the mach ; but from these only small advane was obtained, inasmuch as great part them were rejected, in the same manner the liquids had been. 

Opium, which has been very much recommended in cholera, was not so often tDwn up. But its effects were very injuis, because often operating powerfully on nervous system, it tended to make the ient pass from the mild to the grave state collapse. I combined it with ipecacuanha, 



128 

either alone, or together with calomel, in small doses ; but the result was not less detrimental, (in which case, it produced some good, except when it was administered in the first stage of the malady). Subsequently I prescribed ipecacuanha in doses of 15 grains, and repeated it often in the course of the day, but without any effect. I next gave carbonate of soda with tartaric acid, calcined magnesia, carbonate, alone, or combined with rhubarb ; and I often added to these tincture of cardamum, opium, aromatic confection, and sulphuric aether ; I modified this last method, deducting some ingredients and adding others, but the effect appeared to me quite inefficacious, and sometimes even dangerous. In short, I tried so many medicines, that it would be tedious to recount them all ; but I found nothing better than calomel in large doses. 

There remained the vapour and hot-air bath, but neither this, nor the usual plan for warming a patient by hot bricks, stone bottles with water, &c. &c, was of any service. I therefore think, we may fairly infer, that all 



129 

methods of heating the body are useless ; moreover, the patients in this country, could not endure the touch of warm substances, they preferred throwing off all the bedclothes, and even lying naked on the cold pavement. Irritating frictions, which they could seldom bear, were found to be not Ily useless, but often injurious; subseently T directed them to be rubbed with a ution of morphine and camphor ; this was the proportion of a grain of the former, d three of the latter, to every ounce of ohol. The patients were not only comted by this, but received remarkable be- 

Ilt has been already said, that the external rface of cholera patients, was generally served to be extremely cold, the immeite effect of their morbid state ; the con,nt experience of this led me to reason is, that the cholera virus spreading through s whole animal economy, operated so as concentrate the expansion of heat on the ernal viscera ; acting on this reasoning, I s induced to prescribe the use of cold 

X 



130 

baths, which, attracting the heat from the internal, to the external parts of the body, gave the patients marked ease, more particularly throughout the course of the intestines, and the region of the stomach. The cold bath was tried in this manner ; the patient was laid at full length in an empty vessel, and cold water was poured upon him by three or four buckets at a time ; this application of cold to the whole surface of the body, acted so powerfully that the patient was immediately reanimated, and all the symptoms, as it were by magic, suddenly diminished their malignant intensity. 

I\ girl of 18, who had refused to take any dicine whatever, was found in the last tremity ; as I had experienced the good 3Cts of the cold bath administered to anler female, w 7 ho was admitted into the spital in the stage of grave collapse, I mght it advisable to try it in this second dent. She, however, being at the point death, I began to fear that the remedy uld in this instance lose the credit which lad acquired, if she were to die ; but influenced 



131 

by the reasoning, and exhortations of one of my assistants, and being certain in my own mind that the girl in her present state must inevitably die, I determined at last to subject her to the trial. The success was marvellous, for the girl, of whom we had for several hours ceased to entertain any hope, became at once changed in appearance ; her face showed animation, her eyes completely opened, and her pulse began to be felt ; but after a little while she returned to her former insensible state, and refusing again the medicines, we were under the necessity of subjecting her again to the cold bath, which produced the same good effect as before ; she no longer refused medicine, so that we were enabled to administer the calomel in a dose of 20 grains every half hour ; in the meanwhile she had two other cold baths. The reaction in the patient was mild ; the cure was perfect, and without the slightest salivation or any other unpleasant symptom. I must, however, add, that in almost all the persons on whom the cold bath was employed, a very severe re- 

X 2 



132 

I ion followed, and some of them, though ickly cured of the collapse, fell victims erwards to the reaction which supervened ; ircumstance which persuaded me that the ;hs should only be employed in cases of : most grave collapse. 

IFn young and robust men, where the ack of cholera had been recent, and the s of the serous part of the blood not very 3ious, bleeding, combined with calomel, s very successful ; but it was not so with rsons of a more advanced age, for how-3i" good their constitution seemed to be, lesection was generally productive to them very injurious effects. 

|\.mong the different methods of which I de experiment, for the purpose of arting the further diminution of the serous •t of the blood, was the following : if the ient whom it was intended to subject to s treatment was in the stage of mild colse, and was young and of good constitui, at first he was bled, then I ordered i a scruple of calomel, to be repeated ay hour. But if he was of a more ad- 

7 



133 

vanced age, or of a weak temperament, I omitted the bleeding, and began at once with calomel. I permitted him to drink at will of iced water, and to keep ice in his month ; and if cramps ocenrred, I caused the affected part to be rubbed during the spasm with a weak solution of morphine and camphor in alcohol. 

The prsecordial cingulum was generally liquished by the application of sinapisms blisters. 

|3y this very simple practice, I observed ,t in the majority of cases, after a few ninistrations of these remedies, the icuations became less frequent, and if the ait continued for some time, yet the ctions were composed only of the water ich had been drunk, which, having beae heated in the stomach, disturbed that an, and was consequently rejected by it. 

i[n such a state of circumstances, the omel continued to be administered at the ac intervals of time, but as soon as the .cuations began to be thicker or of a senish colour, and the skin gradually lost 



134 

I livid colour ; when the pulse beat with >re animation, and the voice became sarer, and the thirst ceased to torment the tient ; then I prescribed that the doses of omel should be exhibited with a longer erval of time ; for instance, if in the bening of the treatment they had been en every hour, at this point they were en every two hours. 

I in proportion as the amelioration prossed, the medicine was still more rarely en ; but it was not altogether laid aside :il all the symptoms vanished : when this te had been attained, the patient, if he hed it, was allowed some light food, such rice-milk, barley-broth, or arrow-root, I sometimes even light chicken-broth. 

I Whilst endeavouring to cure a certain ent by means of large doses of calo, having observed that a reaction was Qg place, I thought I might suspend urther administration, as no longer neary; however, in about four hours ptoms of collapse reappeared; I then recourse anew to calomel, but the 



135 

Is of serum, which had occurred dur-1 the suspension of the medicine, had m so excessive, that it produced shortly^ srwards the death of the sufferer. Other es of a like nature happening, I was uced subsequently not to desist from use of calomel, unless very gradually, I found this practice very generally sue- 

Walking one day in company with Dr. Charles Galland, we met with a reverend ecclesiastic, Don Pietro Borge, in company with his sister. I mentioned to Dr. Gal land that this lady was one of the patients whom I had cured by calomel, and I desired Mr. Borge to tell my colleague the number of doses which she had taken ; he answered they amounted to twenty-four, and his sister immediately rejoined, — " I must further say, that on one occasion I happened to neglect taking the medicine but a few minutes after the appointed hour, and immediately I began to feel a great sense of cold." Several other patients made 



136 

i candid confessions of the same nature r they had been cured. 

2nd. As to grave collapse 

If the patient in a state of grave collapse was young, I immediately tried venesection, after which I administered to him a scruple of calomel every half hour. When the praecordia! cingulum was very distressing, which often happened, I applied to the epigastric region mustard poultices, and sometimes also blisters, and leeches. I caused him to drink iced water whenever he desired, and if the extremity of the case required it, I subjected him to the coldbath; at this point, however, it must be kept in mind, that in the stage of grave collapse, the patients, if they were of scrofulous habit, or given to spirituous liquors, and brought to the hospital after a debauch of that kind, very seldom recovered. Any medicine whatever administered to them was totally thrown away. The evacuations of such patients, both on account of the 



137 

Itracted discharge of fluids and of the it of absorption, became less abundant, it were, gelatinous, and of an ashy )ur, having the very remarkable smell of lera, and they soon ceased altogether. 

Whenever the calomel operated beneficially, the malady assumed a different aspect, the evacuations acquired a greenish colour, became more consistent, and almost faecal ; the pulse rose in strength ; the livid colour became lighter ; a certain warmth was felt over the whole body, and all the symptoms gradually improved. This amendment, however, ought not to induce any one to cease altogether from the use of calomel, since a mournful experience, as I have already observed, has taught me that this state was generally followed by most alarming symptoms, which compelled me to resume its use, as I had practised in treating the malady in the mild stage, I mean by a gradual diminution of the administration of calomel. If then the malady continued to advance for the better, some aliment was allowed the patient, but it was 



138 

Icessary to be very attentive to its quality. te best was gruel, composed of vegetable sago, tapioca, salep, and other inaceous substances, more particularly ow-root. These aliments being but •derately nutritive, and therefore of easy jestion, did not subject the patient to >se pains in the rectum, which many thors assert to be the consequences of the order. 



139 

CHAPTER XI. 

fATMENT IN THE THIRD STAGE, OR REACTION. 

However great may be the watchfulnes of a physician, it can never be too intens in the treatment of a patient, at the begin ning of this stage. He must not trust h the least to the feelings of a patient, who when the stage of collapse has ceased, anc a kind of placid calm has supervened, ap pears to himself to be entirely out of dan ger. Such an appearance I found to be almost always flattering, and deceptive ; for often before we could think of it, a new train of the most alarming symptoms pre- 



140 

I ted itself, threatening immediate dissoon; therefore when the patient is observed in the stage of reaction to complain of a pain in the stomach, and when, on a slight pressure, swelling takes place ; when the pulse becomes hard and frequent, the skin hot, and the cheeks flushed, and a R7R 7 ht vomit takes place of greenish matter, the rank seeds of the hidden malady should immediately induce the medical attendant to apply leeches on the seat of pain, to administer abundant draughts of mucilaginous cold drinks, and to use clysters of gruel and other remedies of a like nature ; but if, in spite of these attempts, the inflammation should progress, in that case venesection should be employed, at first generally, and afterwards, if necessary, by applying local blisters. 

If the symptoms indicating gastritis, should be accompanied with enteritis, then immediately, without loss of time, he must have recourse to general bleeding. Blisters also on the thighs and legs must not be delayed, so as to prevent as much as 



141 

Bsible, any affection of the brain which brtunately is too common in such cases. 

If the lungs, or the head should show signs of inflammation, general and local bleeding should be practised, together wit diluent drinks, until some mitigation of th symptoms appears: again, if the heart b affected, blisters should be applied to th thorax, and, if the head is the seat of in fl animation, then behind the shoulders, am the inside of the leg; for all these affec tions the practice of mild laxatives ha been recommended. I prescribed the us of tartarized soda, in doses of two dram every two or three hours, and this no having the desired end, I afterwards ac ministered calomel in doses of three, o four grains, and sometimes also castor-oil the next day ; from this treatment I obtained beneficial results. 

When the patients were persons who had formerly suffered chronic diseases in any of the viscera, every method of cure, under such circumstances, was almost certain to be useless. The inflammation seiz- 



142 

I particularly on the part which had been g weakened, increased so rapidly, that it > impossible to conquer it by any mode practice. 



143 

CHAPTER XII. 

OF PROPHYLACTICS. 

I When cholera appears in a country, it ould be the first duty of every physician to read among the mass of the people the best ections for the preservation of health, earstly advising them to be cautious in the oice of dormitories, and the kind of clothy most fit to preserve the skin against the rnicious influence of the atmosphere, to oid not only abuse in food, but also extraordinary fatigue, which tends to weaken the animal economy ; I shall mention but a few circumstances, which fall within the comprehension of even the most unlearned 



144 

t medicine, but which my experience, dur; the prevalence of this epidemic, induce to recommend to the most careful atteni. 

Food. 

I The best articles of food, during cholera, ! those which are most simple and easiest digestion ; but they should be chosen of food quality, carefully prepared, and used ;h moderation. 

When food is used in a time of cholera to any excess, its volume acting mechanically, impedes the regular venous circulation, it presses on the lungs, occasions difficult respiration, and produces a sense of weight in the stomach ; hence the quantity resists the action of the stomach, and becoming, as it were, an extraneous body, produces local derangements, which induce a general feeling of oppression ; and this occasions vomit or diarrhoea, because the food not being converted into chyme in the stomach, excites vomit in part, whilst the portion passing down, rather irritates the intestines 



145 

than acts as a proper stimulant to them. The consequence of this is diarrhoea. Their proper office being thus altered, if the individual, not being previously predisposed to cholera, has hitherto escaped, he now exposes himself to be easily affected ; and if the malady has not yet developed itself for want of an occasioning cause, he may from these circumstances accelerate the attack ; but it is not necessary, in order to avoid these inconveniences, that we should go to the opposite extreme ; for then the organs being deprived of that which they require to provide against their own decay, would become weakened, their energy diminished, and at length rendered unfit for their proper action. Therefore it is advisable that food should be used in a moderate quantity, so as to guard against that derangement of the animal economy which manifests itself by the painful sensation of hunger. 

iChe inconveniences which are produced excess in quantity may also result from ect in quality. Those substances, which too stimulant and of little nutritive power, 

l 



146 

excite the stomach and other parts too much, and do not give sufficient strength. A continued use of them produces an incapacity for digesting plain food, and also diminishes the heat of the stomach. Aliments deficient in nutritious or stimulating power add little to the nourishment, and do not sufficiently stimulate the stomach to be modified by it ; consequently they pass from this organ insufficiently assimilated into the intestines, and produce diarrhoea, because they are not adapted to excite the proper action of these organs. All this shows that the articles of food should be good in quality, and moderate in quantity. 

|?he kinds of food possessing these qualiin the highest degree are those in which in predominates ; therefore you may with impunity the flesh of sheep, rabbits, beef, if not tough; these kinds of flesh ht to be well dressed, and without aroic condiments. Jelly, inasmuch as it is very exciting and moderately restorative, r be discreetly used, but it requires conents to be well digested by weak stomachs. 



147 

The broth and flesh of veal and chicken, when young, are preferable to all meats, as being nutritive and easily digested. Albuminous food, if too much dressed, produces great disorders of the stomach — therefore you should particularly avoid brains, liver, oysters, eggs, blood, and, above all, fried fish, in which this principle prevails. With regard to this food, I think it proper to state that very many of the individuals who were under my care, both in the hospital and private practice, suffered attacks of cholera a few hours after eating fried fish. These sad effects proceed primarily from the albuminous substance, which having passed into a state of solidity not easily dissolved, and being covered with an irritating coating, becomes altogether indigestible ; and secondly from the oil, which having undergone the action of fire, is so modified as to render it injurious to the stomach. When the atmosphere, indeed, is free from miasma, and the vital organs have not to contend against that powerful enemy, the evils occasioned by irritation of the stomach are much less. 

h 2 



148 

Dishes composed of farinaceous substances, as tapioca, sago, macaroni, rice well boiled, may be used without any fear, since they are moderately nutritive and not irritating ; the condiments used to give these articles a taste, and to render them more or less palatable, ought to be of the simplest and least stimulating kind. Most fruits, when the cholera prevails, are to be avoided, particularly apricots, peaches, cherries, and strawberries. Pumpkins, melons, and figs, are so dangerous as often to cause the malady to develope itself directly after they have been eaten. Many of the cholera patients, who Avere brought to the hospital, assured me that diarrhoea took place after eating fruit of this kind. With regard to figs, the worst consequences were produced by the seeds, which, undergoing no modification in the stomach, irritate by their presence the gastro-enteric mucous membrane. A little good wine at dinner is fitting for those accustomed to it, to others it might be too sti- 



149 

Sleep and Dormitories. 

Sleep should be regulated by the necessity for it — too much relaxes the body, and blunts the mind ; the want of sleep, on the other hand, produces still greater inconvenience, more especially if the intellectual faculties whilst awake have been greatly exercised. You should sleep at night, in order that by day you may profit by the light, which always conduces to health. The places for sleeping ought to be clean, lofty, and easily ventilated , but it is dangerous to expose yourself during sleep to a current of air, or even to have the windows open, because as in the night the watery vapours condense themselves more, the air becomes a vehicle much adapted to introduce miasma ; and if in sleep the absorption, as it is said, be considerably augmented, the malady may, from this circumstance, more easily insinuate itself into the system. 

Clothing. 

Ehe external skin, which in the animal Lomy is the organ that first feels the 



150 

impression of the atmosphere, must, in the time of cholera, be most carefully attended to. As it sympathizes with the gastro-enteric tube, the latter would suffer great derangement if the skin were not kept in a proper state. To prevent these disorders we cannot do better than to guard the skin, as far as is possible, against changes of atmospheric temperature ; this purpose is well answered by woollen garments remaining in immediate contact with the skin ; the slight friction which they produce causes a moderate degree of irritation, and draws towards the surface a quantity of blood taken from that which circulates in the interior of the body ; and as wool is not a conductor of heat, it preserves the skin nearly in an equal state of warmth, and thus the transpiration continues to maintain itself. If these cautions be observed, the atmospheric changes will have no direct influence on the skin, which they would have, if the vestments were of linen. Moreover, woollen clothing receives the moisture of the perspiration, and does not transmit it for some time, and by this 



151 

means also it protects the skin against the atmospheric changes. 

They, who have not the means of furnishing themselves with garments wholly woollen, should at least endeavour to procure a woollen belt to be bound around the abdomen. This practice has been found useful both in India and Europe. 

If, however, these precautions should have been omitted, and more especially if the feet should long remain wet, the skin would be suddenly felt to be cold, its pores would contract, the transpiration would be stopped, and consequently the back and gastro-enteric mucous membrane would re ceive a quantity of blood passing through them, which might open the way to the developement of cholera. In order that the skin should regularly execute its functions, it must be kept constantly neat and clean ; but in order to attain these objects, it is not prudent, in a time of cholera, to use cold baths, which, for the reasons before stated would produce unpleasant effects ; the dirt, however, should be removed by tepid 



152 

Bodily Exercises. 

The motion of the organs, if too long protracted, instead ot giving them fresh energy, renders them at last unfit to exercise their proper functions ; thence follows a debility in the vital and animal nervous system : and the operations of the organs being confused, the assimilation is disordered, the secretions are vitiated, and a general weakness comes on. Repose then becomes necessary, in order to restore a just equilibrium in the action of the animal economy. But this, again, even if too much prolonged, is not so pernicious as an excessive continuance of motion. The total cessation of movement occasions an incapacity to move, an insensibility in the limbs, a diminished activity of the digestive organs, and consequently a defect in the assimilation of food ;" a great quantity of fat is thus accumulated, at the expense of the organs, and in consequence an extreme languor is produced in the fibres. In both cases, therefore, the force of vital resistance being 



153 

Ininished in the organs, they are rendered >re disposed to receive with facility the pressions of the predominant miasma. 3nce it is evident that rest and exercise ght to be reciprocally proportioned to ih other, in order to enjoy the beneficial ects of both. 

Active exercises, like walking, shooting, fencing, gymnastic exercises, &c, so long as they are regulated by a sound judgment, can do no harm in a time of cholera, — on the contrary, it appears to me that they should not be abstained from. Swimming, however, as it impedes the cutaneous transpiration, and augments the action of the gastro-enteric mucous membrane, is no doubt dangerous, more especially to a person who plunges into the water when heated. They who are hindered by any obstacle from using active exercise, should apply to exercises of a mixed nature; such as riding on horseback, but then only after the heat of the day has declined, and the digestion is perfected ; and inasmuch as indolence is a kind of rust, which slowly con- 



154 

I mes the body, and oppresses the spirits, it is cessaiy that they who have not the means enjoying active, or mixed exercise, should ictise that which is passive, such as Ling an airing in a carriage, or sailing in 

Again, we ought not, through fear of this disorder, to neglect the exercise of the intellectual faculties; for besides the loss of their immediate effects, they may even produce a hazard of attack from disease. The total want of all occupation may probably turn the mind to the contemplation of the terrible consequences of the predominant disease. Every one knows what evils are produced by keeping the mind always fixed on a malady, which we are either suffering or fear to encounter. It is, therefore, useful that those who are not addicted to profound studies, should employ their leisure hours in the reading of books, which are either instructive or innocently amusing. 

f Vehement passions, such as terror, or the ck of unexpectedly hearing bad news, among those occasional causes which 



155 

may easily induce cholera. Who docs not know how lamentable their effects are on I nervous system, and consequently on gastro-enterie and urinary passages ? ich caution should therefore be used, and possible prudence observed in commuating information of this sort, that we y avoid all painful regret at its fatal conuence. 



156 

Containing the Names of the Cholera Patients received into the Hospital of the Normal School, and the quantity of Calomel in grains taken by each. Date of Place from Date of Quan- Ad- whence they Age. dis- Date of tity of mission. Name. came. missal. Death, calomel Kemarks. taken. grains. June 20 Nicola Ambrosini . Valletta . 48 .. June 20 .. ) Found in the hospital in a state of re- Raffael Fenech . do. 22 .. 26 ..1 . »f» f h with th M Gaetano Xuerof . do. .30 .. 20 . . f Qvmntnrrl. r 21 Maria Jones . Senglea .32 .. 22 . . J sjmptoms. Salvatore Carnana . Valletta . 64 .. 22 Marianna Caliero . Vittoriosa 47 .. 22 Giovanni Schembri . Forzato . 50 June 23 Angelo Cachia . do. .26 24 Anna Colaira . Floriana . 56 23 23 Giuseppe Psailae . Forzato . 48 25 On this day my service commenced in the hospital. Michele Talzon . Cas. Asciak 42 Giovanni Callus . Valletta 85 .. 24 Mich. Ang. Villa . . Cospicua . 38 .. 30 Bloody evacuations. Salvatire Cremona . Valletta .60 27 30 LRosa Xneref . do. 53 Paolo Debono . Birchircara 54 .. .. 24 Grazia Cutazar . Zabbac . 16 July 1 24 An insane person . Valletta . .. .. .. This insane person, brought to the hot Pasquale Galea . Forzato 28 .. .. 25 . . pital by the police, name unknown. 

TABLE 



157 

Maria Agnis . Zabbac . 70 June 27 25! Giuseppe Magro . Cospicua . 25 Vincenza Maniglia . do. .79 . . 29 24 Giovanni Debono . Forzato ... 19 26 Francesco Glevan . do. .22 . . . . 160 Saverio Farrugia . Valletta 69 . . 25 Grave. 25 Vittoria Grecli . do. . I 24 . . 26 .. Grave. Antonio Mercieca . Forzato . 22 . . 26 20 J Pregnant and great pain. Daniel Nicholson . Scotland .28 .. 29 20 I Refused the medicines, and died in the reaction. Salvatore Xicluna . Floriana j 43 . . 25 . . Lived a few moments. Gaetano Zammit . Cospicua . , 80 . . 27 .. Received from the Civil Hospital. Refused all medicine. Veneranda Fenech . Valletta . i 24 July 5 25! Lived a few minutes. N. N. insane . do. . ; .. .. 160 26 Saverio Farrugia . do. . June 29 25 ? Giuseppe Psaile . Forzato . 48 SO Angelo Calleja . Valletta .60 30 480 Arrived from Fort Ricasoli convalescent. Mina Spiteri . do. .64 . . . . . . Received from the Civil Hospital in a state of mild reaction. Margarita Mifsud do. . j 27 July 7 26 20 Refused to continue the medicine. Giuseppe Grech do. .2 - . . . 160 Margarita Balzan . do. . 66 June 29 29 100 Refused medicine. Teresa Attard . do. . 24 ! July 1 June 29 130 Battis'a Mora . do. . | 12 . . . . 29 . . Refused medicine. Margarita Camelleri. Cospicua . ; :«) . . 26 Received in state of reaction. Giuseppa Volpi Franconi . 23 . . 20 Lived but a few minutes, and refused medicine. Caterina Spiteri . do. .37 1 - . 130 



158 

I j~* j Quan- Date of Place from Date of Date of tity of Arl- Name. whence they Age. dis- death, calomel Remarks. mission. came. missal. taken. j Andrew Adams . Schoo. Rose 23 June 29 .. 240 June 27 Giuseppe Teuma . ! Valletta . 25 .. July 1 20 Refused to continue the medicine. : RosaVassallo . Kirchircava . 70 July!) .. 260 i Vincenzio Xerri . Flonana . 17 3 . - 240 | Concetta I'uschieri . Valletta . 28 . . June 29 50 Died after miscarriage. Michele Xuercf . do. . 91 June 30 . . SO Anna Sclieindri . do. . 53 July 8 230 l Salvator Micallef . do. . 80 June 30 .... 28 ! Madilalena Mamo . do. . 27 . . July 1 40 Refused to continue the medicine. i Robert Bark . >Sh. Somerset 15 July 1 . . 580 Andria Cauchi . Forzato 27 1 . . 480 I Salvatire Zarb . : Floriana .20 June 30 . . . . . . ! Andria Debono . • Valletta . 22 . . June 28 20 Lived a few minutes in the hospital. I An <T elo Spiteri . do. .15 . . 28 10 Refused to continue the medicine. ' Rafaele l\>rtelli '. Naxaro .62 .. July 1.. Refused to take medicine. 29 Bri^eta Buc?eja . Valletta .55 .. June 29 .. Received in a dying state Eminanuele Cremona do. . 10 . . July 3 40 Died in the reaction which followed his admission. Salvatore Agius . Zabbac .26 30 Salvatoiv Azzopardi Valletta . 30 .. June 30 20 AnnaAttard ' do. . 11 July 2 ..80 Gaetano Bussitil . Birchircara 57 . . July 3 20 Refused to continue the medicine. Catarin i Z'thra Siggieui . 70 .. June 30 20 Refused medicine. 30 Benedetta Debono . Valletta . 42 . . July 2 . . Died two hours after his reception into the hospital. Rocco Muscat . ! Zurnio .20 .. June 30 20 Refused medicine. I Nicola Muscat . i Floriana . 50 . . July 3 60 Typhoid reaction. 



159 

Catarina Cassar Senglea . 30 2 . . . . I Vincenzo Tonna . Valletta .40 . . 3 CO i Recovered from the cholera, relapsed, I and refused to take more medicine. Georgio Tava . Forzato .2(5 . . 1 80 Refused to take more medicine. Rosa Mazza . Valletta .54 . . 10 Refused calomel, but took other medicine. Rosa Sieberas . . Floriana .CO . . 5 80 ] Pied in the reaction. Rosa Xerri . . Valletta . (56 .. G j Received in a state of apoplexy. Giovanni Vella . Gudia .50 . . 1 . . Not being able to take any medicine, died in a few hours after his admission into the hospital. July 1 Vincenzo Calleja . Valletta .55 . . 1 Not being able to take medicine, he died a few hours after his admission into the hospital Giuseppe Setuto . Forzato .27 6 80 Angelo Bugeja . Floriana .IS .. 2 40 j Died in a state of great cold. Antonio Mizzi . do. .63 . . 2 60 | Died in a state of great cold. Gio. Maria Curator . Forzato .16 8 340 Angela Micallef . Valletta .24 3 .. 280 Felice Sirortino . Sta. Vennera GO 5 . . 340 Antonio Zerafa . C. Asciak 40 2 40 Unable to take medicine by the mouth. Giuseppe Rogue . Valletta .20 7 ¦ • ICO M ichele Bors . do. . 50 4 . . 80 Giuseppe Vassallo . do. .18 . . 91 Refused medicine. Maria Coleiro . C. Tarscien 20 3 20 Refused medicine. Lorenzo Bondini . Penglea .05 6 400 Maria Paid . Valletta .45 7 •• 80 Giuseppa Borg . do. .5(5 . . 2 80 | Died in the reaction. 2 Grazia Camilleri . C. Asciak .85 .. 3 .. ! Died two hours and a half after he was received into the hospital, and was unable to take any remedy. Giuseppe Fencch . C. Tarscien 87 . . 2 GO Died three hours after his arrival at the 



160 

I Ttat t Quan- ~ ' , mte 01 Place from Date of Date of tity of l mi *. Aame - whence they Age. dis- death, calomel Remarks :miS!)lon: miS!)lon - came. missal. taken. Lorenzo Pullecino . C. Birchircara 14 July 7 i Lorenzo Vella . . Floriana .21 .. July 11 .. : Died after a relapse. Z&SS : iSST. H- 7 2 lbb SSfcSS i Va^ta' :'I - 5 " 2 24 Died^- minutes after being received. CarmaloMih . . do. .48 .. 2 80 Died twelve hours after his arrival at BarnardoFrendi . do. .24 .. 4 .. JSttSLm. RaccoSahba . do. .24 .. 3 .. Refused medicine. Lm^S^Hpfi Ma r- d 2--, " - 45 3 •• Treated with oxide of bismuth. Lisola Spteri . C. Asciak .66 .. 3 .. Refused medicine. Anuunz. Oabaretta . Floriana .12 .. 2 .. Died three hours after entering the hos- JulyS Angela Bezzina .do. .48 .. 5 160 Dfedta the reaction. GmsennpTpV " ' v tiV* '° " 3 320 Die.l five hours after he was received. WuseppeXenu \a!letta . 55 .. 3 80 Died four hours after he was rece ved. v™ * "V nViCt • 55 •• 3 80 Died five hours after he was received. Vincenza Az^opardi . Valletta .80 . . 3i 58 Maria Suda . < do. . I 42 . 6! Franc. Say.S ay . Nicefar..' R. M. F. Re ai '.'. i 12()1 2 () Refused to continue the medicines. AnnaSammut Valletta . 4o .. 3 . Refused medicines. Aloisia Vella C. Zabhac .50 i) 470 Newla Pace . • Valletta .60 . . 3 20 Died soon after he was received into the hospital, do. .19 4 20 



161 

Antonio Cassar . do. - | 70 .. 4 20 Lived seven hours in the hospital, and Nicola Zammit . Vittoriosa . 58 9 340 refui *d to continue the medicines. r.!?JHn 1w? 1 w?r daChino ll a v etta - • r6r 6 44 80 Lived thirteen hours in the hospital. S^tST ! £KSJ 3 ¦•« 3 £ I^ed an h 0U r in the hospital/ 4 saw*. • v ar .s••o! ' i s a ?ed hereaction - SSSLhSSS" 1 * P-4 •S- S » SJ^Stt hours in the hospital. Mar.aC:auchi . ,jo. .40 11 (i6O Salivated. FS P Ho5 laS '. t!S"J - 4 sib Li - dtl - hours in the hospital. John Macleanen . do. . 45 g 050 (iiovanniAzorardi. C. Tarscien . 50 .. 4 .. Lived six hours in the hospital. o e,.pa ,rech . Forzato . 6U .. 5 .. Kefused all medicine. mSS4iS| : r T" 'si - C 5 S L-d seven hours in the hospital. 5 rh^tv 61 !!' 18 • V^ lletta ' •¦ 64 6 m Died in the reaction. Giuseppe vella do. . 14 9 . 100 Maria Attard . Pieta . 27 9 InlirίaS i V do! tta i 27«2 7 « ", ". * 7t 7 t seventeen hours in the hospital. Angelo Isaidachino Vittoriosa 10 9 280 JJISfpSS" 1 : V do? Ua : JB'• J " IIM Livedninehoursin c hospital. 

M 



162 

Kate of Place from Date of Quanad Name. whence they Age. dis- Date of tity of Remarks. mission. came. missal, death, calomel taken. grains. July 5 Maria Aquilina . Valletta . 25 July 9 . . 2GO Salivated. Liberata Said . Floriana -75 . . July 6 . . Refused all medicines. Vittoria Micallef . Valletta .50 . . 6 200 Lived nine hours in the hospital. Teresa Chetcuti . do. . ?fi 19 . . 140 Concetta Spiteri . do. .45 . . 5 Lived a few minutes in the hospital. Teresa Ciappara . Pieta -75 . . 8 180 Died in the reaction. Caterina Debono . Valletta .79 . . 6 . . Entered with symptoms of apoplexy. Ignazio Vella . do. .29 .. 5 40 Lived seven hours in the hospital. July 6 Giuseppe Micallef . Valletta .25 .. 6 140 Lived eight hours in the hospital. Rosa Cauchi . do. .27 . . 6 (50 Lived five hours in the hospital. Lucia Valla . . Floriana .45 20 .. SL'O Salivated. Giuseppe Sammut . do. .54 . . 6 80 Refused to continue the medicines, and lived seventeen hours in the hospital. James Pearce. . Scho. James 18 7 .. 320 Lorenzo Gauci . Valletta .30 . . 6 40 Lived four hours in the hospital. N. N. (Insane) . do. . . . . . 6 Teresh Spiteri . do. . 50 . . . . . . Lost the notes. Antonio Portelli . do. . 26 20 .. 500 Salivated. Giorgio Ciappara . Pieta .GO .. 9 200 Died in the reaction. Angelo Cilia . . Valletta .58 . . 6 20 Refused to continue the medicine. Flllippo Borg . do. .70 6 . . . . The notes lost. L Nicola Gafan . do. .45 7 . . 100 Maria Abela . . do. .52 . . 6 Lived an hour in the hospital. Giuseppe Borg . do. .23 . . 6 100 Lived eleven hours in the hospital. Angela Gambin . do. .28 .. 10 120 Died in consequence of abortion. 



163 

M 2 

Constanza Zueref . do. . lfi (i . • 460 Rosa Carnana . do. 60 7 80 Refused to continue the medicine. Carmela Abela . C. Zabbac 52 7 40 Refused to continue the medicines. Vincenzo Camilleei . Forzato .24 9 . . 580 Carmelo Misl'ud . Valletta 22 7 40 Lived rather less than four hours in the hospital. Andrea Gatt . . Forzato 55 11 360 Died in the reaction, which took the form of typhus. Paolo Borg . Valletta 60 11 260 Died in the" reaction. Marg. Camizuli S.Giuseppe. 28 01 960 This person took calomel in doses of two scruples at a time. 7 Benigno Grech . Valletta 19 10 560 Giuseppe Mercicca . do. .22 9 . . 340 Petronel Sceberas . C. Luca 35 7 40 Lived one hour in the hospital. Frederico Gibiotti . Valletta .13 9 .. 340 Giuseppe Zammut , C. Zurrico .41) 9 . . 340 Vincenzo Vasssallo Notabile . 40 . . 7 40 Lived two hours in the hospital. Michele Zammet . C. Curmi 45 9 8 180 Lived nine hours in the hospital. Emmanuele Agius . Forzato . 50 • • 8 100 Lived eight hours in the hospital. Michele Cashia . Valletta 7? 8 60 Lived four hours in the hospital. Tommaso Sceberas . C. Luca • 9 21 60 Maria Sceberas . do. . 6 21 .. Maria Desavcris . Valletta 40 8 1-40 Lived seven hours in the hospital. Maria Zahra . . do. .50 11 .. 240 Angela Sultana . do. .60 9 . . 48 Anna Benedette . do. .30 9 . . 300 Giovanni Sceberas . do. 62 8 .. Lived a few hours in the hospital. 7 Concetta Spiteri . Fabetta 26 9 200 111 seven days before she was received into the hospital. 8 Giuseppe Xicluna . Senglea . G6 .. 8 100 Lived five hours in the hospital. 



164 

_ , ~~\ Quan- Uate ol Place from Date of Date tity of admls " Name. whence they Age. dismis- of calomel Remarks Slon - came. sal. death. taken. July 8 Maria Cilia . . Valletta .40 July July 9 g . mS> Lived seven hours in the hospital, and .... . _ , refused medicine. ft icola Falyon . . do. .48 15 6-'O Antonio Tonna . C. Tarscien . 81 . . . . Note lost. Antonio Borg . . Curmi 27 10 120 Died in the reaction. Giovanni Bonanno . Valletta . 30 10 .. 620 Giuseppe Muscat . Floriana . 56 11 .. Mislaid the note. Annaίorj? . . Valletta 75 11 .. Refused all sorts of medicine. Carmela Borg . . do. 22 8 Lived one hour in the hospital. Maria Carioto . . do. . 1!) . . .. .. Note lost. Rosa Borg . do. . 33 . . 9 20 Refused medicine. Felice Xicluna . Floriana . 62 .. 9 . . Died a few hours after entering the hos- Matteo Camelleri . Valletta . 42 10 . . 206 Giuseppe Muscat . Floriana .65 .. 8 140 Died in a state of rigor. Giovanni Vella . do. .27 11 8 152 Rafaele De^eovanni . do. .16 9 . . 260 Dammiano" Catania . Pieta .80 18 .'. 320 Antonio Gatt . . do. . 56 10 .. 200 Ant. Franceschini . Forzato . 30 12 7(10 Rosaίuhasiar . Valletta . 55 14 .. 300 Died in the reaction. 9 Albino Gauri . do. 64 9 .. Died a few minutes after being received. Francesco Bonnett . do. .26 17 .. 200 Salivated. movan. Galleja . do. 49 9 80 Lived three hours in the hospital. Caterma Zammit . C. Luca 28 9 Died a short time after his reception in the hospital. 



165 

Maria Hili . . Floriana 33 12] 300 Recovered, relapsed, & died in threehours Salvatore Gatt . do. .12 10 . . I 100 Concel. Azziopardi . Valletta .24 9 120 Grazia Hill . . S.Giuseppe. 46 9 100 Lived seven hours in the hospital. Maria Messina . . Valletta 23 9 40 Lived six hours in the hospital. Innocenza Ellul . do. 45 9 80 Refused to continue the medicine. Antonia Spiteri . do. . 34 27 280 Nicola Testa . . Pieta 74 10 . . Note lost. Francesco Roll . Valletta 32 9 . . Lived half-an-hour in the hospital. Lorenzo Buttegug . do. 30 9 Refused medicine. Aloisia Schembri . Forzato 21 19 100 Refused to continue medicine. Mariana Micallef . Valletta . '28 31 . . 130 Removed here from the civil hospital with diseased liver. Antonia Veila . . Pieta 61 15 •• • . Note lost. 8 Maria Attard . . Floriana . 49 .. 11 . . Refused medicine. Maria Cassar . . Valletta 70 11 . . Refused medicine. 10 Benigno Said . . do. 35 10 20 Refused to continue the medicine. Antonio Xucref . do. 68 . . 100 Gaetano Zammit . do. 75 11 320 Died in the reaction. Nicola Mercieea . do. 54 12 300 Died in a state of intense coldness. Francesco A byer . Forzato . Iff .. . . ? Note lost. Angela Saliba . . Valletta 12 12 . . Received in a state of reaction, with symptoms of disease of the brain. Maria Galea . . do. . 60 . . 10 . . Lived one hour in the hospital. Vincenzo Attard . do. . 05 .. 10 100 Died in a state of great coldness seven hours after his admission. Vincenzo Calleja • do. .30 12 Concetta Said . . do. . 3 . . 10 320 Note lost. Felece Galea . . Floriana . 60 15 . . 400 Teresa Spiteri . . Valletta . 80 .. 10 .. Lived two hours in the hospital. 



166 

I ii t Quan- ~~ ~ ~ — \ a ¦ xt Place from Date of Date of tity of artmis- JName. whence they Age. dismis- of calomel Remarks s '""' came. sal. death, taken. July 1(1 Marcella Vella . . Valletta . 22 July 13 July 2GO Emmanuele Schembri do. "28 15 360 Giuseppe Abela . do. ". 43 14 120 Giovanni CamiUeri . do. .22 13 '. '. 18 Salivated. Sir. : 83* :ll•» ll 4^!! Livedsis hours **»»>*#«• Francesco Bartolo . Forzato -23 17 360 11 Salvatore Bartolo . Valletta .5216 ' 280 MaddelinaMufsud . do. . 22 14 20 Refused medicine. ? feppeFenech . do. . 50 . . 12 Refused medicine. Antomo (Insane, . do. ..... ll .. Lived but few minutes after having been Giuseppe Vella . . Babbato . 29 . . 11 .. LivedTfet minutes after being received Bernardo Gripo . Floriana . 46 . . 12 200 Di^^sS^igor eight hours after RosarioEllul . . do. . 50 . . 1, .. DS D S S^ after being received Maria Xerri . . Valletta . 19 16 40 tot ° «» hospital. G.useppe Mifsud . do. 24 .. ll .. Lived a few minutes after being received Pietro Azzopardi . do. .20 15 140 ">to the hospital. Maria Castaldo . do. .50 16 460 



167 

SaverioTonna . . do. 89 .. 10 ° GeorgioElia . . do. 58 12 ¦¦ Refused medicine. Vincenzo Caruana . Floriana .30 18 .. 220 Teresa Muscat . Valletta . 12 13 Antonia Missud . do. . . 43 17 •• 340 Annunziata Acguilina do. 33 11 20 Eugenia Volpi . Pieta . . 36 .. ¦¦ •• NNote lost. Paolo Zammit . Valletta .19 19 ¦• 920 N. N. (Insane) . do. 11 •• Died a few minutes after he was received into the hospital. Francesca Gallea . S. Genteppe 18 12 30 | Refused to continue the medicines. Carmelo Bonano . Valletta . 31 H 20 Lived one hour in the hospital. Ro^a Cortes C. Curmi 29 I 4I 4 J2O J 20 The reaction took the form of typhus. Anna Schenbri' . Valletta 48 12 20 Died in a state of rigor seven hours after he was received. Vittorai Portelli . do. .19 17 •• 540 _ Antonio Gallea . do. . 15 .. 13 80 Died in a state of rigor seven hours after he was admitted. 12 Francesco Zerrueto . R. M. F. Re 60 15 .. 220 Maria Galea . . Valletta .34 25 .. »00 Maria Muscat . . do. .60 15 .. 160 Teresa Spireri . . do. . 12 . . . . * «0 Maria Barbara . . Floriana 30 12 . . Refused all medicines. Marianna Barbara . do. .5 14 40 _ Rosa Baccarizza . Valletta 50 17 420 Died in a relapse caused by an error in diet. Caterina Gaucci . do. . 10 13 . . Vincenza Arpa . do. .67 20 780 SSlngulo i do". :1.. I 5 18 60 Lived flve^honn. m^the hospital, aud 



168 

Quan- Date of Place from Date of Date tity of admis- Name. whence they Age. dis- of calomel Remarks. sion. came. missal. death, taken. grains. July 12 Mananna Zarafa . Valletta . 45 July 13 July 160 Luigi Callega . . do. .9 14.. 60 Vincenzo Mazzi . Floriana . 70 . . . . 360 Roza Zammet . Valletta . 60 . . \] 260 Maria Grech . do. 62 " 13 60 Lived nine hours in the hospital, and died _. _ , in a state of rigor. Giuseppe Gufan . do. .40 15 . . 480 Took cold-baths three times. Andna Xichma . do. . 45 . . 13 200 Lived five hours, and died in the cold Francesco Finri . Floriana 84 13 20 Entered the hospital in a dying state, _ , _. and lived an hour. Agostmo Portelh . Valletta . .. .. .. Note lost- Cattariua Genni . do. . 11 .. .. ? Note lost. Giuseppe Pulis . Floriana 45 13 .. Refused to take medicine. Francesco Caldon . Valletta 50 13 .. Died a few minutes after he was received. N. N. (Insane) . do. ... .. 13 .. Agostino Schembri . do. . 44 17 I*6o Angela Fiteni . do. 33 12 .. Arrived at the hospital with symptoms of a j- typhus. 13 Anna Azzopardi . do. 70 13.. Lived four hours in thp hospital, and refused to take medicines. Liberata Inguanes . do. 75 U ioo Lived seven hours in the hospital, and . diod in the cold stage. Antonio Carnana . do. 30 13 20 2 0 Lived three hours in the hospital, and . died in the cold stage. Grazia Bugeja . do. . 70 . . 13 160 Refused to continue the medicine, and died in the cold stage. 



Giovanni Aquilina . Floriana .45 21 . 1100 SalivatPrt Alessandro Attard . Forzato • 73 is aim t?a-?v Maria Cauchi - • Pieta .M " » 100 Died m the reactlon - Angela Spiteri . . Valletta 30 . . " Note lost Rosa Anna Spiteri . do. 15 26 -?20 Giovanni Vella • do. .11 17 an Aquilius Mieallet . do. - 12 ?0 cS^p : °- 3 ¦ ¦ g - Idst 1 dsta ge , r efused medicine. m cdicine. p • • • • w . . Expired a few moments after being re- Salvatore Mizzi . R. M. F. Re. 29 15 140 cciv cd. Vittoria Catania . Valletta 47 n *n *• -¦ Giovanni Micallef . do 4(i k™, , 40 lvedt^,° "ours after being received. Salvatore Gauri . do! ". 4 g ' [ " 17 ; ft( , eceived convalescent. ' ¦ • 17 50 ° Recovered from the first attack, relapsed Francesco Borg . Floriana 50 Til on and dl ej in three hours. Antonio Pace - . do '. 5, 16 o fa d . an tI hour j " the hospital. Maria Saliba . . S.Giuseppe 40 " A m " led "' tlle react.on. ppe w l 3 CO Lived three hours in the hospital, and Maria Agius . . Valletta . 42 ]fi on died *" cold stage. Francesco Zammit . C.Birchircara 55 " 3 8 ° ? e^ *» continue the medicine. • ¦ * a A great drinker, lived three hours in the Maria Cassar a . Floriana ; 72 . . 13 Lived a few minutes.in the hospital. ' ld 80 Lived four hours in the hospital, and died Francesca MuHct ' E^ tol ° 41 • • " - H^S $&££ and died in the cold favStt. ! SSS Re 62 - Jf, 2 Diedf^n hours after the reaction. Cannela Matrenza . Valletta 42 "' !^ Died in the reaction. Vittoria Arnand d " Lived but few minutes, Servrio Galc'a * ' • 10 > " 13 '. Lived two hours in the hospital. ' •¦ '4 I 60 Died in the paroxysm of pain. 





170 

I Date of Place from Date of Date tity of adinis- Name. whence they Age. dismis- of calomel Remarks. sion. came. sal. death, taken. grains July 14 Feluc Busuttil . Valletta 75 July July 14 100 Lived nine hours in the hospital, and died in the cold stage. Carlo Saracino do. 29 22 400 Recovered from the first attack, relapsed, and died in four hours. Andria Digabliete • C. Curmi 33 14 200 Lived ten hours in the hospital, and died in the cold stago. Rosolia Zammit . C. Zabbac . 80 .. 18 100 Died in consequence of abortion. Maria Felice . . Floriana 50 15 20 Received in a dying state, not able to take medicine. Giuseppe Carmizuli . C. Zurrico . 30 17 420 Maria Galdies . • C. Curmi 40 10 200 Died seven hours after he was received, in the cold stage. Elena Galea . Floriaua .70-- 14 20 Did not continue the calomel, it being scarce. Mar. Ter Tommani . Valletta 62 15 40 Did not continue the calomel, there being a scarcity of it. Saveria Saliba . . do. 61 14 Lived but a few minutes in the hospital. Maria Xucref . . C. Zabbac 76 17 60 Did not continue the calomel, it being scarce. Giovanni Montibello Valletta . 52 . . 14 20 Lived seven hours in the hospital. Giuseppe Tanti . Forzato .20 17 •¦ 120 Received the fresh calomel and continued to administer it Michele Borg . . Floriana .24 17 •• 840 Salivated. Agostino Tonti . Forzato .23 17 •• 180 Giovanni Spitori . Valletta 15 14 Repeated the medicine. Vincenzo Camilleri . Forzato . 24 17 120 



171 

Liberata Pare . . Valletta .45 1/ .. 220 Caterina Gauci . C. Curmi 80 14 Died a few minutes after being admitted. Maria Ghegue. . Valletta .44 18 .. 160 Antonio Ohircop . do. . 24 16 .. 420 Michele Camilleri . Birchircara 2i 14 200 Died in the cold stage, four hours after his reception. SsalvatoraVella . Floriana 49 16 280 Died in the cold stage fourteen hours after _ he was received. 15 Paolo Abela . . Valletta .60 22 .. 320 Giuseppe Villa do. 72 19 ao Refused to continue the medicine, and died in the cold stage. Luigi Xucref do. 50 15 300 Lived two hours in the hospital, and died _. in the cold stage. Giuseppe Mizzi . do. . 50 Aug. 1 . . 900 Salvatore Genois . C. Zabbac ¦ 15 July2l .. 180 Salivated. Gaetano Borg . . Valletta .21 3o . . 600 Antonio Ferli . . Pieta . 13 19 .. 280 Antonio Cilia . . Valletta .21 17 . . 400 Rocco Sultana . . S. Giuseppe .17 17 .. 1 ()( > Vincenzo Vassallo . Valletta 30 16 500 Died in the reaction. Giorgio Bat Fiorante Napolitano . 56 . . 20 320 Died in the reaction. 9 Grazia Magro . . C. Zabbac . 22 . . 20 60 Refused to continue the medicine. Angelo Scheinbri . C. Curmi 22 22 620 Died in the reaction. Caterina Filodavo . Valletta . 40 Aug. ] . . 140 Maria Camilleri . C. Curmi 40 15 40 Lived four hours in the hospital. Andrea Farrugia . Forzato . 44 Julyl7 .. 160 Andrea Chetcuti . C. Zabbac 50 15 Died four hours after his admission to the hospital. Fortunato Azzopard. Pieta 50 16 240 Died in the cold stage. 16 Maria Sapiano . . Valletta 80 19 500 Died in the reaction. v mcenza MiH . . do. . 10 . . 20 7* Refused to continue the medicine. Filippo Amato . . R. M. F. Re . 49 . . \'J 520 Recovered, relapsed, and died after four 



172 

Date of Place from Date of Date tity of admis- Name. whence they Age. dismis- of calomel Remarks. sion. came. sal. death, taken. grains. July 16 Anna Camilleri . Valletta . 82 July July 16 . . Refused medicine, and lived three hours. Cristina Camilleri ' m Floriana .33 16 320 Maria Vella . . Valletta 40 20 80 Refused to continue the medicine. Saverio Camilleri .do. 73 16 200 Lived eleven hours in the hospital, died in the cold stage. Vincenza Magro . Napolitano . 39 18 . . 460 Gio. Maria Magnin . C. Curmi 60 16 40 Lived four hours in the hospital. Grazia Mifsac . Floriana 65 25 Obstinately refused medicine. Maria Camilleri . Valletta .26 27 3-20 Catarina Borg . . Floriana 57 16 220 Lived four hours in the hospital, and died in the cold stage. Maddalena Zammit . C. Zabbac 60 27 160 Refused to continue the medicine, and died in the cold stage. Antonio Camilleri . Valletta 67 17 400 Lived twenty-two hours in the hospital and died in the cold stage. Salvatore Sammut . Forzato 18 . . . . 160 Teresa Camillori . C. Curmi 15 16 Received in a state of insensibility, and died a few minutes after. Giuseppe Borg . • Floriana 45 . . . . Note lost. Francesca Cassar . C. Zabbac 89 19 200 In this case the evacuations were always black ; died in the cold stage. Antonio Zahra . Valletta . 59 .. 19 500 The reaction was succeeded by inflammation of the lungs. Giuseppe Zahra . C. Zurrico . 23 . . 20 2GO Refused to continue the medicine. Francesco Borg . C. Curmi 70 17 200 Lived twelve hours in the hospital, and died in the cold stage. I 1 



173 

Feliceta Pare . . Valletta 50 17 .. Received in a state of typhoidal reaction. Rosa Rachia . . Floriana 16 17 Absolutely refused medicine. N. N. (Insane) do. 17 17 Francesco Spiteri . Forzato .35 19 .. 340 Francesco I'ace . do. 30 23 .. 260 Maria Miculilf . . Valletta .26 22 .. 340 Madelina Sesandro . do . 10 25 . . 240 l'ietro Agius . . Floriana • 40 30 . . 840 Michele Ellul . , Cospicua . 52 21 240 Giorgio Xucre . Valletta .33 20 260 Carlo Curmi . . Ergostolo . 24 . . 19 Note lost. Maria Camilleri . Vallatta 65 17 Lived three hours in the hospital. Giuseppe Muscat . C. Curmi 70 17 120 Lived ten hours in the hospital, and died in the cold stage. Salvatore Carnana . Ergostolo .30 20 240 Antonio Tonna . Valletta 34 23 800 Recovered from cholera; by an error in diet relapsed, and died in three hours. Andria Farrugia . Ergostolo 44 . . . . Note lost. Marianna Bajdda . Valletta .49 22 220 Giuseppe Azzopardi do. .65 21 500 Arrigo Greca . . Krgostolo 76 18 Obstinately refused medicine. John Skinner . . Sc. Sarah Anne .23 19 160 Antonio Spiteri . Valletta . 33 23 . . 220 18 Francesca Carnana . do. . 55 Aug. 1 . . 220 Anna Baldaschino . do. . 26 July2s . . 400 Rosa Valda do. 40 . . . . Note lost. Anna Fenech do. .75 26 320 Anna Darega J . do. .48 .. .. .. Note lost. Petruccio Cremona . do. .48 . . . . . . Note lost. Giuseppe G. Crimbo Cospicua . 57 . . . . . . Note lost. 



174 

v" u "J t0 . of Place from Date of Date tity of adnns- .Name. whence they Age. dismis- of calomel Remarks sion - | came. sal. ! death, taken. [ : i •July 18 Girolamo Cilia . . Valletta . CO July ljuly 18 Refused to continue the medicines, and Maria Grech . . do. . 21 I . . ! Notios't^ "^ Charles laker .. j Sc. Sarah Anne 36 !20 " 3-20 I>otelost - Rosario Mustoegari . Napolitano . II .. 22 500 Died in the cold sta^e. Emmannelelare . A ulletu . 80 .. 21 300 Refused to continue the medicine, and rr-co \r v i d' ed m tne cold stage. Ursolavclla . . do. . 45 22 420 Teodoro Filodaro . do. . 40 . . "23 . . Refused to take the medicine, and died Maria Spiteri . . do. .31 ' 31 380 in t"^oW stage. Annunziata Micallef . Valletta . 18 | -- 10 400 Lived eleven hours in the hospital, and h.i_*«_. t j j died i! 1 tlie cold stage. Salvatore Tedesco . do . 53 -. .. .. Note lost Maria Agnes . . Floriana . 15 j -- 21 120 Obstinately refused to continue the me- N.N. (Insane) . . Valletta . .. 18 dICJ " c Micheleίorg . . do. j 65 19 460 Lived thirteen hours in the hospital, ano t< rr ¦. , died in the reaction. KSSTa^S: RR d °M.F.Re S -26 ™ ,ffi to continue medicine. Giuseppe Montaldo . Valletta . 12 . . .. Note lost FeSSatitelli to. \g | " ... 2 ° * Died aft -^- in the cold stage. 



175 

Michele Borg . . Floriana . 13 . . 23 560 Died in the reaction. Antonio Muscat . Valletta . 25 23 940 Ignazio Schembri . C. Cumii 47 22 100 Refused to continue the medicine. 19 Giacomo Maturno . Valletta . 9 . . . . . . Note lost. Pubblio Azzopardi . do. .27 24 .. 860 Salivated. Gioacchino Camilleri do. . 46 .. .. -. Note lost. Frsola Vella . . C. Zabbac 30 20 200 Died in the cold stage. Maria Cauchi . Valletta .12 23 .. 240 Giovanni Gatt . do. 48 20 400 Lived eight hours in the hospital, and died in the cold stage. Vineenzo Zammut . EM.F.Re 32 23 .. 520 Brigida Xerri . Valletta 34 25 40 Died in the reaction. 20 i Leonardo Darmanin do. . 20 26 . . 420 Salivated. I Paolo Siberras . do. .31 . . 20 220 Lived ten hours in the hospital, died in the cold stage. Carmela Zarb . Floriana .50 . . 24 260 Died in the reaction. Lorenzo Cullus . C Zabbac . 37 • ¦ 23 100 Refused to continue the medicine. Rosa Cauchi . Valletta . 9 23 180 Maria Sultana . Pieta .60 . . 21 200 Died in the reaction. Vincenzo Camiller . Ergostolo . 24 31 . . 160 Giuseppe Damato . Valletta . 30 27 460 Salivated. Giuseppe Galla . do. .7 29 180 Giuseppe Aquelina . do. .31 . . 20 20 Lived five hours in the hospital, died in the cold stage, and refused to continue the medicine. Salvatore Bajuda . Cospicua .30 .. 21 700 Died by thy relapse caused by errors in diet. John King . . Sc. Sarah Anne 22 . . 26 400 Died in the reaction. Paolo Parisi - . Cospicua .33 . . 21 440 Died in the cold stage. CatarinaPace . Valletta . 40 .. 21 80 Died six hours after being received, in the 



176 

Date of Place from Pate of Date tity"o~f admis- Name. whence they Age. dismis- of calomel Rfmakks Mull, fa ma c «l j i»_ j. i X\r.l\lA KKs. came. sal. death, taken. SSJ& : : ?°ST : S ''* *•" 2X SMS..—. Carlo Green . . do aY "on ,« " ' ' ¦ 20 20 five hours in the hospital, died in 21 Giuseppe Seichel . do. . 57 9 . 2 ,(m, (m the cold stage. ' - ' ll m Ll . ved ft fteen hours in the hospital, died Giovanni Butticieg . do 1-7 in the cold stage. Anna Dinsjli • . do' " -n " "a*. Note lost. Vittoria Galea .do! "4" " 22 inn D . led j n tlle reaction. ' J • • 22 10 ° L L i ved twelve hours in the hospital, died Calcedonia Calleja ¦ S.Giuseppe . 12 23 m m the cold stage. C'arinela Aczopardi . Valletta in '"93 7i, t ¦ *, ¦ " 10 •• 22 40 Lived six hours in the hospital, and died Carmelo Sceberras . R. M. F. Re, 30 00 ?„ ln the cold stage. "" 14U Lived six hours in the hospital, and died Catarina Catania . Misida . 33 o, m t - in , th - c cold stage ' Paolo Spiteri . . Valletta 50 "" 00 m! LIL Iy ed six hours, and died in the cold stage. " " • ¦ 22 400 Died eight houi-s after being received, in 22 Carlo Borg . . do 10 the cold stage. Carmela Sillato . do' " 8 "24 " "ka Note lost> GaetanoGrappetti . do. ! 45 24 " «' Teresa Gasparo . do. 46 ' ' o> i7.a 11 10 ° Lived thirteen hours in the hospital, and died in the cold stage. 



177 

N 

Grazia Sammut . Floriana .20 26 . . 220 , Giuseppe Miftud . Valletta .85 . . 23 200 Died in the cold stage Anna Agius . . Floriana .48 . . 23 Note lost. PietroVella • . Valletta . 13 27 ; . . 126 Generosa Aquilina . Floriana .22 31 . . 680 Salivated. Liberata Carnana . Valletta .24 . . . . . . Note lost. Giuseppe Merrieca . do. .22 . . . . . . Note lost. NicolaN icola Galia . . Floriana .22 . . . . . . Note lost Giuseppe Borg . . Valletta .44 .. 23 220 Livedseven hours in thehospital,anddied in the cold stage. 23 Giovanna Marina . Valletta 60 : 26 160 Died in the reaction. Gabriele Oalleja . Floriana .74 ¦ . 3 480 Recovered from cholera, relapsed, and died in three hours. Paolo Schrembri . Valletta .48 . . 26 600 Died in the reaction. Lorenzo Bolonia .do. .53 .. 23 Refused all remedies. Catarina Grech . Pieta .55 . . . . 40 Lived seven hours in the hospital, refused to continue the medicine. Francesco Cauchi . R. M. F. Re. .24 ¦¦ .. 20 Lived three hours in the hospital, died in the cold stage. Vincenza Bologna . Valletta .53 -. 27 Refused medicines. Gio Maria Mangion . do. .50 •• 23 60 Lived five hours in the hospital, and died in the cold stage. Francesco Vella . do. . 18 .. .. i Note lost. Gio Maria Calafato . do. .50 . . 23 Lived three hours, not able to take any medicine. Teresa Mangion . do. .50 . . 25 Refused medicine. 24 Consolato Schembri .do. .25 . . . . ¦ . Note lost. Maria Carens , . Marsa .80 . . 24 460 Died in the cold stage. Catarina Galea . . Floriana .48 . . . . • ¦ Note lost. ¦ Giovanni Micallef . Valletta .46 . . 26 400 Died in the cold stage. Mariana Psaila .do. .50 . . 24 40 Refused to continue medicine, died in > Consetta Cassac .do. . I 24 26 . . | 140 the cold stage, i 



178 

came. sal. death, taken. Teresa Borg . . Valletta . 45 Jm y jm v l**^ Maria Paragin . do 50 y Antonio Sarco do' 15 A " 9 26 2° 2 ° Refused to continue medicine. Alesandro Carnana . do. ' 21 "o ,a? ™- Saveria Galea . . Floriana 14 "1 Uied in the reaction. Mariana Muscat . Valletta .' 34 July 30 ' m July 25 Maria Farrugia . do -*<i y ' " l 2( 26 Salvatore Bondi .R.M. F. Re. " Auc 2 31 Died in the reaction. 27 Giuseppe Carmillcri . Valletta 57 g " " " 3 ° ? 30 Salvatore Tedesco .do ' 5S "' ' j' ' ote lost - ! " "¦ 30 •• Dled > having scarcely reached the hospital. LONDON : [ PRINTED BY G. J. PALMER, SAVOY STREET, STRAND. 

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