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REVIEW OF REESE ON THE CHOLERA.

A plain and practical Treatise on the Epidemic Cholera, as it pre vailed in the City of New-York, in the Summer of 1832; including its nature, causes, treatment, and prevention. Designed for popular instruction. To which is added, by way of Appendix, a brief Essay on the medical use of Ardent Spirits; being an attempt to show that Alcohol is as unnecessary and mischievous in sickness as in health. By David Meredith Reese, M. D.-Conner & Cooke, New-York. In our number for October, Vol. III., New Series, we gave an historical account of this frightful disease, from its commencement in India, in 1817, down to its arrival in this country, together with a short account of its ravages on our own continent during the summer of 1832. The high excitement which was produced by the sudden appearance, and desolating progress of this disease, has left indelible impressions upon the public mind, and induced fearful forebodings of its return. Indeed it has already returned. Contrary, however, to its course last year, it has begun its ravages where before it terminated, and is now travelling from New Orleans up the banks of the Mississippi and Ohio; and the probability is that it will again sweep over many portions of our land.

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It is not to be wondered at that the appearance and progress of such a desolating foe to human life should strongly excite the attention of professional men. Like the yellow fever, and other epidemics, it has given birth to conflicting theories among different members of the medical faculty, respecting its origin, character, and mode of treatment; showing that even those who assiduously and exclusively devote themselves to the healing art, are often baffled in their estimation of the causes of many diseases which afflict humanity; and also that their efforts, however wisely and diligently applied, cannot prevent the execution of the original decree denounced upon rebellious man,— Dust thou art, and unto dust shalt thou return.' During, however, the prevalence of this awful scourge, as well as since its temporary cessation, a number of treatises have made their appearance on the character, and the probable means of curing the cholera, respecting the relative merits of which, not being physicians ourselves, we are, of course, incompetent to decide with accuracy. So far, however, as we are able to judge, from what we have witnessed of the character and ravages of this disease, we think very favorably of the treatise before The author had ample opportunities of testing his theory by an extensive practice during the prevalence of the epidemic in our city last summer; and though it could not be expected that all would be cured of a disease so new, and of such a malignant character, yet we have reason to believe that Dr. Reese was quite successful in arresting the

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disease in numerous instances, and of restoring his patients to health, as well as preventing, by a timely application of remedies, its fatal influence upon the system.

One objection against putting works of this character into the hands of people generally is, that the uninitiated into the science of medicine are unable to understand them. In the treatise before us this objection ceases, in a great measure, to exist. For though it is hardly possible to avoid the use of all the technicalities of the science in treating on the causes, symptoms, and remedies of disease, yet the author has happily succeeded in adapting his style to the comprehension of the generality of readers, so that they may understand and profit by what they read. And those who are accustomed to the author's style of writing will at once recognize in this the same clearness, terseness, and sprightliness, by which his writings are distinguished, as well as the same zealous endeavor to mend the morals, while he labors to enlighten the understandings of his readers.

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In front of the title page are the outlines of a map of the city of NewYork, on which are depicted the several places where the cholera at first and mostly prevailed, and where the several hospitals for the accommodation of the sick poor, were located. From this it appears that it commenced its ravages in Cherry and Roosevelt streets, within the circle of the fourth ward, though almost simultaneously it made its appearance in Reed, Washington, and Duane streets, in the third ward, and at that sink of iniquity, a disgrace to a civilized city, the Five Points, where are congregated, in crude and disgusting masses, those whose steps take hold on hell:' These several places, being at some distance from each other, furnish Dr. Reese with an argument in favor of his theory, that the cholera, though infectious, is not contagious, but is indigenous to any place which is previously prepared for its generation by the infectious state of the atmosphere, from filth and intemperance. It very soon broke out in other sections of the city equally distant from each other as the former, such as Greenwich Village, Bellevue, Laurens street, Corlaer's Hook, Yorkville, Haerlem, and finally in almost all parts of the city. To the reader of this book, the accompanying diagram, with its explanations, will afford facilities in tracing the cholera to the places where it first commenced its attack, and the manner in which it made its frightful progress into different parts of the city, and the adjacent villas.

Having thus presented to the reader a concise view of the origin and progress of the cholera in the city of New-York, and stated the various opinions of professional men respecting its character, the author gives his own opinion in the following terms:

I conceive the essence of cholera to consist of a retirement of the circulating mass of the blood from the external surface of the body,

and its consequent accumulation in the larger and internal vessels. This is the first symptom in all cases, whether with or without observation, and indeed is the only diagnostic which is uniform and infallible in the early period of the disease. Indeed, a coldness of the skin is often complained of either before or at the commencement of the diarrhoea, regarded as the first stage of the disease, and arises from the absence of the blood from the capillary vessels. This loss of balance between the external and internal circulation soon results in an inverted excitement, during which the insensible perspiration from the skin ceases, and in bad cases the exhalations from the lungs are partially or altogether suppressed; and hence the voice is so strangely altered, even before asphyxia has supervened. In many instances nature is successful in expelling the morbid impression by the diarrhoea, especially if vomiting be superinduced early in its course, either spontaneously or by the salt and water or mustard emetic, as was frequently and judiciously exhibited.

The prostration of the nervous system, by the epidemic influence, is not only found to accompany the premonitory diarrhoea, but is sensibly felt by those who, by judicious means of prevention, avoid the exciting causes, and entirely escape the discase. A sense of exhaustion, however, if it be accompanied by a coldness of the skin, and intestinal evacuations of a watery character which are large and frequent, will, unless speedily relieved, develope the alarming characteristics of cholera.

Thus it will be perceived that I regard the general and almost universal morbid sensations complained of during the prevalence of cholera, as only giving evidence of liability to an attack, by the operation of the remote cause having excited a predisposition, or epidemic constitution, as it is sometimes called. And more or less of the signs of this predisposition were found to exist in the whole community whereever the epidemic has prevailed. It was known by a disturbance of the digestive organs, a sense of heat, fulness, and uneasiness or pain in the abdomen, a furred tongue, a sense of general debility, with occasional cramps of the muscles, especially at night. And thousands in New-York, and elsewhere, felt these evidences of predisposition, and yet altogether protected themselves from an attack by prudence and discretion in their habits of living, and were not even afflicted with a single "premonitory symptom."

In like manner, the diarrhoea and other premonitory symptoms, as they are called, are all to be understood as only giving evidence that some one or more of the exciting causes has been applied, and that, under the epidemic constitution or predisposition, the disease itself is about to be developed, unless the indications of nature be followed, and the morbid agency controlled. Still, however, the patient cannot be said to have cholera, nor will he yet suffer from an attack, if judicious means be used. Hence it has been truly affirmed that in this stage the epidemic need never be fatal, and accordingly preventive treatment is urged upon all who suffer from premonitory symptoms as indispensable. I insist, however, that the thousands who have been cured of these symptoms, have not suffered an attack of cholera.

I apply the term, therefore, only to that train of phenomena which

present themselves subsequently, if the premonitory diarrhoea be present, which is by no means universal. For in many cases, particularly during the rise and at the climax of the epidemic, the attack has been sudden, and even instantaneous, and the patient is "seized with the cholera," or in the language of many of the patients in Paris, who represent themselves as struck with a blow: "Frappè comme d'un coup de baton." In India, by the testimony of Dr. Johnson, there were no premonitory symptoms.

Most generally, however, it must be confessed that, in this country, the onset of the disease has been preceded by diarrhoea of some hours, and frequently of some days' duration. In all cases in which this premonitory diarrhoea ceases spontaneously, is checked by art, or is inadequate to the expulsion of the disease, which is often the fact in bad cases, an attack of cholera, properly so called, will supervene. The patient will now have pain in the bowels and in the chest, vomiting, with coldness of the skin, tongue, and breath, increasing prostration of strength, spasms in the limbs, and often in the abdomen and thorax, and the pulse will be found to be labored, and indicate that state of the circulation known among physicians as one of suffocated excitement. If these symptoms be not promptly relieved by art, the patient will very soon fall into a state of collapse, as it is vaguely called, evinced by asphyxia, or a total loss of pulse at the wrist, impeded or obstructed breathing, an increase in the character and extent of the spasms, a profuse, morbid perspiration over the whole body, with a thirst that is intolerable, a total suppression of the urinary and other secretions, and an alarming increase in the vomiting or purging, or both.

These are the true characteristic symptoms of cholera, and without the most of these the patient cannot be said to have the disease, whatever signs of predisposition, or premonitory symptoms, he may have presented. When most or all of these alarming features have subsisted over three or four hours, the case will often defeat the best directed efforts. If, however, they have just appeared, or have existed but for an hour or two, they are not so formidable as has often been represented. Into this state, justly denominated the incipient collapse, most of the cases had fallen in the early progress of the epidemic, before physicians were called, and the treatment of such symptoms was therefore the first lesson we had to learn.

The reaction and consecutive fever, of which so much has been said, I have already affirmed to have no peculiarity by which they can be distinguished from these morbid phenomena when they are the sequela of other congestive diseases; and their obstinacy and danger are ordinarily the result of previous neglect or mismanagement. Experience has amply demonstrated that even after convalescence commences, by a single act of imprudence or excess in eating, and especially if any irritating medicine be given as a purgative or otherwise, the most disastrous results will follow. Several instances occurred within my knowledge, in cases which had decidedly convalesced, that by taking a single glass of wine or brandy to strengthen them, or a simple dose of rhubarb or castor oil, injudiciously prescribed by some officious neighbor, a consecutive fever was ushered in which resisted every. remedy, and terminated fatally in a few days. In some few cases the

same result was observed to follow by indulging that morbid hunger which attends convalescence, by a single meal. These and similar facts show the importance of the greatest possible caution in those who have passed safely through the severe form of the disease, and that during their recovery their food should be of the simplest kind, and but sparingly taken; and above all, that they should take no kind of stimulating drink or irritating medicine.

Relapses were seldom if ever observed to occur; but mismanagement, soon after recovery, was followed by this fever of which we have been speaking. Numerous instances of a second attack of cholera were witnessed, some of which were fatal; but such second attack was invariably the result of gross imprudence or excess, and generally in the use of ardent spirits.'

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Next comes the consideration of the causes of the cholera. here the author combats, we think successfully, the theory of its contagiousness:

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The history of this formidable disease, in the various countries which have been successively the theatres of its ravages, has uniformly furnished the same evidences of its origin, spread, and fatality; and therefore when we become acquainted with its course in any one city or country, we are prepared to understand its nature and causes as fully as we could by the most detailed account of successive visitations in different and distant places. For this reason I shall not dwell in detail upon its history in the various countries where its track has been one of devastation and death; nor shall I trace its progress through our own country, many portions of which have been visited during the last year; but must refer to the works professedly written on this department of the subject. But I propose to myself only a brief summary of the etiology of cholera, as it prevailed in the city of New-York during the months of July, August, and September, 1832, and refer to its history in other places only by way of illustration.

Among the supposed causes of cholera, the opinion most general among the unprofessional, and one which receives the sanction of many distinguished physicians in other countries, and of a few such in America, is, that it arises from a specific contagion, and of course that it is communicated from one place to another by persons or things, as the small pox and other contagious fevers are propagated. The obvious and irreconcilable difficulties in the way of this doctrine, exhibited with uniformity in every place where it has prevailed, have, however, compelled its advocates to invent a modification of their theory, and hence they have adopted the terms "contingent contagion," as expressive of the opinion that it is contagious only under some peculiar atmospheric circumstances. This theory, however, only involves the subject in still greater obscurity. For if the disease be strictly a contagious fever, it can originate from no other cause than contagion, and hence the term contingent, as applied to contagion, in this case is absurd. Even its advocates concur in admitting that it may and often does originate from other causes, and that it afterward becomes contagious by reason of adventitious circumstances, though it is not so without them. This is virtually an abandonment of the known laws of contagion, and seems

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