THE CHOLERA UNMASKED;

OK,

ITS TRUE NAME, NATURE, AND CAUSES POINTED OUT;

ALSO

A MORE CONSISTENT AND SUCCESSFUL MODE OF TREATING IT.

BY BRACY CLARK, F.L.S.,
Member of the Royal Institute of France, 8fc.

CORRECTED FROM A COMMUNICATION FORMERLY ADDRESSED TO THE EDITORS

OF THE MEDICAL GAZETTE.

LONDON�1848 :
FEINTED FOR THE AUTHOR, TAUNTON PLACE, REGENT'S PARK.

In the midst of the numerous, opposite, and very conflicting opinions which
prevail at this time respecting the direful epidemic called cholera, permit me to
address you, as this disease still exerts its fatal ravages in spite of all that
has been done, and the opinions respecting its nature and its treatment seem
to be almost as various and unsettled now as they were at the commencement
of it, if we may judge, at least, from the recommendations every day proposed
in the medical periodicals.

Under these circumstances you will, perhaps, pardon the suggestions of one
who, though formerly educated for it, is not now strictly one of your honour-
able profession, and allow him to advance an opinion which he has long
entertained, and which, if it be not founded in truth, has one merit at least�
that of novelty. These views have, however, been shown to a few of his
medical acquaintance, who do not see any thing in them to forbid the reason-
ings and conclusions here drawn, which has induced him, with great deference
however, to make them more publicly known. If they should be admitted,
they will certainly lead to a more decisive, and perhaps more successful mode
of treating this deplorable malady.

Many physicians having observed that there was often a great deficiency
of bile in the intestines after death, were led into a state of doubt whether
this dreadful epidemic, although designated Cholera morbus, was, in reality,
that fatal disease, since medical books everywhere proclaimed it as of a most
highly bilious character, whilst the disorder appeared very commonly entirely
deficient in that essential respect. It is, however, as we shall presently see,
the genuine Cholera morbus of the physicians, but which had been strangely,
for ages, even from the times of the Roman, Celsus, described as a disease of
dreadfully bilious origin, and which opinion continued down to our own times,
even with physicians the most eminent and by the highest medical authorities;
as in the historical or second part of our dissertation we shall presently exhibit

from passages deduced from them. It would appear, indeed, that this truly
excellent man and physician, Celsus, living in times when liver complaints,
perhaps from gross and voluptuous habits among the Romans, strongly pre-
vailed in the Roman states, and attracted an unusual degree of attention to
it, and caused them to regard these disorders as of an high atrabiliary distem-
perament, and Celsus giving it this character in a striking degree, led succed-
ing physicians, seduced by so great an authority, into this egregious error.

The violent purgings, also, that often assailed the patient in this disease,
caused it to be mistaken, at other times, for a diarrhaeous complaint; but still
as proceeding from a redundant bile, both of which opinions we shall see
to have had no solid foundation in truth. Its true diagnostic symptom we
propose to point out, and which will much serve to simplify our view and
understanding of this dread malady; for the purging and the bile called in
so unnecessarily to explain the nature of the disorder, have only served to
throw an almost impenetrable veil over it, and to render it unintelligible:
and thousands of valuable lives, we believe, might have been saved, had these
views, we are about to give, been more early seen and adopted and acted upon.

Perusing the various descriptions of this disorder, as well in England as on
the Continent, I have been a long time firmly persuaded that its prevailing
character bore a nearer analogy to a complaint that I had had often to contend
with among animals, than to any enumerated in the books on human nosology;
and that, in fact, it was a more or less complete suppression of the process of
digestion or chylifaction, as we shall presently illustrate by actual cases, and
that it bore a closer resemblance to, and was proceeding from, very much the
same fatal causes as the Strophos, or the Gripes, of horses; in which com-
plaint, in the early part of my practice in this great metropolis, I had had
a large and not unsuccessful experience, having discovered its true cause, and
a mode of combating it, that generally gave a favourable result.

Attacks of this complaint, like the cholera, often carried off the animal in
a few hours; and in the commencement of my practice, though employing and
using all the then known and recommended remedies, (and such are sure to be
numerous and discordant enough, where the character of the disease and its
treatment are not understood,) I frequently lost my patients. Fearful of
losing my credit also, I took unusual pains, by watching, dissection, and other-
wise, in satisfying myself of the nature of the disease, and of what should be
its proper treatment, and at length so far succeeded, that for years I never lost
apatient, though often contending with protractedand cruel cases. Thesuccess
that attended my treatment induced me, for a considerable period, to keep the
remedy a secret, and it was extensively sold privately; but, at length becoming
more generally known, and abused also, and not given with the laws prescribed
with it, I determined on publishing an account of it, and (what was of fully
as much or more consequence) my views respecting the nature and causes of
the complaint itself, and how it should be treated by properly sustained mea-
sures in aid of the medicine.�(See "Essay on the Gripes of Horses," London,
1816.)�I believe, in the different large breweries in this metropolis that I at
that time attended, some thousand pounds worth of horses were saved by

this medicine and what I called a duly-sustained treatment of the complaint,
and of which, testimonies were given me, which appear at the end of the above
treatise.

In respect to the cause of the disease, I traced it satisfactorily, at its com-
mencement, to an insufficient power in the alimentary organs to carry on and
perfect the digestive process, either from the accession of some debilitating
cause, which rendered these organs unequal to the task, or from the unfavour-
able nature of the contents of the viscera as to quality or quantity, or from
both or all the above causes combined. The lowering agency of a sudden chill
to the abdomen would alone produce it under ordinary circumstances, and still
more easily if a refractory quality or unusual quantity was superadded. De-
rangement or entire suppression of the chylifacient process taking place in the
intestines, the disease would be carried on there to its termination in death;
or it might be communicated by sympathy or by connexion to the stomach, or
vice versa, beginning in the stomach, it might be carried to the bowels. In either
case the suppression or arrestation of the digestive process would quickly pro-
duce tormina, which, if not relieved by the restoration of the digestion, would
quickly terminate in death, either by inflaming the mucous membrane of the
bowels or stomach, or by its operation upon the brain through the agency of
the nerves of the stomach. In horses, who could withstand a severer shock
of this sort than the more sensitive human being, inflammation would have
time to establish itself pretty fully in the membranes of the bowels, and pro-
duce appearances not very unlike what Dr. Annesley has given in his work
on Indian Cholera, on an athletic race of British soldiers; for extreme vio-
lence in the attack from several causes combined, with great strength of
constitution to resist it, would have much the same effect in the animal as
often happened in the severe and protracted cases related in India.

We may, perhaps, illustrate the cause of the sudden termination of the
complaint in the following way:�that many substances assume a poisonous
quality if they are not digested; but if digested they are perfectly inert.

If you give to a horse four ounces of the leaves of the yew tree, on an
empty stomach, it will destroy him in a few hours, and but a very slight ap-
pearance of inflammation will the stomach exhibit, in bright petechia?, or spots
of the size of the little finger nail. But if to this quantity of the acrid veget-
able you add eight ounces of oats, and mix them together, he will eat the
whole, will digest them well, and will not even be incommoded : so that in
the former case he must have been destroyed by the influence of the undi-
gested matter upon the brain, acting upon the nerves of the stomach before
the other symptoms attending the suppressed act could have had time to
display themselves.

It may be asked, what should be the cause of this epidemic at this particular
time, and why it should be almost wholly, if not quite, a human one? This
I would not undertake to account for, any more than for the plagues in Egypt
or Jerusalem, or the causes of any other scourges with which the Almighty at
times has assuredly visited mankind. I can however, in reply to it. only just
observe, that if the atmosphere was, by any changes in it, rendered less stimu-

lant to the ordinary act of human digestion, it would readily produce such an
effect; nor could we, perhaps, by any analysis detect the cause, though it is
possible that we might, if truly, anxiously, and industriously employed upon
it. That the atmosphere, for a long time past, has been more thick, turbid,
and hazy, than I ever remember it before, I can from frequent observation
testify ; but whether this appearance did or did not belong to the production
of the disease, I do not undertake to determine, though I fully believe so:
admitting, however, but for a moment the position, we should then see that
the naturally weak, the debilitated from intemperance, the glutton, the drunk-
ard, the imprudent, the exposed and the destitute, would be the especial
objects of its visitation; as, in fact, they have been amongst its most frequent
victims. General Diebitsch was a remarkable instance of it, being a whole-
sale devourer of punch.

No better account has ever yet been given of the immediate cause of many
a pestilence, many a fever and plague, and for which we can only present as a
cause, the inexplicable general term malaria, or the Almighty will, and no
further yet have the profoundest researchers into primary causes been able
to get.

One of the best related cases I have seen of the cholera, and most minutely
detailed, was that of a gentleman at or near Glasgow, I think, who had eaten
an unusually hearty meal of pickled salmon, being fond of it. The mass was
too considerable, either from the quantity itself, or the debilitating influences
of the malaria, or both, for it to pass through the usual stages of chylification;
he was seized with what were called the genuine symptoms of cholera, which
no one ever disputed they were, and he died. Now all the circumstances here
could be readily explained upon those principles which I have laid down in
explaining the gripes of horses ; but there, in some of the most violent and
rapid cases in their termination, we had a direct and visible cause in a chilling
atmosphere with or without rain, and the animal also sweating from labour at
the time of its application, and thus doubling the chill and susceptibility; so
that any peculiarity in the atmosphere, more than its being a cold north-easter,
was not found to be necessary to its production. The magnitude of the
intestines of the horse�the prodigious mass they would contain of vegetable
food, least liable of any to digestion�the thin membranes composing them,
and the vast abdominal surface exposed to the atmospheric influence, it was
that rendered them quite unequal to the task of carrying on the digestive
process under such untoward circumstances; and digestion ceasing, tormina
succeeded, and the disorder once begun, led to others producing active in-
flammation in the mucous membrane, brain affections, &c.

Now what has been said most to produce this cholera, was the eating of
cucumbers and melons, and unripe fruits, and bad pork, and hard meats�
and why? because these are amongst the most difficult of the vegetable and
animal substances of digestion, and, refusing digestion, they become poisonous,
and so do they act in producing tormina, knotting of the abdomen, and writh-
ing ; and from whence the ancients very naturally called it Strophos, from
the verb strepho, to turn, twist, or writhe about. And may we not also

readily account for the extraordinary coldness of the tongue, the coldness,
lax, and corrugated appearance of the skin, so often noticed, on these prin-
ciples, from the well-known sympathy of those parts with the stomach, and
from its chilled, rigid, and enfeebled state, and the total absence of digestive
power, the blood then retiring from these to other parts of the body, as the
vena cava, and large vessels of the heart.

In respect to the cure, which all will be desirous to know, it consists only in
well-known remedies; but their operation will be rendered more effectual by
understanding the true nature of the disease, and the point to be obtained, viz.,
the restoration of the digestive function at all events; for before I found this,
I rested when the remedy had been given, nor knew what to do if it did not
succeed or take effect, my practice having been then almost purely empirical;
but if the train of operations in the stomach and bowels were not restored at
one dose, I resorted immediately to a repetition, regardless of the terrors
about inflammation (a bugbear which former idle apprehensions had filled
me with), by a third, a fourth, or a fifth, pursuing it without delay, and by
other measures externally, also nearly as potent, till I saw the healthy actions
return, or a recommencement of the. digestive process, which being sustained
by prudent measures, the case did well. If inflammation had begun, some
slight after-treatment might be necessary.

With the horses, I led them to a warm place, immediately shut the doors
and windows, covered them with rugs, threw down straw for them to roll upon,
and gave them successive doses of the Tincture of Pimento, about a quarter of
a pint at a dose, waiting half or three quarters of an hour between every dose.
Getting my hands under the rugs, I rubbed the abdomen with flannel; and
sometimes, with all this, it took seven hours, in very bad cases, to restore the
digestive process; but many a one supposed to be dead recovered; for the
relief is so great and soothing to them after the excruciating agony they had
just suffered, that they dose often on losing their pain, or sleep as though
really dead.

I will now relate a human case and its treatment. A very respectable
middle-aged woman, in service, not far from my house, had eaten a free, but
not very copious, dinner of liver and bacon, and, I believe, had taken porter
instead of water with it. She dressed and went out in the afternoon, with
a friend, to the Bazaar in St. James's Street, and loitering about to look at the
various articles, and a wind blowing through the avenues of the building at
the time, she suddenly became uneasy, and soon in violent pain. She returned
home as fast as she could, and complained very much of sickness, and a deep,
oppressed, painful feeling about the prsecordia. She vomited violently, but
this did not relieve her pain, which became excruciating. I then ordered her
to shut the door of the apartment she was in, and to put the kettle on, with
a pint of water�this small quantity only, that it might the sooner be heated;
and of this, when nearly boiling, I made her drink, as hot she could in any
way get it down, three parts of a pint; her vomiting continued, however, and
her pain; and she has since informed me, which I had not paid much attention
to at the time, that she had violent spasmodic cramps or pains in the calves of

her legs. I next, therefore, ordered half a pint of hot ginger tea, which she also
took, but without relief. About an hour had passed over in this way, still in
severe pain. I now ordered her to bed, sending with her a good pan of hot
coals to warm it well first; and to this I added a glass of hot gin and water, a
little sweetened, which she sipped as hot as she could take it. In less than
five minutes after she felt a sudden remission of the pain; she slept well after,
and the next morning was at her work as usual. She seemed, however, head-
achy towards the afternoon and I recommended a dose of Glauber and Epsom
salts mixed, which restored her usual health.

A few days ago, a gentleman of my acquaintance, whose son was not un-
acquainted with my opinions respecting this complaint, was suddenly seized
one evening with excruciating pains about the prsecordia, and unlike any thing,
in point of severity, he had ever experienced before ; he compared it to being
screwed through with a screw. A fire was made in his room, and brandy and
water pretty strong, with laudanum (which I do not recommend), was given
him by his son; and at the end of two hours, by these remedies, and with
rubbing the abdomen with flannel, he was relieved, and was out the next day
on his morning walk, when I saw him and heard his description of what he
had gone through; and his son related to me what he had done for him.

I consider myself as having been twice attacked with an arrested digestive
process, and which, if permitted only a short time to have gone on, would have
ended in what is called a true cholera (for names, though apparently simple, are
frightful things often in misleading our views). I immediately closed the
apartment, took to drinking hot water (as hot as I could get it down) ; I sat
by the fire and rubbed, with a flannel bag over the hand, the abdomen, and in
a quarter of an hour had dispelled the symptoms. This is the simplest form
perhaps of the complaint, or rather the point of commencement of it, when it
can be more easily subdued�especially if there be no great opposition from the
mass of food, or from its quality not being of a very refractory nature, and the
animal powers in tolerable force. The knotted state of the abdomen appears
to arise from the recti and other abdominal muscles being contracted in sym-
pathy with the suffering parts beneath. For some remarkable cases, where
the restoration in the horse was opposed by a combination of untoward cir-
cumstances, I must particularly refer the reader to the treatise above described,
and for a great deal of reasoning and observation which would be out of place
in this small sketch.

As to anodynes or opiates, it must be obvious, relieving pain by mere
soothing and lulling the nerves must be nugatory while the causes of that pain
remained uncontrolled: I, therefore, early quitted the use of them, and found,
by doing without them, their total uselessness ; and as bleeding may exhaust
the very powers we want to rouse, that also I never resorted to till the next
day, if any inflammatory symptoms appeared to remain from the lateness of
the remedy or from the extensive application of it, when a gentle purgative or
a venesection was decisive.

There may be cases, though I believe but rarely, where the cordiac system
(or heart, arteries, and veins) may be oppressed by an overcharge of blood,

as in some plethoric people, where breathing a vein would set the springs
more at liberty for motion, and be of service; otherwise blood-letting I believe
not to be necessary, unless to suppress, as we have stated, any inflammation
consequent upon the remedy, or that may have arisen from its late application.

After this manner may be successfully treated, we believe, a very great
number of these strophic attacks, if for once we may be allowed to drop the
erroneous term cholera, for there is certainly no x⁰^ or bile to characterise the
complaint, or concerned in it; but rather, perhaps, a want or suppression of
this secretion; and which want of this important daily purgative of life it is
which adds to the facility of the access, and the severity, perhaps, also of the
complaint: and may not the diarrhoea, complained of in so many cases as
preceding the complaint, derive its origin from the want of the stimulation of
this natural fluid ? the intestines really inflaming from the want of its usual
operation upon them�and thus inducing a capillary arterial flow into them
and a purging�for the same causes that suppress the digestive act, will also,
it is probable, tend to diminish biliary secretion.

Though by no means generally, yet in several instances we have of late
observed that the remedies proposed were of the description here pointed out.
Horseradish tea has been given at Ely, in Cambridgeshire, and a cholera
tincture is now sold in the shops; but in the manner of using them, there
does not seem to be a full understanding of the true nature of the disease,
which they continue to call cholera; nor do they appear to be aware of the
necessity of making their treatment efficient by a combined plan of operations
in the attacking it; so that their treatment is almost an empirical one, and
would not, in this case, be attended with nearly so extensive a success.

A few additional remarks, which tend to confirm the identity of
Cholera with the Gripes of Horses.

In the treatise above referred to on the Gripes of Horses, we have shown
from observations made more than thirty years ago, that the atmospheric influ-
ence was alone sufficient for the production of this fatal disorder in the horse,
and that a loaded stomach, especially of undigestible food, or from its having
been too hastily eaten or ill chewed, or even without these attentions, would, if
a chilling atmosphere prevailed, and especially if accompanied with draughts of
air or of dampness or rain, become fully adequate to the production of the dis-
ease. And we now learn, from the accurate observations of certain French
writers, that such causes or agents were actively present on the occasion of the
cholera first breaking out in Paris. fThese relate that for many days previous to
its appearance, the heat or temperature of the atmosphere about the middle of
the day was considerably greater than usually attended that season of the year,
but that during the evenings, the nights, and mornings, there prevailed a strong
chilling wind, blowing from the north-east, which, after continuing some time,
shifted suddenly to the north-west, (which in all probability brought relaxing
vapours and dampness in abundance), and immediately upon this change did
the cholera commence its ravages in the most formidable way in the metropolis,

carrying off many thousands in the course of a week. See Gendrin, Mono-
graphic du Cholera Morbus. Also Bouillard, Traite pratique du Cholera
Morbus). So that perhaps is here exposed all the machinery necessary for the
perfect production of so terrible a visitation; but whether any other cause
were superadded, that our analytical knowledge does not extend to, is only
known to Him who can say,

" necessity or chance
Approach not me, and what I will is fate."

and who can point the pestilence at his pleasure, in a way inscrutable to us
poor mortals.

We shall again advert to the proposition recommended in the foregoing
communication, as to the administration of salts in the diarrhoea, or purging,
which at times precedes the access of this disorder. It would perhaps ap-
pear to some a strange anomaly of prescription to give salts to a person
already labouring under a diarrhoea: their efficacy, however, I can from much
experience speak of in respect to horses in arresting a super-purgation (see
Pharmacopoeia Equina, p. 32), and there are practitioners who have con-
firmed the fact of their utility in this way in the human. It may appear unne-
cessary, or presumptuous in me, to attempt an explanation of their operation,
or I should be induced to observe that they can operate in three ways in pro-
ducing so favourable a result: 1 st, by inducing a new and different action to
those already going on in the stomach and intestines; 2dly, by the alkaline
and sulphurous properties of the salts themselves, in correcting any acescent or
acrimonious quality in the fluid contents of these organs; and finally, and
perhaps most efficiently of all, by causing a flow of healthy bile into the intes-
tines, where there had previously been a deficient quantity, or a total sup-
pression of that very necessary stimulant to due intestinal performance.*

In respect to the case of cholera above related, we advert to it again just to
state, that had it not yielded to the combined effects of the hot water, hot
ginger tea, hot bed, and hot gin and water, we should have pursued our course
by still stronger measures�with brandy and water, and with the Gripe-
tincture, which is brandy, or proof spirit and aromatics or spices : see the
above Treatise on Gripes, p. 10.

Some of my readers of the above communication have demanded further
proof of food not digested assuming poisonous qualities. In reply to this
demand I have noticed to them the effects which shell-fish sometimes produce.
The most notorious of these is the Muscle, which eaten hastily, or without the
priming of some stimulating agent, as pepper, salt, or vinegar, or eaten in too
great quantity, will refuse digestion, and all the phenomena of poisoning be
exhibited: so much so, that those called in to the case have often declared that
it was a true case of poisoning, and by copper, and that these animals must
have lain upon, or eaten copper, and as coming from some coppered vessel that
had been stranded! So that, to fulfil this theory of poisoning by copper,

* That the salts produce their effect by inducing a flow of the bile into the intestines from the
gall bladder, for we have found, on continuing them for several days, that they cease to have the
same effect, apparently from the gall bladder becoming exhausted.

these innocent animals must have committed suicide; and perhaps it might
have been added, in order to be revenged on those who should so unmercifully
devour them�for there is no doubt they possess too delicate a discrimination
in taking food, to take copper and not know it, and therefore must have had
some strong motive for so extraordinary an act. That this case will illustrate
our position, and singularly serves to confirm it.

In respect to the whitish or grey foecula, compared to rice water, observable
floating in the liquids of the intestines in this disease, should we not conjecture
that such was perhaps the effect, or an imperfect attempt at forming chyle, in
degree decomposed and coagulated by the morbid arterial distillations or effu-
sions into the intestines, and which the constricted and paralysed condition of
the alimentary canal did not admit of being absorbed in the usual manner by the
lacteals�or it may be a curdling or decomposition of these arterial effusions;
and does not the general colour of these fluids in the intestines sufficiently
exhibit the non-presence of bile, and demonstrate the deficiency of this secre-
tion? but after which, in supposing a redundance, the complaint has been falsely
named. Sometimes, however, regurgitations of pent-up bile in the gall-
bladder thrown into the intestines by spasm, or otherwise, might vary or disturb
this general and usual appearance, but should not be allowed to deceive us, as
the contrary appearance was found to be by far the most usual on dissection
after death. So that if disentangled from its supposed bilious nature, and
divested also of its diarrhoea, casually only attending it, and if to this we add
a knowledge of the poisonous nature of some kinds of food when not fully
digested, then acting fatally on the gastric nerves and brain, we shall then,
I believe, be able to solve the grand enigma of the dire Cholera morbus, and
be able to account for nearly, or quite, all the intricate phenomena attending
it; reducing it thereby to almost a simple case or example of Strophos or
Gripes; and this fully understood might, perhaps, lead us into the use of
many of the champignon and agaricous tribes we dare not now make use of,
preventing their ill effects by preparing them with a much higher degree of
stimulating and spicy accessories and additions than we now are used to em-
ploy, in order to our being assured of their ready and quick digestion, these
being in themselves among some of the most grateful and salutary of our
condiments.

We now, in a second Essay, enter on the Nomenclature, the Classification,
and highly curious history, of this lamentably fatal disease.

PAET II.

OF A

DISSERTATION ON THE EPIDEMIC CHOLERA.

In the preceding part, or memoir, I endeavoured to consider the true origin and nature of this disease,
and why at times it assumed such a very sudden and fatal termination, viz., from the undigested
mass acquiring a poisonous character. This also would explain the cause of the furious riots in
Paris and St. Petersburgh on the first breaking out of the epidemic, the populace conceiving that they
were poisoned by the doctors, and also by the vintners, many of whom nearly lost their lives through this
suspicion.

And we also endeavoured to explain why at other times, as in the more protracted cases, without
actually destroying the patient at once, it produced effects on the nervous system, such as gave to
it very much the appearance of a low nervous fever, or typhus. To these remarks were added what we
conceived to be the genuine principles for its treatment, by recalling, by every possible means combined,
the restoration of the impaired or lost digestive and chylopoietic functions.

In the present memoir, it is proposed to inquire into the antiquity and original signification of the
term Cholera, and to examine the views and opinions of those physicians who followed immediately after
the ancients, and from whom we have principally derived our present erroneous views of the disease,
and then those of our modern physicians, and to conclude by giving to the disease a new name and
arrangement in the medical system.

Desirous of ascertaining more exactly the origin of the term Cholera among the ancients, and the
sense in which they employed it, and how these erroneous notions of the bilious nature of this complaict
first originated, I was led, in order to pursue these researches, to avail myself of the two noble medical
libraries in Lincoln's-inn-fields, that of the College of Surgeons, and that of tie Medico-Chirurgical
Society, and I acknowledge with pleasure my having received the most polite attention and satisf'catory
aid from the two respective librarians having the care of these valuable collections.

As far back as Hippocrates, the word cholera is found, it several times occurring in his worts, and
always standing by itself, amd without the modern adjunct of morbus attached to it. It is therefore of
very remote antiquity, but in his descriptions of the disease he does not appear particularly to refer it to
a bilious origin, neither does he appear to have ever seen it in the character of a terrible epidemic,
such as it has appeared of late years in India and in Europe.

Before Hippocrates, however, Erasistratus describes the disorder, and without appearing particu-
larly to insist on its bilious origin or character.

But the word cholera is to be found long antecedent to both the above writers, and at a period
nearly coeval with the earliest graphic records. It occurs several times in the original Hebrew of the sacred
writings, and as early as the books of the Pentateuch of Moses. In the Hebrew the word is often
divided into two, i^ri choli and 1 ra; sometimes, however, united. According to the Hebraists, choli
simply signifies illness, sickness, inflictive disease, or plague, without any reference to, or as being in any
manner derived from, bile in particular. They infoim us also that the additional ra signifies that the
said infliction or disease was in an excessive or superlative degree. We subjoin the references to all
those passages where the term is said to be found, as well in the writings of Moses as in the other parts
of the Scriptures, that any one more deeply versed in the study of Hebrew, than we profess to be, may
have the opportunity of fully considering the true meaning and sense in which they have been em-
ployed. These passages, we ought also in justice to state, appear to have been first collected and ob-
served by a gentleman of the Cambridge University, E. H. Smith, Esq. Deut. xxviii. ver 59, vii. ] 5 ;
2 Chron. xxi. 15 ; 1 Kings xvii. 17 ; and others.

And choli is from chala he was sick or sickened, from the prefer perfect tense of the verb choul to
be sick or ill, used also for nervous tremor of the bowels such as attends an irresistably violent colliqu-
ative sickness. And what appears singular is that Misrahim appears to have been the Hebrew Ver-
nacular or ancient native name of Egypt.

Here it is pretty clear and evident, that in this very ancient use of the term choli, it had no relation
to the liver or any of its secretions, but did merely indicate a dire disease, or infliction. And may it
be otherwise than fair to conclude, that as Moses was said to be " skilled in all the learning of the Egyp-
tians," and was an Egyptian by birth, that he derived the very term from this extraordinary people, and
is it not also as fair to conclude that the Greeks obtained it from the very same source, or rather from
the Hebrews, and for reasons we shall see hereafter.

For it may be worthy of remark, as a singular fact, that two words so nearly allied as the Hebrew
choli, and the Greek xoArj in which, in pronunciation, there is hardly a difference, should have had such
very different significations, when used by two neighbouring states or nations; and that one should sig-
nify disease only, whilst the other should signify bile only, since the Greeks appear to have had no other
phrase for this secretion. It is therefore but reasonable to conclude that this would give them a bias
towards considering it a bilious disease, not easy to disembarrass themselves of, and in a still greater
degree would be this bias in those who consulted the Greek physicians and learnt their language and
their arts exteriorly, and such we shall see has been the general bias of nearly all European physicians.

The additional ra alone serves to distinguish this term from the expression for bile, x^o^v ^ano^ ^as ra
would signify nothing in the Greek if so added, but is of powerful effect in the Hebrew, it must be clear
that it is of Hebrew or Egyptian origin.

This word ra seems to be a word of a singular description and power, and of most extensive and
important application, always meaning something strong and powerful added to or preceding words Co/era
would seem to have signified a strong or powerful bilious affection, the Ra added to Eastern names seems
to confer power and nobility, as the Rajah of Travancore &c. following the name it also has the same
important effect as, Elmira, and perhaps Palmira 1 perhaps sometimes pronounced softly as e, by which
we get re the king, and rego that is to say re Ego 1 the king, and hence rego, rexi we obtain the term
Hex, and regnum a Kingdom, &c. and Israel powerful in the Lord�Rechab i.e. abre descended from the
King? Rehoboam having the life of the King.�[In the British Museum of Egyptian antiquities is a
hawk headed rod, under it stands the God ra ? Gallery of antiquities, p. 261, Ed. 1839,] our English
word raw pronounced broad as denoting anything very repulsive, unfit, or uncouth, may have had its ori-
gin also in this Eastern source.

We shall now see these remarks in a singular manner verified on referring to Celsus, who followed
those early Greek physicians above noticed, at no very distant period, and here we find him ascribing to
cholera directly a bilious origin, and supporting the opinion apparently by his own observations on the
disease. I cannot any where find, however, the quotation of Dr. Mason Good, who tells us that Celsus
derived cholera from t^oXjj bile, and ptw to flow, for no such derivation occurs with him : Celsus probably
knew better. This is another instance of false quotation, showing how necessary it is to examine quota-
tions, and not to take them on trust, for this passage has been lately often repeated by others. The real
words of Celsus are well worth remarking, and are as follows :�« Nam shnul et dejectio, et vomitus est;
prceterque hcec, inflatio est, intistina torquentur, bills supra infraque erumpit, primum aquce similis,
deinde ut in ea recens caro lota esse videaiur, inlerdum tlba, nonnunquam nigra, vel varia. Ergo eo
nomine morbum nunc yoXtpva Grceci nominantur." Celsus, lib. 4. c. xi.

Here we see that Celsus fully falls into the idea of a dreadfully bilious disease, and to confirm his
apprehensions, this excellent man is led to imagine that the bile can assume nearly all colours and forms,
and as being '�' sometimes limpid as water, sometimes in lumps like parboiled bits of flesh, sometimes,
white, and sometimes black, or various." In the cure, however, he recommends warm water, as we do,
hut seems to defer spices and wines till towards the conclusion of the disorder !

The physicians, after the time of Celsus following his example, more and more embraced, almost
invariably, the notion of a bilious origin to this complaint, and not from a suppression, which is generally
the fact, but from a redundance of the bile. Yet very numerous accurately-conducted dissections of late
have convincingly proved the contrary to be the case, by the fullness of the gall-bladder itself, aud from
the dark colour of the retained bile. Hence I was led in an early part of my former communication
to say, that either the disease was wrongfully referred to, or the name of it, implying bile or as of bilious
origin, was a misnomer, and such proves now to be the fact, and we must go back to the simple Hebrew
sense of the word to justify the name at all.

It is, however, possible that a very contrary state, viz., a suppression of the bile, may so derange the
health as to render a person more obnoxious to the disease, or predispose him to receive it; though even

then the disease must be proximately or primarily induced by certain conditions of the stomach, as to
food and of the atmosphere, as to chill or damp_: fully to induce the access. For that cannot at least, in
any proper sense of the term, be called a bilious disease, where this secretion, instead of abounding, is
deficient or rendered difficult, In what sense the ancient Egyptians employed the term it would be
now hard to discover, but it is fair to conjecture perhaps in the same simple sense that we find it with
the Hebrews ; as a pestilence of whose origin they knew nothing.

Having in some degree corrected the terms used, and estimated their proper value, we may now
more safely venture to consider, and more usefully also, some of the less ancient writings of physicians
upon this complaint, and from these pass- to the modern writers, proposing a new name afterwards more
expressive of the nature of the disease.

Before, however, I quit this part of the subject, I could desire just to remark, that during my stay
in Germany about two years ago, and with this complaint raging all around me, I observed that the
Germans pronounced the word cholera very differently to what we do in England, pronouncing the e
long, Cholera, instead of short, as we do, Cholera. Whether it may serve to guide us I do not undertake
to determine, but the Greeks certaintly spelt it with an eta (rj) or e long, and, I should therefore be led to
believe this ought to be the normal pronounciaticfc of it, and that it was so pronounced by the Eastern
nations, from which the Germans are more likely, from their actual locality, to have received it, than
ourselves. It is singular, however, and worthy of notice, that in the foregoing quotation from Celsus,
we see it spelt with an epsilon gravely accented, and not as we find it in the Greek writers generally
written, which may perhaps be explained from the frequent transcriptions by the Romans, and by scribes
who knew not Greek, and had no letter in their alphabet corresponding to the eta or e long.

Eecouraged by the opportunity these splendid libraries afforded me, I thought it well also just to
examine respecting the opinions of some of those physicians who succeeded at some distance those
ancients we have lately spoken of. Alexander Trallianus was one of these, and appears to have lived
about the reign of the Emperor Julian, the Apostate, and was by birth a Syrian, writing in his native
tongue: his works were translated into Greek, and afterwards published with a latin- version, by the
industrious Germans at Andernach. He appears to have regarded the Diarrhoea, which sometimes
attended this complaint, as not particularly proceeding from bilious discharges ; and he appears also to
have entertained very just views of the complaint itself, ascribing it to indigestion and to chills, and
recommending warm clothing and warm spicy medicaments ; hence his practice must have been eminently
successful. Neither does he make much mention of bile in it; in one part of it indeed its presence in the
organs of digestion is expressly denied by him. Edit. Andemachia; Jihenensis, lib. vii. cap. 14.

Callus Aurelianus, DeAcutis Morbis, lib. ii. cap. 19, is under great difficulties as to the origin of
the word Cholera, but throws no new light upon the subject, and most fully supposes it the consequence
of a redundance of the bile, and all his reasonings are full of those imaginations which such a doctrine
naturally leads to, and are hardly worthy a repetition here.

Arceteus, De Morbis Acutis, lib. ii cap. 6, His treatment and views are evidently confused, and
without any clear conception of the nature of the malady, or of what he ought to do with it. What
there is of good in his book is evidently copied from the writings of Celsus, of which it is very
much a commentary. He is full of the notion of a redundant bile, and of the necessity of its
evacuation.

Exactly at what period of time the word morbus became first added to this disease I am not aware,
or wherefore it was done, as it appears to be gratuitous and unnecessary. It was, perhaps, added
under the pretence of separating this disease from those affections of the mind termed choler, or
choleric, angry passions or temperaments, or of distinguishing it from the mental affections which the
Greeks termed melan choli. Whatever the motive may have been, the addition certainly gave it a more
sounding and terrific effect, and especially when attached to one of the most awfully sudden and fatal
of human maladies ; and the Latins, in translating melancholi by atrabiliaris, thus made it wholly a
bilious disease, and left it in no equivocal sense but as originating in black bile.

The first use of this expletive addition that I noticed in the course of these researches was found
in the Latin translation of Avicenna, the Arabian physician, printed at Venice in the year 1607, though
it is possible its use might have been introduced still earlier. There is not much in Avicenna upon this
disease that is at all satisfactory, it is but a rambling sort of copy from the Greek and Latin physicians.

I am now led to open the volumes of some of our more modern and recent writers upon this
subject, as it will afford me, without much prefatory detail, the opportunity of introducing some novel
views on this subject, which I have some time entertained, and which respect the nature and also the

proper classing of this complaint, and so introduced will remove the necessity of a more lengthened
disquisition in explaining those opinions.

As standing among the first in erudition and comprehensive views, appears the work of my late
esteemed and early friend, Dr. Thomas Young, whose premature loss all true lovers of science must
sincerely deplore ; he has, however, left behind him an imperishable monument of his acuteness, learning,
and perseverance, in first opening the long-closed door of Egyptian literature by his unwearied labours
with the triglyph stone, a very precious relic still seen among the rare treasures of our national museum.
On this stone he first learnt to decipher the symbolical acrostic manner of writing, and of inscription,
used by this ancient and wonderful people.

In that astonishing collection of nosologic matter, his Medical Literature, p. 287, Dr. Young, has
noticed this singular disorder the cholera morbus, as he also terms it, and prepossessed with the
feeling arising from the Greek name of it, and of the great medical authorities in respect to it, he fails
not to apprehend it to be a disease of entirely bilious origin and character. And, perhaps, in
endeavouring to reduce it to some given place in his general system of diseases, he not impossibly
felt a little embarrassment where to arrange, and how to dispose of this three-legged monster of
a disease, or under which of his genera he should particularly place it. Having for its characters a triple
share, viz. vomiting, purging, and tormina. And I may also confess that I remember to have had myself
formerly, in early life, an indescribable feeling of horror aud confusion left in my mind, after reading in
medical works a description of this complaint. Whether such might have been his feelings or not, when
he was measuring this disease for its place in his system, I do not undertake to determine ; but, however
this might be, he at length makes his choice, and unfortunately fixes upon the purging character of it,
which leads him to place it immediately under the genus, or order, of Diarrhoea, It was evidently
necessary to fix it somewhere, as it must inevitably belong to one of the three, and could not with any
propriety, as we shall see hereafter, constitute a class, or proper genus, of itself.

His choice, however, was unfortunate, inasmuch as we have already seen that the diarrhoea is not
present in well marked cases of this disease, and even when it is, it is not by any means the leading
character of it, nor of any fatal or destructive tendency; but is indeed almost as frequently absent
as present, and therefore could in no respect be entitled to so predominant a distinction as that of being
the essential or leading character of the disease.

Had he made his election upon the tormina, or strophic character or symptom of the disorder, it
would have brought out a very different issue in his arrangement, and in all probability would, after due
consideration, have led him to have settled it among the species of the genus Colica, and from its
destructive character to have given it a very prominent and foremost situation in this painful and fatal
group or family of diseases, where, we are confident, it will ultimately be bestowed, and be found truly
to belong. For it is now most evident that it is no proper choleous or bilious affection, such at least as
the imagined Greek term cholera has generally served to convey a notion of, but a real cholic, with, in
general, a suppression more or less complete, of this salutary function of the bile. This position for
it will, we believe, greatly facilitate and tend to simplify all our views and apprehensions about it, and
likewise its treatment, opening away also to the fully appreciating the various descriptions and doctrines
of its treatment which have, from an almost innumerable host of authors, been given and proposed for it
as for an incomprehensible kind of disorder.

As to the vomiting, or third head of the Cerberus of a malady, it would appear to be no other than
the mere natural effort of the stomach to throw off those contents which it finds an inability or want of
power to act upon, and digest. Sometimes, indeed often, whether owing to meie debility and want of
effecient force in the organ itself, the disease unrelieved, goes its course afterwards in spite of these
efforts : at other times they prove an effectual relief, and where encouraged on this account by many eminnt
practitioners, particularly Sydenham. And where it is ascertained, which should be particularly enquired
into, that the patient has eaten of stale pork, shell fish, hard mutton, certain fruits, or any of those
things which undigested exhibit poisonous properties as we have formerly stated, it is, perhaps, in these
cases to be encouraged by artificial means, especially if the quantity taken be such as the use of stimuli
may be long in procuring the digestion of, otherwise the latter course would perhaps be safest in a
general way to rely upon ; many substances being perfectly inert when fully digested, which are rank
poisons otherwise, destroying the patient through their effects tipcn the nerves of the stomach, and
acting fatally by sympathy upon the brain, and in more protracted cases producing the appearances of
a typhoid disease.

Should the human physician deem these views worthy his attention, they will, we believe, go far to

explain many circumstances and appearances attending the complaint that were before quite obscure and
thought inexplicable. Under these views and impressions we shall now venture to take up some others
of the most approved writers on the subject; and first with reverential feelings due to so great a cha-
racter for learning and worth, the justly-admired Sydenham, and we shall see, that guided by his
acute practical observatation, and that admirable tact which he so eminently possessed, and aided
also by the study of the ancients, how very near he came to the true treatment of the disease,
though his views upon it were evidently not distinct, but considerably clouded by the prevailing
feeling of preceding ages, of its bilious character and a redundant bile. In other respects
he describes the disease well, calling it cholera morbus, see Sect. 4. eap. 2. and says, that in his
days, that is from the year 1669 to 1674, it made its appearance every year in the autumn season, on
the first chills of the decliningsummer, with as much regularity " as the coming of the cuckoo in the
spring, or of the departure in autumn of the swallow." He describes it with its three characters,
vomiting, purging, and gripes, and recommends for its treatment, not exactly the warm water of Celsus
and Hippocrates,* but something of a more digestible quality�plenty " of warm chicken broth ;" it is
in its effects not very distantly allied to our hot water, which, however, has the advantage, in all
situations, of being more quickly attainable. He recommends encouraging the vomiting, and especially
on no account to suppress it; and, aware that some cause of offence remained with the stomach, he
recommends spear-mint tea also ; and also laudanuum in the advanced stage of the disease, but expressly
forbids its use in the early stage, that it might not repress the vomiting. No doubt finding from expe-
rience that it tended to arrest the stomach from performing any of its usual functions, such at least it is
fair to conclude would be its effect, and with injurious consequences as to digestion. But towards the
latter end, and when in reality the danger has passed, he recommends, as did the ancients, small por-
tions of generous wine. Here, according to our notions, he was somewhat deficient, and in a very bad
case would, in all probability, have lost his patient, for the want of these stimuli being more early
applied ; but washing the stomach out instead of digesting its contents, may suffice sometimes in mild
cases and in feeble attacks of the disorder, and hence the proceeding by emetic will often be found to have
succeeded, as may be seen from the history of very many cases where the mustard emetics were employed
which were much used in England at the commencement of the appearance of the epidemic, but were
discontinued afterwards, from finding, perhaps, that they had often failed, For if we view the indication
for cure rightly, " it is the return of the digestive, and chvlopoietic functions " that can alone insure the
safety of the patient.

And, in the course of our perusing later writers on this epidemic, both French and English, it was
singular to observe, how frequently they relieved partially, and even at times wholly cured, their
patients, by stimulents opportunely exhibited, yet from their feeble manner of doing it, and in doubting
and want of faith in what they were doing, instead of persevering, they often left them, in pursuing
other measures, miserably to perish; not following up the treatment with the suitable auxiliaries in aid
of the remedy : and what was most unfortunate, they afterwards drew conclusions unfavourably to the
practice, and forbid their use as prejudicial and injurious, trusting, afterwards often, to the frail aid of
mercurials, opium, bleeding, saline slops, venous injections, and other worse propositions.

At other times, again, were these strong stimuli applied naked, if I may be allowed the term, and
with nothing given along with them, to qualify and aid in their operation, and therefore with injurious
effects ; for pure brandy in itself, and alone, is certainly no digester of food, quite the contrary; but where
it acts well it is aided by combining with the mass of matter already in the stomach or with fluids given
along with it: it then does so, by calling forth the powers of the stomach to throw out its juices and
to perform those actions which are necessary to the digestive function : but where it was so circum-
stanced as not to produce these effects, it would be likely to do harm and be mischievous ; or when not
supported by the aid of warm demulcent fluids, or aided in every other way that could remove the
operation of the paralysing cause, it would get into discredit also. The placing the contents of
the stomach favourably, in order to digest, and the whole system also, should first, we humbly
apprehend, obtain our care and attention, and then the stimuli administered will generally have the
desired effect; one measure co-operating with another, encouraging and aiding their effects by frictions
and mechanical measures, not applied to the legs on account of the cramps, but to tho abdomen itself
and stomach, the seat of the mischief. Diluting also the spirit and facilitating its digestion, by easily

* Who appears to have taken it from Erasistratus, Lit). 1; as quoted by Calius Aurelltttms, p. 262.�" Salutarium utatur tepido
potu vomitum provocans vel acrimoniam temperans fellis."

digestible things given along with it, and aiding it, if there be occasion, by warm spices and other
stimuli. Encouraging also, by tepid measures, all the organs concerned, and even the extremities of
the body, all which circumstances are required in very bad cases. Milder cases will yield to very
simple measures, such as friction, and warmth even alone, applied to the region of the stomach.

But if the case be only partially relieved, and these aids are but imperfectly administered, then a
protracted case will be the issue, accompanied with those apparently anomalous effects upon the brain and
nervous system which often, or generally, end fatally. So that the perfect resuscitation of these offices
is indispensably necessary for the accomplishment of the restoration of the sufferer; and we may
also see, on this taking place, a return of the most perfect health ; that is, if the case has not been of the
severest, and its removal has been speedily accomplished, and without much delay, as we might prove
in the history of hundreds of cases, which shows most plainly that there can be neither contagion nor
any thing fatally depressing about the disorder, even hardly a moment longer than its actual invasion
so that the very same day, or the next day, the patient can return to his usual occupations, of which
here is no example, I believe, after an attack of one of those diseases which are by practitioners
generally admitted to be really and truly of a contagious character.

Sydenham recommends also gum arabic, and barlay-water, with a view, appraently, to sheath and
protect the coats of the stomach and bowels from the acrimony of the supposed bilious discharges.
And we have thought, if to our hot water were added a little farina of some kind, as flour, starch, oat-
meal, or arrow root, if at hand, it would more readily lead on to the commencement of the digestive
process, than mere water, but net at all given with any view to sheath the mucous membranes from sup-
posed bile or acrimony of any kind. A gentle stimulation with spices might also be not incongruously
added to these farinaceous liquids ; as Kyan or white pepper, especially if stale pork, conger, shell-fish
such as muscles, or unripe melon, has been the offending article.

Having thus copiously remarked on the works of this valuable writer, and as most of the other writers
of eminence have generally drawn from him and partaken largely of his views, so we shall not proceed to
a further consideration of them, but in respect to a more suitable name for it, and a more appropriate
locality in the general system of medicine ; submitting, with all due deference, what we have to say on
this head to the correction of abler heads and more practised hands than ours, for the devising something
better ; hoping that every attempt, however feeble, that leads to another attempt, may be thought a step
and an advancement.

If, in following our suggestion, we may be permitted to place it along with its proper family, as we
believe it to be, of the Colicce, we should next propose to inscribe it, for its specific name, with the term
tridolor, in allusion, as the reader will perceive, to its three distressing accompaniments, vomiting, diarrhoea,
and tormina. And, as this proposition may be objected to, from the name Colica being subject to some am-
biguity, as leading to the apprehension that it was the colon that was chiefly the seat of the disorder,
which would not be true : for although this large intestine may at times chill, and become the first
organ of the arrested function, yet is the stomach as often, or indeed much oftener, the first part
affected; so that to do away all ambiguity, if such might be thought desirable, we should propose to unite
the two genera into one, that is, Cholera and Colica, under a new name, and in order to remove any
possible misnomer, inscribe it with the name Slrojthos, the Greek appellation for the tormina, and which,
perhaps, always present, attending all the species of the genus thus, making the griping or tormina
the essential and leading character, of this large family.

And ]f after giving it this more natural arrangement, we might be allowed to give it a specific name
also, indicative of its dangerous character, we should if it be not thought inappropriate, or till some
better shall be devised, and we propose to give to it that it may also serve as a timely warning of the fatal
consequences of its invasion if neglected, the epithet Tetralge, or the four misery disease, from rerpa,
quatuor, and ayXrj, dolor; conjoining to the three above enumerated affections, a fourth, viz. the
wretched cramps and spasms of the legs and abdominal muscles, which so frequently, but not invariably,
attend the disease : and thus constituted and titled, it may be said to be somewhat as the candid rattle-
snake, always carrying about with it its salutary warning. Such is, however, merely a proposition for
adoption or rejection, as may be judged right in a system of medicine. The public will ever, probably,
continue to call it by the dread name of cholera morbus, though ambiguous and wrong as to iti signifi-
cation as now used. For names are of no mean importance in leading our- views and opinions, and
the nearer these approach or approximate to the truth, the danger of error will be the more diminished,
and the facility of forming just reasonings and conclusions be augmented. The catalogue of the
genera of human diseases will be also diminished by the measure we have proposed, by the removal of

one of its most obscure genera, which cannot but facilitate the labours of the rising generation of phy-
sicians in acquiring their art.

Arrived at this point of the subject, and furnished with the preceding data, we may now profitably
turn our attention for a moment to the consideration of one of the latest and most popular, as well as
most generally read and used, of the medical works of the present day; that of Dr. Mason Good,
entitled, Studies of Medicine. At Vol. i., p, 248, wo have his views of this complaint, and like a re-
doubtable systematise he commences with taking the genus Cholera, and dividing it into three species�
the biliosa, the flatulenta, and the spasmodica. In describing the first of these, the biliosa, he falls
fully and without reserve into all the vague notions about the bilious character of the complaint, as,
indeed, the name he has chosen for his first species implies ; and under this apprehended species, he
enters the one half of the dire history of this terrible complaint, reserving the other moiety of its hosts-
of slain, as an offering to his third species, the spasmodica, which are al! most evidently but one and the
same complaint, the spasms or cramps of the legs and abdomen accompanying the disorder, (as he
himself indeed inadvertently admits) in both species ; and it is to be remarked that these spasmodic
aSections do accompany the complaint most severely where there is considerable or excessive vomiting-
attending it.

As to his second species, flatulenta, is evidently, at least as we believe, no other than an anoma-
lous case of wind colic, drawn in to fill up and make ont a respectable family species. This serves
to bring to our recollection as suiting the present place, what we had before purposely omitted to
mention, the cholera, '�,r,pa, of Hippocrates, or cholera sicca, of his translators, or dry cholera ; which,
appai-ently in complement as it were to the great father of medicine, Hippocrates, Sydenham also makes
mention of, but afterwards adds, that he never saw but one case of it, so that the existence of any real,
essentially specific disease, may be fairly doubted : and may not such a case be easily explained, by a
view of those cases of common cholera which are attended with no previous diarrhoea, and which would
be necessarily a- puzzle to those who were fully possessed of the notion of the bilious origin of this
complaint, from whence they apprehended the pm-ging sprang, and which to them would give it all the
appearance of another and different disease. It would appear either to have been this, or some anoma-
lous case of dyspeptic colic, reducible to no certain rule or character. And as to flatulence, or wind, it
accompanies all kinds of imperfectly-arrested digestion, especially where the powers are strong to resist
the access of the full character of the disease in a perfect suppression. And that such flatulence does
generally occur, we may prove by reference to the description of Celsus, and innumerable cases re-
corded during the late epidemic ; so that surely it cannot constitute with propriety a specifically-different
disease.

There is one remark, I find, with Dr. Good, which appears to deserve a more particular attention
here, and which seems to be well founded on fact, viz., that powerful inpressions upon the sen-
sorium, especially of a nature to excite grief, or any sudden alarm or fright, will sometimes have the effect
of bringing on an attack of this complaint; and if such be admitted, it will go some way in explaining
a considerable number of those cases of cholera, where the evidence of contagion appeared all but
decisive. Instances of relations and friends falling immediately one after another, as though they had
certainly communicated it to each other, gave to it indelible impression of an infectious disease: being
seized in the presence of their friends, or dying before them, so filled them with fear and apprehension,
and took such possession of their minds, that they became in consequence (other things perhaps, at the
time conspiring, as similarity of food, and similar exposure to atmospheric impressions,) obnoxious to
the disease, from a suspension of the proper functions of the nerves leading to the parts, which losing
their influence over the digestive organs in particular, would induce the attack ; so that nothing, under
such circumstances, could shake the belief of the spectators that such w^rere true cases of con-
tagion. In the Philosophical Transactions for 1667, there is related a case, with every appearance of
truth, where a terrible loud clap of thunder appeared immediately to have the effect of bi inging on the
disorder ; and 1 think, in the course of perusing some of the more ancient writers on this disease, I have
also seen recorded testimonies of its invasion from similar causes.

Dr. Mason Good seems very much to depend upon opium with tonics, as Calumbo root, in his treatment
of the disease, given very much after the manner of Sydenham. As to the probable effect of opium we
have already delivered our sentiments.

That dampness and chills, and not contagion, led to the complaint, is also strongly corroborated
by a remark of Gendrin, p. 312, "Le plus grand nombre ont etc atteintes pendant la nuit," #c. ,�
and Bouilland also informs us that smaller colicky affections of the stomach and bowels preceded for

several weeks the grand attack of the disease in Paris, so that the acting cause came on gradually,
which would also appear to confirm our opinion of the nature of it, and to remove the idea of any specific
contagion. These smaller affections were called by the French physicians, by way of distinction, the
Cholerine.�Traite du Cholera Morbus, p. 191.

If further proof were necessary, we may have the most unquestionable of the propriety and advan-
tages of the stimulant plan of treating this disease by reference to the writings of Dr. Burrel, (vide
Bombay Reports, p. 68�80,) who states, that the bile sometimes flows during this complaint, which
affords us the opportunity of saying, that neither its suppression or its flow is a necessary or invariable
character in the disorder, but that either may happen according to the individual case ; still a suppression
is the more usual condition, from the cause we have formerly stated, viz., that that which arrests digestion
will probably also have a tendency to arrest the flow of bile. And also from the works of Dr. Orton on
Indian Cholera, 2 vols., Madras, 1820, and since edited in London. Also from the writings of Frederick
Corbyn, an eminent surgeon in the company's establishment in India, and a considerable number of his
medical associates, in an excellent communication to Sir Gilbert Blane, inserted in the Medico-
Chirurgical Transactions, vol. ii., p. 110. On turning to the writings of Dr. Cullen, we see that he
gives a most woeful description of the highly-bilious nature of this complaint, and that " the bile is
acting both upwards and downwards." &c. As to his treatment, it is chiefly derived from Sydenham.

And now, in conclusion, may I presume to state that this stimulant plan of treatment was strongly
urged by me, and with all the combined agents necessary to render it successful in the treatment of
horses, as far back as 1804-5, and of which I ascertained and gave a full account to the public in
a dissertation printed in London in 1815, where many interesting particulars and remarks may be seen
not here introduced. And may I not also state, that from having contemplated the disease in the simple
form in which it appears in the horse, I was led to extricate it from its so generally imagined bilious origin,
and by comparing and transferring those observations to the human body, was led to see also that the
bile had hardly more to do with the disease in the one case than it had in the other.

Having brought to a conclusion my observations on this perplexing malady, in token of long friend-
ship and sincere regard, I now inscribe them to my very worthy and learned friend, Dr. Hodgkin.

Taunton-place, RegenVs-park, 6 mo. 1st, 1833.

FINIS.

Linaiey, Printer, 9, Old Bailey, E. C.



	THE CHOLERA UNMASKED; OK, ITS TRUE NAME, NATURE, AND CAUSES POINTED OUT; ALSO A MORE CONSISTENT AND SUCCESSFUL MODE OF TREATING IT. BY BRACY CLARK, F.L.S., Member of the Royal Institute of France, 8fc. CORRECTED FROM A COMMUNICATION FORMERLY ADDRESSED TO THE EDITORS OF THE MEDICAL GAZETTE.

	LONDON�1848 : FEINTED FOR THE AUTHOR, TAUNTON PLACE, REGENT'S PARK.

	In the midst of the numerous, opposite, and very conflicting opinions which prevail at this time respecting the direful epidemic called cholera, permit me to address you, as this disease still exerts its fatal ravages in spite of all that has been done, and the opinions respecting its nature and its treatment seem to be almost as various and unsettled now as they were at the commencement of it, if we may judge, at least, from the recommendations every day proposed in the medical periodicals. Under these circumstances you will, perhaps, pardon the suggestions of one who, though formerly educated for it, is not now strictly one of your honour- able profession, and allow him to advance an opinion which he has long entertained, and which, if it be not founded in truth, has one merit at least� that of novelty. These views have, however, been shown to a few of his medical acquaintance, who do not see any thing in them to forbid the reason- ings and conclusions here drawn, which has induced him, with great deference however, to make them more publicly known. If they should be admitted, they will certainly lead to a more decisive, and perhaps more successful mode of treating this deplorable malady. Many physicians having observed that there was often a great deficiency of bile in the intestines after death, were led into a state of doubt whether this dreadful epidemic, although designated Cholera morbus, was, in reality, that fatal disease, since medical books everywhere proclaimed it as of a most highly bilious character, whilst the disorder appeared very commonly entirely deficient in that essential respect. It is, however, as we shall presently see, the genuine Cholera morbus of the physicians, but which had been strangely, for ages, even from the times of the Roman, Celsus, described as a disease of dreadfully bilious origin, and which opinion continued down to our own times, even with physicians the most eminent and by the highest medical authorities; as in the historical or second part of our dissertation we shall presently exhibit



	PAET II. OF A DISSERTATION ON THE EPIDEMIC CHOLERA.

	In the preceding part, or memoir, I endeavoured to consider the true origin and nature of this disease, and why at times it assumed such a very sudden and fatal termination, viz., from the undigested mass acquiring a poisonous character. This also would explain the cause of the furious riots in Paris and St. Petersburgh on the first breaking out of the epidemic, the populace conceiving that they were poisoned by the doctors, and also by the vintners, many of whom nearly lost their lives through this suspicion. And we also endeavoured to explain why at other times, as in the more protracted cases, without actually destroying the patient at once, it produced effects on the nervous system, such as gave to it very much the appearance of a low nervous fever, or typhus. To these remarks were added what we conceived to be the genuine principles for its treatment, by recalling, by every possible means combined, the restoration of the impaired or lost digestive and chylopoietic functions. In the present memoir, it is proposed to inquire into the antiquity and original signification of the term Cholera, and to examine the views and opinions of those physicians who followed immediately after the ancients, and from whom we have principally derived our present erroneous views of the disease, and then those of our modern physicians, and to conclude by giving to the disease a new name and arrangement in the medical system. Desirous of ascertaining more exactly the origin of the term Cholera among the ancients, and the sense in which they employed it, and how these erroneous notions of the bilious nature of this complaict first originated, I was led, in order to pursue these researches, to avail myself of the two noble medical libraries in Lincoln's-inn-fields, that of the College of Surgeons, and that of tie Medico-Chirurgical Society, and I acknowledge with pleasure my having received the most polite attention and satisf'catory aid from the two respective librarians having the care of these valuable collections. As far back as Hippocrates, the word cholera is found, it several times occurring in his worts, and always standing by itself, amd without the modern adjunct of morbus attached to it. It is therefore of very remote antiquity, but in his descriptions of the disease he does not appear particularly to refer it to a bilious origin, neither does he appear to have ever seen it in the character of a terrible epidemic, such as it has appeared of late years in India and in Europe. Before Hippocrates, however, Erasistratus describes the disorder, and without appearing particu- larly to insist on its bilious origin or character. But the word cholera is to be found long antecedent to both the above writers, and at a period nearly coeval with the earliest graphic records. It occurs several times in the original Hebrew of the sacred writings, and as early as the books of the Pentateuch of Moses. In the Hebrew the word is often divided into two, i^ri choli and 1 ra; sometimes, however, united. According to the Hebraists, choli simply signifies illness, sickness, inflictive disease, or plague, without any reference to, or as being in any manner derived from, bile in particular. They infoim us also that the additional ra signifies that the said infliction or disease was in an excessive or superlative degree. We subjoin the references to all those passages where the term is said to be found, as well in the writings of Moses as in the other parts of the Scriptures, that any one more deeply versed in the study of Hebrew, than we profess to be, may have the opportunity of fully considering the true meaning and sense in which they have been em- ployed. These passages, we ought also in justice to state, appear to have been first collected and ob- served by a gentleman of the Cambridge University, E. H. Smith, Esq. Deut. xxviii. ver 59, vii. ] 5 ; 2 Chron. xxi. 15 ; 1 Kings xvii. 17 ; and others. And choli is from chala he was sick or sickened, from the prefer perfect tense of the verb choul to be sick or ill, used also for nervous tremor of the bowels such as attends an irresistably violent colliqu- ative sickness. And what appears singular is that Misrahim appears to have been the Hebrew Ver- nacular or ancient native name of Egypt.