11TJINICAL  RESEARCtI ES
THE   IM01IEOPATIlIC  TREATMIENT
OF
ASIATI C  CHO L E R A.
PRECEDED BY
A REVIEW  ON  TIlE ABUSE OF TIIE NUMERICAL METIIOD
IN  MEDICINE.
BY
J. P. TESSIER, MI.D.,
PHYSICIAN TO THE HOSPITAL SAINTE-MAARGUERITE IN PARIS.
TRANSLATED
BY
CHARLES J. HEMPEL, M.D.,
FE LLOW AND CORRESPONDING MEMBER OF TIIE 1IOMEOPATIIIC COI, TIECE OF
rPENNSYLVANIA; IIONORARY MEMBER OF TIlE i.IAIINEMANN SOCIETY OF'
LONDON, &C. &C.
NEWV-YORK:
WILLIAM RADDE, 322 BROADWTAY.
PHILADELPHIA: RADEMACHER & SHEEIx. —]3STON: OTIS CLAPP. —IANCHESTER, E.N-G.: TURt-ER, 41 PICADILLY.
1 855.




Entered according to Act of Congress, in the year 1855, by
WIL L I AM   RADDE,
In the Clerk's Office of the District Court of the United States for the Southern
District of New-York.
IfENnY LDowIo, Printer, 45 Vesey-st.




ON THE ABUSE
OF THE
NUMERICAL METHOD IN MEDICINE.
I have stated in my " elementary principles" of homceopathy, that Hahnemann's method is systematically rejected by
certain physicians for no other reason than because it is a
theory. In the eyes of these learned men, every doctrine,
every theory, every system is an obstacle to the scientific
progress and development of medicine: hence according to
their logic, Hahnemann's theory must necessarily be false
and dangerous.  Indeed, if every theory is necessarily
false, there is no reason why Hahnemann's doctrine should
be true.
The systematic opposition of these physicians to a philosophical reform of therapeutics, which seems to me fraught
with great results, naturally leads me to examine this great
question: Whence comes the truth in medicine? Does it, as
has been supposed, emanate from the men of genius who
have successively produced their medical theories and systems? or does it flow from the adoption of a certain logical
method, as was proclaimed by Bacon, believed by Pinel,
stated by Chomel, and repeated by Louis?
The theory of knowledge is one of those questions which
no one treats who is not either an accomplished metaphysician or a presumptuous ignoramus. I do not consider myself
capable of judging between Aristoteles and Plato, Descartes
and Bacon. In this respect I abide by the conclusions of
the schools and of good sense; this is sufficient for my
purpose.  Not being competent, I do not wish to meddle
with the question of the origin of knowledge in its generality.
1 shall content myself with examining whether the medical
reformers who proscribe Hahnemann's ideas, because they
did not come into the world as, according to their own in



iv               ON THE ABUSE OF THE
fallible wisdom, they ought to have come, have or have not
common sense on their side in what they themselves teach;
in one word whether the method by means of which our
observers and statistical philosophers pretend to reconstruct
the medical edifice upon a new basis, is a serious truth or
a utopia.
I shall say a few words of Pinel's endeavor to base medical
science upon analysis; of Chomel's attempt to present a
doctrine exempt from all theory; and lastly, I shall arrive at
the medical reform of Louis, and shall dwell upon it at some
length.
Pinel lived at a time when analysis was spoken of as we
talk now-a days of progress, at a period when, in order to
pass for a man of intellect, one had to be a friend of analysis
as one has to be, in our time, a friend of progress. Pinel
fell into the trap which the philosophical sophistry of his
period laid to the simplicity of his genius. He imagined in
good faith, but with a feeling of honest vanity, that, previous
to his teachings, physicians had neglected analysis, because
they made no more mention of it than they did of synthesis.
He therefore betook himself to the task of basing medicine
upon analysis, of declaiming without rhyme or reason against
all theories, systems, flights of the imagination, premature
conclusions, &c. But when he undertook to compose a book,
the analysis remained outside on the cover, and the book was
a synthesis or a nosological classification very much resembling
that of' Cullen. Moreover, Pinel believed in what he called
the eternal principles of the healing force of nature which is
as synthetical and hypothetical an idea as ever was. As a
philosopher, Pinel is therefore without any merit, since he
was unable, in the matter of method, to distinguish his right
from his left hand. This does not take away his claim as
a medical authority; but we cannot admit that it was his
mission to direct the intelligence of the medical profession
in a new  channel of philosophy. To conduct others we
must in the first place be able to walk without leading-strings.
The reform of medicine by analysis is therefore an illusion
which the spirit of the age rendered excusable.




NUMERICAL METHOD IN MEDICINE.              V
Chomel who was an eminent practitioner and a distinguished
pathologist, was frightened in his younger years by the impetuosity of Broussais, and this impression has clung to him
all his life time. Seeing the pernicious influence which the
theory of irritation had on the general science and practice
of medicine, he conceived an aversion against'all theories.
He suspects every thing, which is not a simple isolated fact,
or some direct inference from particular facts which it is
easy to establish.
The dread of an evil frequently leads us to a worse one.
Chomel arranged his personal impressions into an absolute
system; this was an error. More than this; since it is just
as impossible to do without theories as it is to live without
air, and since Chomel is subject to the common laws of
humanity, it follows that he has theories, that he propounds
theories without knowing it, and that, in this respect, he
lives in a complete illusion.  I will proceed to the proof
of this.
Chomel closes his "Elements of general pathology" with
these words: "our object has been, we do not hesitate to
to repeat it, to find.the limits of our subject, to endeavor to
reach them without going beyond them, and to present on an
essentially abstract subject, a doctrine exempt from theories,
and exclusively founded upon facts, and upon their immediate
and rigorous consequences."
Here we have an author who is well convinced that he is
no theorizer, that he has presented a doctrine free from
theories, and who would blush to have followed a theory.
This author does not even inquire whether there can be doctrines without theories, or, which is the same thing, whether
it is possible to think without ideas. Well, let us examine
his preface: "I have spoken of disease in general as I
should speak of a particular case of disease, if I intended
to give as complete a history of this case as it is possible to
give.".....  Hence Chomel's pathology is the description
of some fictitious malady, a malady that comprises every thing
which belongs to pathology and therapeutics, an imaginary
being, in one word, a fiction; and this is no theory! Chomel




vi                ON THE ABUSE OF THE
is mistaken: it is not only a theory, but it is the oldest theory
that has ever been known in medicine; it is the theory of
the absolute unity of disease, of the unity of the pathological
type. This theory is the opposite of that which teaches
that every disease is an entity, and which therefore admits a
plurality of types, and a radical distinction of these types in
pathology. The theory of the absolute identity of all diseases, belongs both to the followers of Hippocrates and those
of Broussais: the only difference existing between these
two classes of philosophers is this, that, according to the
hippocratists, disease is something general, a reaction of the
vital principle, whereas the Broussaisists consider it as something Hippocrates teaches: fever is every thing; Broussais:
irritation is every thing in pathology.
It is the application of the theory of the typical unity of
all diseases to general pathology that Chomel calls a doctrine
without theory.  The pretension of furnishing a doctrine
without a theory, is therefore an illusion just as much as the
pretension of basing the medical edifice upon analysis; and,
although excusable on account of the early impressions of
the author, it is nevertheless an illusion, and not by any
means a new guide to the activity of professional minds.
So far then we do not see that there exists a new method
of discovering truth in medicine.  And, if this new  method does not exist, is it right to avail one's-self of some
supposed truth as the exclusive condition of the perfection of
art, for the purpose of proscribing the therapeutic reform of
Hahnemann and those who wish to ascertain the truth or
falsehood of this theory, precisely because it is a theory?
It seems to me that, if it were possible to mistake an illusion
for a new method, a new truth might easily be mistaken for
an illusion.
I have now arrived at what I term the abuse of statistics
in medicine, the so-called school of observation, the numerical method. I will at once explain why I look upon this
method as an abuse of statistics.
From time immemorial observations and numbers have
existed in medicine. From time immemorial there have been




NUMERICAL METHOD 1N MEDICINE.             Vii
good and bad observers in medicine, and numbers have been
resorted to for good and bad purposes; and the defect of a
method being charged upon the inadequacy of those who
apply it, and not upon the method itself, it has been supposed that the first scientific duty of a physician at all
times was to observe, to observe unceasingly, and to meditate
upon his observations rather than to count them. Indeed
numbers will always be something secondary in medicine,
but it would be wrong to reject them on this account, for they
may be exceedingly usefull in some cases. I have not the
remotest thought of condemning numbers, no more than the
exaggerated importance which is attached to them; this sort
of extravagance is inherent in the very character of the
numerical method, and is scarcely deserving of being noticed.
The abuse to which I am desirous of calling the attention
of physicians, is not exactly the tiresome and extravagant
display of useless figures; but the fact, that the natural order
of things has been inverted, and that the numerical method
has been substituted in the place of the medical art.
This substitution constitutes the greatest possible abuse of
statistics.   This abuse is a characteristic feature of the
School of observation, of the numerical School, of the statistical physicians, in one word, of those observers who oppose
with all their might every endeavor to verify by observation
Hahnemann's theory, because it is a theory.  If we succeed
in showing that this new basis upon which they attempt to
construct the medical edifice, is a utopia, we shall be fully
justified in pursuing other methods than those of our modern
so-called observers; we shall be fully justified in not having
adopted the sterile errors which these innovators offer as the
source of all truth  in one word, in not having believed that
it is possible in medicine to do without ideas, without theories,
or doctrines, any more than without practical observation.




FOS SALE BY
WILLIAM RADDE, 322 BROADWAY, NEW-YORK,
PUBLISHER OF HOM(EOPATHIC BOOKS AND SOLE AGENT FOR THE LEIPZIG
CENTRAL HOM(EOPATHIC PHARMACY.
HOMCEOPATHIC MEDICINES.
WM. RADDE, 322 Broadway, New-York, respectfully informs the
Homceopathic Physicians, and the friends of the System, that he is the
sole Agent for the Leipzig Central Homoeopathic Pharmacy, and that
he has always on hand a good assortment of the best Homceopathic
Medicines, in complete sets or by single vials, in Tinctures, Dilutions
and Triturations; also, Pocket Cases of Medicines; Physicians' and
Families' Medicine Chests to Laurie's Domestic (60 to 82 Remedies)EPP'S (60 Remedies)-HERING'S (60 Remedies to 102).-SmallPocket
Cases at $3, with Family Guide and 27 Remedies.-Cases containing
415 vials, with Tinctures and Triturations for Physicians.-Cases with
268 Vials of Tinctures and Triturations to Jahr's New Manual, or
Symptomen-Codex.-Physicians' Pocket Cases, with 60 Vials of Tinctures and Triturations.-Cases from 200 to 300 Vials, with low and
high dilutions of medicated pellets.-Cases from 50 to 80 Vials of low
and high dilutions, &c., &c. Homweopathic Chocolate. Refined Sugar
of Milk, pure Globules, &c. Arnica Tincture, the best specific remedy
forvbruises, sprains, wounds, &c. Arnica Plaster, the best application
for Corns..Arnica salve, Urtica urens tincture and salve and Dr. Reisig's
Homweopathic Pain Extractor are the best specific remedies for Burns.
Canchilagua, a Specific in Fever and Ague. Also, Books, Pamphlets,
and Standard Works on the System, in the English, French, Spanish
and German languages.
1  Physicians ordering medicines will please mark after each one its
strength and preparation, as:
moth. tinct. for mother tincture.
1. trit. or 3. trit. for first or third trituratlon.
6 in liq. or 30 in liq. for sixth or thirthieth attenuation in liquid.
6. in glob. or 30 in glob. for sixth or thirthieth attenuation in
globules.




ASIATIC CHOLERA.
SEVENTEEN years ago I studied at the Hotel-Dieu,
under Magendie, the Cholera, which then raged so fiercely
in Paris. At that time I observed about seven hundred
cases.* Another cholera-epidemic enabled us to make
new observations. The interval between the two epidemics gave us time to reflect on the character of the
disease. It is the result of these investigations that we
now publish for the purpose of proving two things, first:
that Asiatic Cholera is as well known to physicians as
any other malady; secondly: that the treatment of this
disease can be founded upon a truly scientific basis.
These two propositions are opposed to the general
opinion existing among laymen as well as among a large
number of physicians.  This seems to furnish an additional reason why these erroneous opinions, which are
prejudicial to our art, should be removed.
It is not, by any means, my intention, to give a complete history of the cholera epidemic, from its origin.
I shall confine myself to the principal points in the physiological, pathological and therapeutic analysis of the
epidemic. This plan will enable me to treat a few of
the serious questions that have been raised, and which,
it seems to me, have not yet been satisfactorily solved.
We shall perhaps likewise be enabled to draw the line
of demarcation between what can be and what cannot be
cured at the present day. In this way we shall point
* See Magendie, Lectures on Cholera at the College de France
Paris, 1832, one vol. in R,




2                  PHYSIOLOGICAL ANALYSIS.
out what has been done and what has yet to be done.
It seems unnecessary to justify the plan of this work by
any other reasons.
OI. PHYSIOLOGICAL ANALYSIS.
The question is not to give or to find a physiological
definition of the Cholera that shall account for all its
phenomena. Such an investigation, after straining our
imagination to the utmost, would lead us where it has
led all those that have given themselves up to it for the
last twenty-four centuries, to a more or less ingenious
methaphor. To my mind there is nothing less scientific
than a metaphor, except the mind that contents itself
with it. Let us send the physiological physicians, the
organists, humoralists, chemiatrists, mechanical practitioners, &c., in search of the quintcssence of Cholera; we
will limit ourselves to the study of the phenomena that
it presents to us.
Cholera assumes three different orders of symptoms,
according as it attacks the animal, vital or natural
functions.     The  first manifest the invasion  of the
* Here is a description of this traditional division of the functions,
taken from the Latin of Bcerhaave:
"The functions are habitually distinguished into vital, natural and
animal.
" Vital functions are such as are indispensable to the preservation of
life; among these we number the muscular action of the heart, the secretory action of the brain, the pulmonary action, and the flow of the
blood and of the vital spirits through those organs and their arteries,
veins and nerves.
" Natural functions are those whose business it is to assimilate the
food to the organs; these are the action of the viscera, vessels and
humors, namely: the action of receiving, retaining, moving, changing,
mixing, secreting, applying, excreting, consuming.
"Animal functions are so related to man that the mind either derives
corresponding ideas from their action, or the will is influenced, or, stimulated into manifestation by this action; such functions are: tact,
taste, smell, sight, hearing, perception, imagination, memory, judgment,
reasoning, affections and voluntary motions."  (H. Boerhaave, Institutiones medice, Paris, 1747, p. 361-362).




ASIATIC CHOLERA.                  3
disease by a sense of malaise, anxiety, aphonia, cramps,
spasms, delirium, coma; the second by the thinness, frequency, smallness, irregularity, collapse of the pulse,
the weakness of the beats of the heart, and the embarrassed respirationi the third by diarrhoea and vomiting, derangement of the secretions, some of which
are entirely suppressed, by a sudden emaciation, by a
suspension of the phenomena of nutrition, by coldness,
blueness of the skin, hippocratic or choleric face, and
this external appearance of the body which has been
characterised by the equally correct and energetic appellation of cadaverous. To this group of symptoms
we have to add congestions and inflammations that develop themselves before or after the febrile reaction,
in order to have a complete aggregate of the phenomena
that succeed each other with more or less regularity and
connection in an attack of cholera, and the progressive
aggravation of which brings the patients so frequently
and so rapidly into the grave.
Whatever part of the body may be assaulted, the epidemic does not seem to confine itself to an alteration of
the phenomena of sensibility and contractility. Its action
is deeper; it taints the very sources of life, the essential,
formative powers of the organism.
When the fundamental conditions of life are attacked,
it is not only particular functions that are disturbed,
but their whole relation to each other, their whole
mechanism becomes deranged.
Animal functions. —It seldom happens that sensibility or contractility are the first functions that are
attacked in cholera; it happens, however, in some cases.
Thus, for instance, the disease has set in with cramps,
pains, in various parts of the body, in the head, legs or
in the extremities. More frequently, before experiencing
any other pain, the patients experience a marked weariness and weakness in the muscles, a vague and general




4               PHYSIOLOGICALT ANALYSIS.
malaise.  All this, however, occurs irregularly, and alterations in the animal functions do not always usher in
the epidemic.
The seat of the cramps or pains varies; in some cases
the extremities alone are attacked, in others the lumbar
muscles or the large muscles over the thorax; the face
and nape of the neck, and other parts are likewise invaded.  When unremitting, the pains may become agonizing. Then they extort cries from the patients, and
may even cause convulsive spasms.  Almost all the
patients retain their consciousness; the general sensibility is likewise preserved; the senses are but little or
not at all impaired. In very serious cases they are rather
duller; the hearing is rather hard, and the patient complains of buzzing; in almost every case there is loss of
voice. At a later stage of the disease, delirium and
coma set in.
Admitting that all these phenomena proceed from an
alteration of the nerves of the animal sphere, what would
be the seat of this alteration? The brain, the spinal
marrow or the nerves? or would it in one case be one of
these parts, and in another case another? And the
muscles, are they affected directly or only indirectly in
consequence of a counter-shock emanating from the alteration of the nerves that are ramified through their
tissue'I
The phenomena which we observe, are not sufficiently
constant to be traced to the same portion of the nervous
system. As regards the question whether the muscular
irritability is affected primarily or secondarily, we are
unable to affirm anything positive in this respect. Either
of these two circumstances may occur.  If we attempt
to establish an order of succession in these modifications
of the animal functions, two contrary opinions will likewise become apparent. Either the phenomena which
seemed isolated at first, react, each in its way, upon the




ASIAT'IC CHOLERA.                5
brain, and there become concentrated; or else the phenomena emanate from the cerebral mass as their focus,
and localize themselves successively in the various elements of the animal functions. The specific mode of
action as well as the unity of the nervous system, the
double evolution of its phenomena from the centre to the
periphery and from the periphery to the centre, do not
permit any affirmation in this respect, for the positive
demonstration of either of these mechanisms is impossible.
Vital functions.  In the history of the vital functions
we have to examine the blood-vessels, the circulation,
the blood and respiration. The tone of the vessels is
sensibly affected by the cholera. It is well known that
their tone depends upon the voluntary expansion and
contraction of their tissue.  These properties are entirely different from their elasticity, which is not spontaneous.  The coats of the veins are flabby, although
these vessels are not empty. If a vein is opened, and
the blood pressed out, the coats of the vein do not
contract, they remain what they were. I do not know
whether a similar phenomenon takes place in the arteries; inductive reasoning would seem to lead us to think
so. The beats of the heart are weaker; its contractions
seem without energy; they are not unusually -excited
by the obstacle which the capillary circulation seems to
oppose; on the contrary, the action of the heart is just
as depressed as that of the veins and arteries.  It
would seem as though the blood could not pass beyond
the capillaries, for it accumulates in these vessels, especially in their terminal ramifications, and there produces
these passive congestions, and this blueish color which
are one of the characteristic signs of cholera. Generally
however, when the blood does not flow to a part in sufficient quantity, without there existing any obstacle to
the venous circulation, this part assumes a livid pallor.




6               PHYSIOLOGICAL ANALYSIS.
The veins seem to swell, and the venous blood bears no
proportion to the corresponding arterial blood.'  In
cholera a state of inertia prevails at the centre as well
as at the periphery of the sanguineous system.  The
circulation is still going on even when the pulse has become imperceptible. This is evident from the fact that
camphor or ether which has been deposited in a mucous
bursa, is absorbed; but the circulatory movement is exceedingly depressed.
The blood is visibly altered in epidemic cholera. This
alteration affects the proportion of the fluid to the solid
constituents of the blood. Becquerel has furnished an
interesting description of these alterations. Beside the
chemical alterations, the blood presents altered physical
and physiological properties. The first alteration, which
was pointed out by Magendie in 1832, is the extreme
viscidity of the blood during the disease as well as
after death. This viscous blood does not turn red when
exposed to the air; but if previously mixed with a
certain quantity of water, it will then turn red when
exposed to the air. This viscidity seems therefore to
be owing to the absence of water, and to certain changes
in the proportion of the solid constituents of the blood.
As regards the physiological alteration of the blood,
consisting in the fact that it is no longer coagulable, it
remains even after the addition of water, or after the
blood has turned red. This is a most important phenomenon. It shows that the blood has lost its only vital
property, its plasticity. This loss of plasticity corresponds to the loss of tonicity in the organized tissues;
it is the cessation of the spontaneous molecular movement
by means of which life becomes manifest according to
* Before making any artificial injections in animals, it is even useful
to tie the arteries of the part that is to be injected, a few moments
previous to the operation. By this mean's the part through which the
tied artery courses, becomes bloodless.




ASIATIC CHOLERA.                 7
its inherent quality. In severe cases of cholera this
alteration develops itself progressively; it indicates a
disorder that is carried to its extreme limits, since it is,
so to say, the commencement of death.
Does this vital alteration of the blood take place
directly, or is it the effect of the excessive alvine evacuations? If this latter supposition were true, the alteration
of the blood could only take place after considerahle
discharges from the bowels had taken place. But it is
seen even at the commencement of the disease, before
the bowels had been much affected.  I am therefore
inclined to think that the alteration of the blood takes
place directly, and that, on the other hand, the evacuations exercise a marked influence on' the constitution of
this fluid.
In its mechanical phenomena the respiration does not
seem disturbed; but may we not suppose that the blood
in the lungs remains unaltered? It would seem so, to
some extent at least, since the arterial blood, during the
course of the malady, is as black as the venous blood.
These extraordinarily rapid and deep alterations of
the vital functions constitute one of the particular
features of cholera; they do not exist to the same
extent in any other disease.
Natural functions. —These functions are the first
that become altered during an attack of cholera. This
alteration exists in every stage and form of the disease.
From the mouth to the anus, all the phenomena are
modified; it is not only the secretions that are altered;
the tissues are likewise changed by characteristic symptoms of inflammation. The most striking changes are
excessive intestinal and gastric secretions, suppression of the bilious secretion after a few evacuations, and
suppression of all the other secretions.
The altered appearance of the secreted substance
indicates the derangement in the natural functions.




PHYSIOLOGICAL ANALYSIS.
The unitary relation of the secretions shows itself by
the suppression of some, and the excess of the gastrointestinal discharges.
If sweat appears, it is only a partial sweat, in the
face, on the extremities; the unity of the secretions is
least perceived on the skin.
The external changes of the body are exceedingly
remarkable.  The totality of these changes produces
the well known cadaverous aspect of ch6lera-patients.
They show a deep alteration in the nutrition of the
solids.' The skin is either the seat of partial congestions
in the face and at the extremities, or else extending all
over the body; these congestions have a livid appearance.  Simultaneously with the appearance of the
congestions, the mucous membrane collapses, and the
skin loses its tonicity.  This coincidence of the congestions with the loss of tonicity and the diminution of
animal heat in the affected parts, is a sign of a most
violent attack on the vital forces; it is the sign of a
death-struggle from the commencement of the disease.
In order to oomplete this physiological analysis of the
morbid phenomena of the cholera and group them into a
unit, it remains for us to determine their order of succession or mutual relations. This can only be done imperfectly, but it may be useful to make the attempt.
In cholera life is attacked to its very foundation, but
not to the same extent in every case. The vital principle
cannot be attacked in its very sources, in its formative
power, without vital products manifesting a corresponding
alteration.  Indeed, in all the affected parts, we not
only notice a functional derangement, but a perceptible
alteration of nutrition and of the properties of these
parts themselves. I have already pointed out the diminished tonicity of the tissues, and the diminished
plasticity of the blood.  These, however, are not the
only alterations in the phenomena of reproduction, since




ASIATIC CHOLERA.                9
simple irritations may be succeeded by real inflammations, the signs of which become more marked in proportion as the disease develops itself beyond its cold stage.
The phenomena of cholera are different from the socalled nervous phenomena, which simply affect the surface
of the vital functions. In cholera the depths of life
itself seem to be tainted. The phenomena of irritability
depending upon those of reproduction, it clearly follows
that these must be succeeded by an altered sensibility
and contractility in each of the various apparatuses
attacked by the cholera.  Here follows the order of
succession in the phenomena of cholera as manifested in
each of these parts.
The organs of the natural functions are always attacked,
but they may be attacked alone. The derangement of
the natural functions is generally succeeded by a derangement of the vital functions; in such a case the organs of the
animal functions are scarcely ever left intact; sometimes
the derangement of the animal functions even precedes
that of the vital functions.  These alterations vary
through a whole series of degrees; they are either more
marked in the natural, animal, or simultaneously in two
of these three orders of functions. One may likewise
cease whilst the other is just commencing, and the
disease may thus attack one apparatus after the other,
abandoning at least in a measure the former before it
attacks the second, and the second before it passes to
the third.
In some cases these three classes of apparatuses are
struck simultaneously by the disease from its very
commencement, and with an extreme violence.  Not
only may the organs of the natural, vital and animal
functions be deranged, but the central nervous system
which maintains the normal relation of these organs to
each other, may likewise be attacked. If this happens,
we observe in the production, succession and relation of
1*




10            PHYSIOLOGICAL ANALYSIS.
the morbid phenomena those strange irregularities which
are designated under the name of ataxic cholera.
Last question. How does death take place in cholera?
We have seen that the phenomena of formation are
intensely altered in an attack of cholera; we may
therefore, conclude, that death takes place in consequence
of the immediate lesion of the vital principle. As to the
mode of dying, it varies according as the patient dies at
one or the other period of the disease. In the cold
stage the vital spark becomes extinct gradually and
progressively; nevertheless death finally takes place
when the irritability of the heart has become extinct,
and its beats cease in consequence. The organs, in this
case, present all the symptoms of death by syncope, as
Bichat has described them, without, however, the characteristic cholera-changes being any the less on that
account. After the reaction, death almost always takes
place by the brain; but, since at the last.moments, the
alteration of the vital functions is combined with that
of the central nervous system, and the coldness and
blueness reappear with the cessation of the arterial
pulsations, it follows that death takes place both by the
derangement of the cerebral functions and by the discontinuance of the heart's action. Indeed the signs of
death by the brain, and those of death by the heart, in
other words the signs of asphyxia and those of syncope
are found combined.*
I shall not carry the physiological analysis of cholera
any farther. It may be said that this analysis does
not shed any light on the inmost nature of cholera.
This is true, but we ought not to ask of physiology what
it cannot give us. Beyond analysis we have fancies,
arbitrary hypotheses, illusions and deceptions. They
* See Bichat's Investigations of life and death. (Recherches sur la
vie et la mort.)




ASIATIC CHOLERA.                 11
all lead to extravagant conclusions, from which the
cholera would not be an exception.
II. PATHOLOGICAL ANALYSIS.
The term cholera is thus defined by Boerhaave: A
violent evacuation from  the stomach and bowels upwoards and downwards.* If applied to the disease,
whether epidemic or sporadic, of which we treat, the
term morbus was originally added to it: cholera-disease,
real cholera. The disease is, therefore, named, in accordance with its principal symptom.  It is not my
intention to describe it here in all its completeness, not
having any thing to add which is not perfectly known
to every body; I shall limit my pathological analysis
to the forms which the cholera presented in 1832 and
1849. These forms were the same in both epidemics;
the only difference consisted in the frequency of the
cases or the intensity of the disease. But these differences which will be indicated when we come to speak of
the particular varieties of the epidemic, are sufficiently
marked to enable us to account for the general physiological difference between these two epidemics.
By form I mean what pathologists were in the habit
of designating as varieties. A form is, therefore, not
characterised by a single symptom, but by an essential
change in the combination and order of succession of the
morbid phenomena.t
The cholera disease presents itself under the following
four forms:
1. Cholerine.
2. Simple cholera.
3. Ataxic cholera.
* See Boerhaave's Institutiones medicoe, Paris, 1774, p. 401.
t This does not seem an appropriate place of entering largely upon
a discussion of this general pathological question; I have said enough
for every enlightened reader.




12                   CHOLERINE.
4. Black or galloping cholera.
I do not consider such general symptoms as an undefinable malaise, lassitude, more or less painful embarrassments of the bowels, and slight attacks of dyspepsia, which many individuals experience during an
attack of cholera, as belonging to the disease. I shall
simply point out the phenomena which belong to every
epidemic, and which proceed in a measure from fear,
chagrin, a pre-occupied state of mind, a change in diet
and general habits, and from the precautionary measures
which had been taken with more or less discretion
against the disease.
CHOLERINE.
We frequently designate by this name the diarrhcea
that precedes an attack of cholera.  By cholerine we
here mean the real cholera, also termed cholera diarrhoeica, which is the least dangerous variety of the
disease.
This form presents itself with various modifications.
Sometimes the accompanying symptoms are so slight,
that one hesitates, but improperly, in our judgment, to
consider the disease an attack of cholera. These symptoms are a malaise, a sense of soreness and weariness,
accompanied by a diarrhcea which is at times a mere
serous discharge without colic, and at times a slightly
dysenteric attack with acute colic and some nausea.
After having lasted from one to three days, this condition disappears of itself, leaving behind it a more or less
painful torpor of the digestive canal, which either ceases
in a few days, or else continues for several weeks and
even months.
In another degree of cholerine we notice either a sudden or else slow and progressive invasion of a serous
diarrhoea, which is at first colored and afterwards whitish,
accompanied by a general sense of weariness, slight




ASIATIC CHOLERA.                13
shudderings, followed by nausea and some slight vomiting, after which the sense of general coldness and weakness becomes more marked; at this period some slight
cramps are experienced in some part of the body, sometimes in the trunk, and at others in the extremities.
This condition is generally transitory. A remission of
the symptoms soon takes place, the colic and diarrhoea
decrease, the vomiting ceases, the general temperature
is restored, accompanied by a slight febrile motion of
a day's or half a week's duration. The cramps generally disappear together with the nausea and vomiting;
at other times they continue, the patient experiences
them several times in the course of twenty-four hours,
or else a continuous and dull pain or a weakness, which
remains unchanged for a long time, takes their place
in the region where the cramps were experienced. The
least error in diet may bring back all these accidents,
even after they had completely disappeared. A relapse
may likewise set in in consequence of great bodily exertions, exposure to the cold air, an excessive repast,
violent emotions.  In such a case it is a more serious
form of cholera that attacks the debilitated constitution.'A relapse in this form of cholerine should be represented to the patients as something very dangerous.
Another modification of cholerine consists in a derangement of the digestive functions and organs, accompanied with a moderate febrile motion. The coldness is
only felt at the beginning of the disease, when bilious
vomiting takes place, together with the bilious or serous
diarrhoea, which constitutes a feature in this modification. The head is heavy and painful, the face is more
or less flushed, the eyes are slightly injected; the buccal cavity presents symptoms of a congestive irritation,
and even of an inflammation, wLich is characterized by
the swelling and redness of the free margin of the gums,
the soft deposits on their convex surface, the redness




14                SIMPLE CHOLERA.
of the tongue at its edges, the thick coating which
covers its dorsal surface with more or less uniformity
or irregularity, the dryness of the throat, and an intense thirst; the epigastrium is sensitive and feels
painful when pressed upon; considerable heat is felt in
the region of the stomach, which sometimes extends as
high up as under the sternum; in the abdomen the patient complains of seated pains around the navel, or of
shifting pains in the hypogastrium or in the sides; the
urine is scanty, turbid, and the discharges are not frequent. Cramps occur but seldom; but the soreness,
weariness and pains in the extremities are habitual
symptoms.
This condition generally lasts seven days; in some
cases, however, the malady terminates critically by
sweat, nosebleed, abundant or cloudy urine, an erythematous eruption on the skin; generally the malady
disappears gradually, leaving behind it, for a shorter or
longer period, consecutive phenomena, such as a troublesome stomacace; painfulness of the stomach and dyspepsia; distention and torpor of the bowels, or an irregular diarrhoea; either of these symptoms may occur
when the patient exposes himself to the cold, or commits
the least error in diet.
Cholerine, which is almost always cured in young
people, very often terminates fatally in old persons;
they sink gradually, and die after a series of slight, relapses. In such cases the intestinal inflammations are
generally accompanied by prostration and a comatose
drowsiness.
SIMPLE CHOLERA.
This form is generally considered typical of epidemic
cholera. i have seen many instances of it towards the
close of summer, between the two epidemics of 1832 and
1849. Sauvages asserts, that in his time, some twenty




ASIATIC CHOLERA.               15
cases of it were admitted every year into his hospital of
St. Eloi of Montpellier, if I am not mistaken. This is,
proportionally, a much larger number than occurs at
Paris, when the disease is not epidemic.
The simple cholera presents two well-marked periods:
a frigid period, and a period of reaction, when a cure is
about to take place, or else a period of collapse, when
the disease terminates fatally. For the sake of more
completeness we will divide the phases of the disease
into a greater number of periods.
Period of the precursory Symptoms.-The precursory symptoms vary.  Sometimes they consist in a
diarrhcea without colic, with increasing alvine discharges first of foecal matter, afterwards of a watery
substance which is green or of a pale color, and finally
assumes a whitish appearance. This phenomenon may
be accompanied by others, but it is sometimes isolated
until the actual invasion of the disease. The diarrhoea
may be accompanied by colic, with an urging to stool
as often as the colic is felt. In such a case the patient
generally experiences an increasing feeling of weakness.
In other cases the precursory symptoms consist of more
general, and more vague phenomena; the head is slightly embarrassed; slight attacks of vertigo take place
every now and then; sleep is disturbed; the patient is
tormented by an undefinable uneasiness. There is loss
of appetite, anorexia, with or without thirst, a bitter or
fiat taste in the mouth, slight nausea, a certain fulness
in the epigastrium,.and a sensation as if the hypochondria were traversed by a bar that now rises and then
descends again; the abdomen is distended; the patient
is seized with urging to stool, after which the diarrhoea
develops itself, consisting nearly of profuse serous discharges without any feecal odor. The patient complains
alternately of heat and cold; his face is pale, his complexion sometimes sallow, he looks sad and his voice is




16                SIMPLE CHOLERA.
somewhat hoarse and thinner. These phenomena increase and decrease alternately.  The nausea which
accompanies the alvine evacuations, increases more and
more; and the nausea is accompanied by weakness,
vertigo and coldness until the moment when the disease
breaks forth.
If the precursory symptoms do not exist in every
case, the cases where they are wanting, are, at any rate,
very few. The duration of the precursory period varies
from a few hours to several days. During this period
most of the patients attend to their business or pleasures.
It is sometimes after a meal that the second period
commences.
Period of invasion.-This period has three principal
symptoms, diarrhcea, vomiting and cramps.
After a feeling of anxiety and malaise, the patient
is suddenly seized with a copious vomiting of alimentary
substances mixed with liquids and the gastric fluid; he
feels easier after the vomiting, but he, at the same time,
experiences a sense of coldness, which runs through the
trunk and extremities; thirst sets in, but the introduction of beverages into the stomach excites fresh and
easy vomitings of fluid substances, which look more or
less bilious; the vomiting is speedily followed by a
light-colored and profuse diarrhoea, accompanied by borborygmi and soon after by sinking of the abdomen. The
nausea which exists simultaneously with the diarrhoea, is
soon followed in its turn by vomiting. In the bends of the
knees, or in the knees, loins, hypochondria, and in the upper and lower limbs, the patient experiences simple pains,
or distressing cramps. At this stage the patients generally take to their beds and try to get warm. But their
rest is unceasingly disturbed by alvine or gastric evacuations, or by muscular pains, partial shuddering and coldness. The invasion of the disease is sometimes progressive and, except the vomiting, this period cannot be dis



ASIATIC CHOLERA.               17
tinguished without difficulty from the preceding one.
It sometimes lasts for some hours without any new symptoms supervening. At other times it sets in abruptly,
and the disease develops itself at once as soon as it invades the organism. In some cases the diarrhcea ceases
for a moment as soon as the vomiting takes place; there
are likewise cases where no cramps occur.
On examining the condition of the organs at the time
when the first attack takes place, we find a well-marked
inflammatory congestion of the gums and tongue; on
its dorsal surface the tongue is covered with a uniform,
characteristic, white coating, and at its edges and on its
inferior surface, it exhibits a red, somewhat livid color,
which contrasts very decidedly with the color of the
coating. The throat is likewise irritated; the cesophagus is sometimes painful in its whole extent, the epigastrium is painful to pressure, the abdomen is tormented
by colic, which spreads from the navel to the neighb.oring parts. The urine, which had been scanty until
then, ceases to flow; the skin of the hands is cool, likewise that of the face. The aspect of the patient is not
yet much altered; but when the attack takes place with
violence, the features of the patient alter at once.
Period of increase. —This is termed the cold period,
on account of the new symptom which is added to the
former. After the vomiting a remarkable change takes
place in the pulse, which becomes feeble, irregular, intermittent. The temperature of the extremities sinks,
first of the lower, then of the upper. The skin of the
extremities looks livid; the face changes rapidly; the
eyes seem to retreat into their sockets in consequence
of the collapse of the cellular tissue; the nose becomes
cold, the lips blueish, the general malaise and the anxiety
increase; cramps set in after the alvine discharges, which
become more and more frequent, and look whitish, are
mixed with grey or white flocks resembling the offal of




18                SIMPLE CHOLERA.
washed meat, or rice that had been boiled too long.
The vomiting becomes more and more copious; the
patient is no longer relieved by the vomiting as at first;
on the contrary, it is preceded and followed by burning
at the epigastrium, under the sternum, and by a painful
pressure at the epigastrium. The patient is restless,
complaining at times of coldness, at others of heat of the
extremities; the cramps become much more frequent;
the face and extremities exhibit signs of rapidly increasing emaciation; the livid color of these parts changes
to a blueish violet color, which becomes more and more
marked. The eyes are dull, dry, the nostrils are Trequently covered with a dusty substance, the nose is
pointed; the blueish parts are covered with a cold
sweat; the pulse becomes smaller, feebler, more imperceptible. at times regular, at others unequal and intermittent, or slower or more frequent than in a normal
state of the system. The voice becomes gradually extinct, and the patient speaks only in a low tone of voice,;
and when he does speak, it is only to ask for drink,
wherewith to quench his burning thirst. He is also
heard to moan or to utter plaintive cries when the violent
cramps seize him. The cramps become more and more
painful, more and more general. Generally they decrease
under the influence of heat and frictions. But all such
relief does not last long.
Sometimes the accidents seem to cease for some hours,
and it seems as though a real remission of the symptoms
were setting in; but soon after, the diarrhoea, the vomiting, cramps, blueness and coldness reappear with an increased intensity. These illusory remissions may last
a day or a night; but then the symptoms return with
increased violence at the hour when they had broken
out the day before. These remissions have given rise
to the belief that there is an intermittent cholera.
The period of growth lasts from a few hours to twenty



ASIATIC CHOLERA.               19
four and even forty-eight hours, after which the symptoms seem to remain stationary for some time.
Acme.-When the disease has reached its acme, the
symptoms remain for some time the same; they present
a complete development of the cholera.
The patient generally lies on his back; the position
of the patient varies according as he is quiet or restless.
The features of the patient exhibit what is termed
the hippocratic face. Its complexion is cyanotic, especially the ears, nose, eyelids, lips; this blueish color invades
the upper part of the neck, and sometimes the whole
neck. Generally the face is without any expression;
nevertheless the sensations and even the feelings of the
patient are still depicted in it; it looks frightful when
the patient is tormented by cramps.
The skin of the trunk frequently preserves a certain
warmth; that of the extremities is cold, livid, blueish,
wrinkled, dry or moist. The intellectual faculties are
undisturbed, the senses preserve their respective faculties. However, the patient is troubled with vertigo,
buzzing in the ears, and does not wish to talk.
The pains are more or less violent and scattered; the
most intolerable of the pains are the burning under the
sternum, the bar across the epigastrium, and cramps in
the muscles of the trunk.
The muscular strength is considerably decreased;
nevertheless the patient is still able to sit up in bed
either for the purpose of drinking or vomiting; the
trunk and the extremities move with an astonishing ease.
The breathing, which is frequently natural, is often
embarassed by the constrictive cramp-pains of the thoracic muscles; it is sometimes hurried. The voice has
no resonance, or it is hoarse and feeble; at the base of
the thorax the patient experiences an anxiety which
sometimes increases to a perfect agony, and makes the
patient say that he is choking.




20                SIMPLE CHOLERA.
The beats of the heart are weaker than in a normal
state; the pulse of the large arteries corresponds with
the beats of the heart; at the wrist the pulse sometimes differs, being either very small or completely extinct. Sometimes it is only felt on one side.
The tongue and miouth are the seat of a well-marked
stomacace; in many cases the throat is similarly affected.
The vomiting at this stage may be considered typical
of the vomiting in cholera; likewise the atonic discharges. In the discharges from the stomach or bowels,
the bile has entirely disappeared. The urinary secretion is completely suppressed; the secretion of tears
and nasal mucus likewise ceases.  In some patients
sweat breaks out, not only on the extremities, but on
the trunk also.
Terminations: in death.-After a momentary remission of the symptoms and a slight reappearance of
warmth at the extremities and of the radial pulse, this
latter becomes frequent, small, imperceptible; the vomitings take place at longer intervals, and the stools
become involuntary. The patient is tormented by a desire for sleep, which he is wumihl t-c -t6.   h, L.s~s
silent, closes his eyelids, remains motionless, except
when he is seized with the cramps or the vomiting; the
blueish color becomes still darker; it extends above the
wrists, where it changes to a livid hue, that gradually
spreads over the trunk. A viscid sweat covers the face
and extremities; the beats of the heart become weaker,
the breathing. shorter, hurried, the eyelids are almost
motionless, half open; the eye is so dry that the choroid
membrane is almost seen through the sclerotica, and the
patient dies after a death-struggle of a few hours.
In recovery.-If the disease terminates in recovery,
we have a different group of symptoms.  The morbid
phenomena disappear gradually in the reverse order of




ASIATIC CHOLERA.               21
their original development.  The symptoms that appeared last, are the first to yield.
The warmth of the extremities returns gradually; the
blueness disappears; the eyes become more prominent,
the features assume a more pleasant expression. The
blueness is gradually replaced by a less livid and brighter
color. The pulse begins to beat feebly, but regularly;
the cramps become much less frequent; the vomiting
becomes easier, less frequent and copious; the evacuations again become bilious, first yellowish, afterwards
greenish, and, instead of continuing serous and grumous,
they change to evacuations of foecal matter. The patient
desires to urinate, and succeeds in emitting a slight
quantity of cloudy urine; the voice becomes stronger;
the patient feels better, although he still complains of
malaise, headache, heaviness of the head, burning in the
chest and stomach.
If the remission continues, the symptoms gradually
disappear; the blueness ceases entirely, the coldness is
succeeded by a warmth, which is either uniformly mild
and equal, or else unequal, slight at the extremities and
burning at the trunk. The urine is secreted regularly,
the cramps cease, the vomiting becomes less and less;
the diarrhoea, which was the first symptom when the disease broke out, is the last to yield.  Finally, sleep sets
in, and with it a feeling of ease.  Recovery is not always as easily accomplished. A more or less intense
fever sets in, with congestions of the head, eyes, local
inflammations of the mouth, stomach or bowels. All the
symptoms may have ceased, and a single one may have
remained.  Sometimes the cramps remain, at others
the bilious vomiting, as effect of a gastritis, or a bilious
diarrhcea, from which we infer a bilious inflammation of
the bowels; the cerebral congestion sometimes yields
with much difficulty. As long as the symptoms have not




22                SIMPLE CHOLERA.
entirely disappeared, some new disorder frequently shows
itself retarding the happy termination of the disease.
The period of reaction is sometimes a deception both
to the patient and the physician. After a remission
of the symptoms, which is always incomplete in such a
case, and may last from a few hours to one or two days,
the symptoms of the disease suddenly reappear in all
their intensity; the cerebral congestions again develop
themselves, the breathing becomes shorter, the coldness
and blueness again become perceptible, and the patient
sinks into the stage of collapse, which is sometimes accompanied by a profound coma, and, at other times, is
without any cerebral congestion and without coma.]
Genuine cholera generally terminates on the first day,
on the third, seventh or fourteenth, from the day of invasion. This termination takes place with or without
critical changes, generally without. The most frequent
critical changes are sweats, nosebleed, cutaneous eruptions; after these crises there sometimes remains some
important secondary phenomenon, such as stomacace,
gastritis, enteritis, or muscular pains and weaknesses;
these frequently occur in the lower extremities.
Convalescence does not really set in until after the
crisis. It lasts more or less long, according to the
the age; old people recover slowly and with difficulty,
young people on the contrary, recover speedily, easily,
and completely. I have never noticed any desquamation
of the epidermis or falling off of the hair taking place
during this period.
Simple genuine cholera has a number of varieties,
especially in regard to the intensity of the disease, which
is of several degrees, although always very serious.
These various degrees of intensity depend upon the intensity of the symptoms in the cold stage, or upon the
affections which develop themselves during the period of
reaction. The more or less rapid development of the




ASIATIC CHOLERA.              23
symptoms of the first period, the decided character of
the remission and the setting in of positive convalescence;
or the oscillations between the remission and the return
of the phenomena of the period of increase; the duration
of the period of reaction; the difficulty of restoring the
functions, and lastly, the secondary phenomena: all these
various conditions constitute important differences.
This form of the disease prevailed principally at the
commencement of the epidemic of 1849. This was not
the case in 1832. Although many cases occurred during
the first period of the epidemic, nevertheless, the black
or galloping form of the disease was much more frequent
than during the second epidemic. This accounts for the
difference in the mortality of the commencement of the
two epidemics. With a few exceptions the first hundred
cases all terminated fatally in the various wards of the
Hotel Dieu. In 1849, on the contrary, the mortality
was proportionately less at the commencement than during the progress of the epidemic. The cause of this
was, that there were more cases of simple cholera at the
beginning, than towards the middle of the epidemic.
This form of the disease is much less fatal than either
of the two forms, of which we shall now proceed to give a
description.
Ataxicform.-Like the former variety, so has this
one precursory symptoms; but I am not prepared to
assert that these symptoms have anything characteristic.
It has three well-marked periods, an irregular cold
period, a period of incomplete remission, and a typhoid
period. The frequency of this form in the epidemic of
1849 seems to have constituted one of its peculiar
features. It was very scarce in 1832. Let us proceed
to a description of its progressive development.
COLD PERIOD.-This period commences and develops
itself to all appearance as the period of increase in
simple cholera. An attentive observer, however, may




~24               ATAXIC CHOLEr,A.
discover differences which are sometimes very striking
and at other times very doubtful.  Thus, the patients
show from the commencement a prostration of strength
which is not at all proportionate to the other symptoms.
The discharges may be very slight and the weakness
may nevertheless have reached a high degree of development. On the other hand, excessive evacuations from
the stomach and bowels take place without either cramps
or cyanosis being present. Or the face may have assumed a slightly blueish tint, and the pulse be entirely
gone at the wrist; and, on the other hand, the pulse
may still exist, with feeble, frequent, unequal and irregular beats, whereas the cyanosis of the face and extremities is already fully developed. As regards the
temperature of the body, it is likewise very irregular:
the lower extremities may be cold, whilst the upper extremities are warm, and vice-versa.  The discharges
may be moderate, whilst all the other symptoms are
strikingly developed, the face and extremities are of a
violet-color, and the pulse is imperceptible. Generally,
the patients are either very restless, or very drowsy,
and dislike to be roused.  These are the principal irregularities which distinguish the cold period of ataxic
cholera. They do not, by any means, exist together in
the same individual. In some cases only one of these
irregularities exists, in others several; in some again
they are found united. In the former case it is almost
impossible to distinguish, at this period, ataxic cholera
from  the simple form, which has many varieties.  The
cold period generally lasts from six to twelve hours, and
sometimes longer.
Period of incomplete remission.-I have scarcely
ever seen it wanting entirely, but it is more or less
marked.  What distinguishes it from the period of remission in the simple cholera, is this that the symptoms
do not disappear in the reverse order of their original




ASITATIC CHOLERA.             25
development.  The blueness may disappear, and yet
the warmth not return.  The pulse which had ceased
to beat, may become perceptible without the cyanosis
disappearing; and the cyanosis and coldness may
have given place to a natural color and temperature,
whereas the evacuations are much more copious and frequent. The vomiting and the alvine evacuations may
cease, and yet the strength, the warmth or the pulse
may not return. The patient may be talkative, restless;
he may not feel thirsty, or he may experience a fainting
sensation in the epigastrium, which seems to him like
hunger. In some cases the cramps are violent and extremely painful, in other cases they are scarcely perceptible, some patients keep their voice almost entirely.
This period may last a few moments only, or two and
even three days, it is always followed by the third
period which we shall proceed to describe.
Typhoid stage.-This period sets in with drowsiness
or delirium. But in proportion as the cerebral phenomena develop themselves more strikingly, we behold,
in the place of a febrile reaction proportionate to the
cerebral irritation, a marked development of cyanosis
and coldness. Nothing is more remarkable, more characteristic than these cold inflammations which develop
themselves in the typhoid stage of ataxic cholera; this
is the highest degree of the malignant form of the disease. In some cases, the bronchia, the stomach or bowels
are the seat of well-marked congestions or inflammations, without any diminution of the cyanosis or coldness.
Generally the pulse remains perceptible, except during
the death-struggle, which is almost always protracted,
slow, accompanied with coma, and very frequently with
a stertorous, noisy respiration.
Whereas, in simple cholera, the local irritations of
the period of reaction set in with a marked febrile ex6itement, they are accompanied in the ataxic form of cholera
2




26           GALOPING OR BLACK CHOLERA.
with coldness and cyanosis. It seems scarcely necessary
to point out this difference.
The ataxic form is deceptive; at first it seems less serious than simple cholera; its symptoms are less united,
and some of the ordinary cholera-symptoms are even
wanting; but' the spurious and incomplete remission
which develops itself in the second stage, soon disturbs
the physician; nevertheless he may remain deceived
even then. The third stage can only deceive those who
wish to be deceived.
Galoping or black Cholera.-So far as a description
of its symptoms is concerned, this variety is the simplest
of any. Generally it has a precursory stage; but it
does not always last any length of time, only a few
hours; in some cases the precursory symptoms are entirely wanting. The diarrhoea, vomiting, blueness, coldness, and cramps set in all together. The patient may
be struck during his sleep, at table or while taking a
walk. It even happens that he is unable to rise from
the chair on which he had seated himself to support his
bowels; sometimes he suddenly falls down in a swoon;
the voice becomes extinct, the features are altered; the
color of the face and that of the extremities change visibly, and the blueness gradually spreads over the whole
body. After the attack has commenced, the patient is
not allowed any rest; the discharges and cramps succeed each other without interruption; the pulse disappears, the secretions stop, the cadaverous aspect becomes more and more marked. Life frequently ceases all
at once in the midst of the cramps and discharges that
have become involuntary; or the patient may sink into a
collapse of some hours, during which the mind and the
muscular movements become progressively weaker, whilst
the whole body turns black, becomes icy-cold, covered
with a clammy sweat and looks truly frightful. This
variety lasts from two to twenty hours.




ASIATIC CHOLERA.               27
Having analysed the phenomena of cholera through
their order of succession and combination, and having,
in this way, given the history of the different varieties
of this epidemic, we might now study each separate
symptom and lesion, and study their modifications in
regard to form, degree and period, for the purpose of
arriving at a proper appreciation of the diagnostic and
prognostic value of each symptom; but howsoever useful and necessary to a complete picture of the choleradisease this might be, such an undertaking would carry
us too far away from the end that we have proposed to ourselves, namely: the application of Hahnemann's method
to the treatment of this disease. We have been obliged
to limit ourselves to what has seemed to us indispensable.
Moreover the therapeutic analysis will, in a measure,
replace the semeiotic portion; we will therefore pass
over at once to the principal object of our investigations.
III. THERAPEUTIC ANALYSIS.
The preceding chapters have, it seems to me, sufficiently established the fact, that the physiology and pathology of cholera are as well known as those of any
other severe disease. It remains to be shown, that the
treatment of cholera can be conducted upon a truly
scientific basis. This does not mean that such a treatment must prove efficacious in every case; the facts
would contradict any such assumption. All we mean
to affirm, is, that the indications and corresponding
curative means in cholera can be scientifically shown;
that the successes or failures in the treatment of cholera
can be accounted for; and that what has been done and
what yet remains to be done in this matter, can be accurately determined.
Let us commence with the facts; afterwards we will
explain the method.
By facts we mean a description of the first twenty




28            THERAPEUTIC ANALYSIS.
cases which came into our ward in the epidemic of 1849.
Of the cases which arrived afterwards, we simply took
a few notes. It would have been impossible, at a time
when the increase of the epidemic brought to our hospital an increasing number of patients, to conciliate the
duties of our office with the ime required by elaborate
statements of the cases. These twenty cases will be,
moreover, found sufficient to enable us to substantiate
our inferences.
We shall give the cases in the order in which the
patients were brought to the hospital; and we shall accompany each case with such remarks concerning its
nosography or therapeutics, as may seem requisite to
place its most striking features in a stronger light. It
should not be forgotten that the description which we
have given of cholera, is not taken from these twenty
cases, but that it results from the study of the two epidemics of 1832 and 1849.
CASE. I.-By Dr. Guyton. —Epidemic Cholera;
variety: simple Cholera. —Cure.
Sefert, 58 years, carpenter, was brought to the hospital on the 29th of March, 1849, ward St. Benjamin,
No. 10, (hospital Sainte Marguerite.)
The patient seemed to have a good constitution, and
looked robust. Six days previous to being taken with
cholera, he had been attacked with a diarrhoea that was
sufficiently violent to compel himn to quit work on account of the frequency of the evacuations. They did
not make him very sick, however. Having become impatient, Sefert concluded to stop his diarrhcea by a violent remedy, and got drunk. About midnight he returned home, went to bed, but the next morning he was
so weak that he was unable to dress himself; and laid
down again. About noon a relative who came to see
hlin; and who got frightened by the vomiting, the diar



ASIATIC CHOLERA.                29
rhoea, and the altered features of the patient, had him
carried to the hospital.
One o'clock.-The patient showed the following symptoms: marked cholera physiognomy, eyes sunken, nose
pointed, malar bones very prominent, features shrunk.
Tongue moist, whitish, cold; pain at the epigastrium,
sensation as if a bar were stretched across; loathing,
frequent nausea; ardent thirst; abdomen flat, not painful to pressure, except at the epigastric region. Immediately after entering the hospital, the patient was
seized with copious vomiting of a clear watery substance
which had a slightly greenish tinge. During my visit
at half past two, the patient had four successive vomitings of the same substance.
The breathing was a little shorter and more frequent
than in a normal condition; no aphonia, pulse very
small, filiform, almost imperceptible; marked blueness
of the fingers, hands; some of the veins of the forearms
were swollen, blue, and very prominent on the skin.
Coldness of the tongue, face, the whole surface of the
body, and more particularly of the extremities; frequent
cramps in the calves, insteps, hands; they are very
painful. Complete suppression of the urinary secretion; percussion showed that the bladder was empty.
Prostration. Mind unimpaired; the patient's answers
are not always very clear, and he waits some time before speaking.
Took Carbo-veget. 6, a small tablespoonful every
hour, and on account of the feeling of loathing and the
sickness at the stomach, Bryonia 3, every ten minutes;
warm blankets.
At four o'clock, two stools of a sickly smelling substance, having a whitish-grey color, and resembling perfectly a decoction of rice, several grains of which had
split open, and were crushed.
At five o'clock, took Nux-vomica 3, a spoonful every




30             THERAPEUTIC  ANALYSIS.
ten minutes, for the desire to vomit, instead of the
Bryonia, that did not seem to have produced any effect.
Half past seven. Same general appearance. The
patient has warmed up, about the head and trunk, even
on the feet, but the warmth is not regularly distributed.
He complains of internal heat. The pulse is stronger,
more frequent, but continues very soft and compressible.
The blueness has disappeared; there are only some
traces of it under the nails. Respiration short, frequent; sound of the voice rather false, hoarse. Tongue
moist; intense thirst. No stool; two other attacks of
vomiting; abdomen sunken in, not painful to pressure,
except in the epigastric region, where pressure excites
an acute pain, that makes the patient to distort his
features. These pains in the stomach, however, are
spontaneous; they constitute a rest of painful compression; some slight paroxysms of cough increase them.
Cramps in the legs and fingers are a little less frequent;
the motions of the hands are yet beyond the control of
the will. Headache, but no tightness or cramps. Gave
Arsenic 6, in solution, on account of the sensation of
internal heat. Afterwards a solution of Carbo-veg. 24.
No urine, skin dry.
March 30.-The face looks about the same. The
tongue is moist, but continues colder than in the normal
state. Breathing hurried, but longer. Pulse a little
fuller but soft and compressible, 60 per minute. Skin
tolerably warm, dry. Abdomen depressed, painful in
the epigastric region. Shifting cramps. No vomiting
during the night, the patient has slept a little at various
times. This morning a stool of middling quantity, but
of a different character, of a uniform yellow color, some
consistence, resembling a bilious diarrhoea of fair appearance. Passed a small quantity of urine. The patient complains of acute seated pains in the knees.




ASIATIC CHOLERA.               31
Carbo-veg. 24, and China 12, both in solution, for the
pain in the knees.
Four o'clock in the evening. Two attacks of vomiting of a leek-colored substance, bilious, perfectly characteristic, of middling quantity. Tongue moist, whitish, still a little cold. The expression of the face is
somewhat improved, the features are less shrunk, the
eyes still sunken, and dry. Skin warm, dry, pungent
heat on the abdomen, and in various other circumscribed
places. The bowels are depressed, the pain at the epigastric region still continues. No stool, or emission of
urine. Pulse 64; dull headache.
March 31.-Expression of the face improved, intelligent; the eyes are less sunken, more animated; the
region of the cheek-bone is dark-colored. Tongue moist,
of a normal temperature, covered with a whitish coating,
the edges and the tip somewhat red; gums red with a
whitish border (slight stomacace). The heat of the
body is milder, uniform, of the common temperature of
the breath; the pulse is fuller, firmer, 64. No pain at
the abdomen or epigastrium from pressure. The patient coughs now and then; he sneezes freely. No
cramps; the pain in the knees continues. Calm sleep
in the night, and of some length at times. No headache, no vomiting, no stool, one emission of urine.
Breathing longer, quieter, the voice has a more natural
sound.
The general appearance of the patient is much better,
the mind clear; there remains some uneasiness and restlessness in the manner, gestures, speech and looks ot
the patient.
Carbo-veget. in solution: wine of Bagnolles.
Evening: Mild, even, respiratory warmth; moist skin;
eyes moist, full of tears; breathing easy, several quiet
naps in the day-time. No headache, or pain at the
stomach; no vomiting or stool. The patient passed




32             THERAPEUTIC ANALYSIS.
urine three times in considerable quantity, and without
any difficulty. No pain any where, except in the knees.
Pulse 60, regular, firm; the patient feels much better,
he wants to eat. Broth and wine.
April lst. —Is getting better all the time. Sound
sleep, normal temperature, no pain, pulse 60, urinary
secretion perfectly restored, good appetite. Broths and
soups. The pain in the knees continues. China 12 in
solution.
April 2d.-Complete convalescence.  Last night
had a papescent stool, of a natural color and smell.
Urinary secretion, pulse, breathing, temperature all natural, return of strength, knees free from pain, has
some more flying pains in the legs.
China in solution. One tumblerful.
In the day-time the patient takes a walk in the garden.
April 3d.-The pains have ceased; the treatment is
stopped. The convalescence went on without any interruption; on the 7th of April the patient's health was
perfectly restored; on the 11th he was discharged
cured.
This case is an example of what we have termed
simple or genuine cholera. It was a severe case, without, however, presenting any very intense symptoms.
We took a lively interest in this case; it was the first
case of cholera treated homoeopathically in our hospital.
At the commencement of the treatment we hesitated
a little between Bryonia and Nux-vomica. Nux effected
an improvement. However, it having been given together with the charcoal, it might be difficult to determine the part that each remedy had in this result.
Arsenic was substituted for Nux, and since then, the
cure advanced slowly but perceptibly.
On the third day the disease seemed broken, and the
patient's convalescence beyond all doubt. The only obstacle in the way was the continuance of the pain in the




ASIATIC CHOLERA.               3a
knees and legs.  Consequently the period which we
have termed the period of reaction, was a real remission.
CASE II. —By Dr. Guyton.-Epidemic Cholera;
galoping or black Cholera.-Death.
Ward St. Benjamin, No. 1.
Regeret,.62 years old, basket-maker. Brought to the
hospital at 6 o'clock in the evening.
Yesterday and this morning the patient enjoyed good
health; he worked as usual until 9 o'clock in the morning;
suddenly he was attacked with diarrhoea and copious
vomiting. Intense thirst; pain in the back, cramps;
quite cold.
He was brought to the hospital in the following state:
Cadaverous physiognomy, in the full sense of the term;
eyes deeply sunken; face shrunk, livid, cold as marble;
tongue white, moist, cold; intense thirst. No pulse;
general cyanosis; the extremities almost black. Quite
cold all over.
Breathing short, superficial, frequent; complete loss
of voice.
The abdomen is sunken; the epigastrium painful;
sensation of cramps at the stomach. Liquid vomiting
after entering, clear as water, with a slight greenish
tinge.
Understanding perfectly lucid, muscular strength
pretty fair; painful and frequent cramps in the calves
and toes.
Solution of Veratrum 3.-Application of warm clothes.
-Water sweetened with sugar.
From 9 o'clock until midnight the patient warmed up
over the lower half of his body; the upper portion of the
trunk, the neck and face are covered with a cold, clammy
sweat, collecting in drops here and there. These parts
become likewise more livid; the skin loses its elasticity.
The features become more and more altered, the eyes
sink, become dull, lose their expression; the eyelids are
2*




34             THERAPEUTIC ANALYSIS.
depressed. Acute cramps in the legs. Constant pains
at the stomach; no more vomiting; three bright, yellowish stools. The breathing is frequent and feebler. No
pulse. Auscultation scarcely reveals a tremulous motion
in the region of heart, indicating the contractions of this
organ, and partially obscured by the respiratory murmur.
I left the patient at two in the morning, I had expected for some time to see him die every minute.
April 3d.-The patient is still alive, but in great
agony, the understanding perfectly clear; the cadaverous appearance becomes more and more marked. Pulse
scarcely perceptible. The skin on the chest has warmed
up a little under the influence of the warm clothes; but
it seems a superficial heat. No reaction; the skin has
taken up a little of the warmth of the surrounding objects. It continues covered with a viscous sweat that
seems rather warm, but leaves a sensation of coldness.
Tongue cold, intense thirst.  Yellow-watery stool,
uniformly colored, not grumous. Liquid and clear vomiting, with a slightly greenish tinge.
Voice gone. The animal strength is not quite prostrated; the patient sits up in his bed, turns about.
Painful cramps in the feet.
Two attacks of vomiting in the day-time; another stool.
About three o'clock, the patient who had been gradually sinking since morning, becomes listless, ceases to
answer questions, the breathing becomes shorter and
shorter, and he dies at 6 o'clock.
At the morning-visit, the patient had been ordered to
take Arsenic and Carbo-veg. 6, in solution, every five
minutes, alternately.
There never was a sign of reaction, no pulse. The
patient looked like a speaking and feeling corpse; it
was a condition that defies description.
Autopsy: Right ventricle, and the large veins filled
with black, coagulated blood; the abdominal veins full of




ASIATIC CHOLERA.              35
blood. Viscera empty. Peyer's glands greyish, perfectly
perceptible, somewhat prominent. Scattered red spots
in the bowels.
Bladder empty.
No morbid signs in the brain.
This case of black cholera set in at once, without any
precursory symptoms, with all the intensity of the disease. The cyanosis was general. There was no reaction. Is the prolonged agony to be attributable to the
treatment? This seems indeed all that it accomplished.
CASE III.-By Dr. Guyton.-Epidemic Cholera;
simple Cholera.-Cure.
Ward St. Benjamin, No. 35.
Durand, 37 years, gardener, brought to the hospital
on the 7th, when the visits were taking place.
For five days past, has had diarrhoea, loss of appetite.
In the night from the 6th to the 7th the patient is
suddenly attacked with vomiting and diarrhoea, the discharges being very frequent. On entering the hospital,
the patient showed the following symptoms:
Characteristic cholera-face; marked lividity, especially
at the tip of the nose, round the mouth, and on the chin.
Eyes sunken, blueish circle round the orbit; respiration
frequent, much shorter than in health; voice feeble,
husky; pulse small, soft, disappearing under the slightest
pressure, and sometimes ceasing for a time. Cyanosis,
especially at the above-mentioned parts. The fingers,
back, hands are livid; the skin is shrivelled.
General coldness, especially of the extremities, face,
neck, tongue, extremities; skin dry.
Tongue moist, slightly whitish, cold; abdomen depressed, painful to pressure, the epigastric and umbilical regions are painful without any pressure being
made; these pains are acute.  Thirst intense.  The
Patient has had many attacks of easy vomiting during
the night; the liquid is projected in one stream; it is




36             THERAPEUTIC ANALYSIS'.
white, watery containing a small quantity of mucus that
contrasts with the transparent fluid.  Stools liquid,
copious, resembling a decoction of crushed rice, white,
having a sickly smell, and expelled without trouble.
Urinary secretion suspended; bladder empty.
The understanding is perfectly clear; the patient
answers questions promptly and correctly; he seems resigned and submissive; the strength is natural, the
patient turns about in his bed, helps himself; has some
cramps in the lower extremities.
We have then diarrhoea in the precursory stage, and
afterwards sudden invasion of severe cholera. A general
examination of the case shows that the patient is very
sick.
All the symptoms are well marked. The preservation
of the pulse, however, although it is very feeble, is a good
sign. The frequent vomiting (several attacks occurring
during the visit), and the peculiar pain at the stomach
point to Veratrum 3, and Carbo-veget. 6, in alternation
every five minutes; and, towards evening, every ten
minutes. —Warm  cloths; water sweetened with sugar
for drink.
Eight o'clock in the evening.-The patient who had
been closely watched all day, has warmed up after a
few hours' treatment. The warmth is mild, of a good
quality, without sweat. The patient has had several
attacks of vomiting in the afternoon; towards four o'clock
the vomiting is much less frequent and less copious, one
or two mouthfuls each time. Three characteristic stools,
liquid as mentioned above, including the morning-evacuation. The last stool is less copious, and more consistent
than the other two.
The face has a better expression; the tongue is
warmer. Voice, respiration, condition of the abdomen,
as above.  Pulse fuller, stronger, less frequent; a few
cramps; no urine.




ASIATIC CHOLERA.               37
April 8th.-The patient has had several naps during
the night. Two or three attacks of slight vomiting, before 10 o'clock. During the night, three stools: the
first a little more consistent than the former evacuations,
liquid but with a greenish tinge; the second stool less
copious, still more consistent and greener; the third
still more consistent, of a strong greenish-yellow color.
There was a marked progression from the liquid to the
physiological normal form in these evacuations; every
successive stool contained a larger proportion of intestinal mucus and biliary matter. This morning an attack
of vomiting half clear, half leek-colored.
Temperature good, pulse full, tongue warm. The
cyanosis of the face and hands disappears, physiognomy
improved.  Pain in the bowels less; some nausea.
Cramps subdued; no urine.  Carbo-veget. 6, Ipecac.
12, in solution, every hour alternately, in tablespoonful
doses.
In the day-time a stool similar to the above.
April 9.-Improved expression of countenance, quiet
features. The lividity has disappeared, the eyes look
natural; no cyanosis. Uniform mild warmth all over
no sweat. Pulse regular, of normal frequency, soft but
not feeble. Breathing good; the voice has recovered
its sound and vigor. Abdominal pains less; no vomiting; scanty stool; three discharges of urine in the
morning. Little thirst; sound sleep; good night's rest.
Carbo-veget. 6, in solution.
Evening.-Papescent very green stool; three easy
discharges of urine, copious in the afternoon.
April l0th.b-Convalescence perfectly evident; refreshing sleep; mild warmth of the skin, like the
temperature of the breath; pulse normal.  No pain.
Two stools since last evening: the first thick and green;
the second green and in form. Normal discharge of urine.
Tongue looks natural, appetite and thirst natural.




38            THERAPEUI'IC ANALYSIS.
Two platefuls of broth; water with wine and sugar.
Carbo-veget. as above.
Evening.-Craving appetite; abdomen of natural distention, no pain.
April 11th.-Complete convalescence.  During the
day an eruption like nettle-rash breaks out on the abdomen, lower extremities, back and arms. Inconvenient
itching.
A meal; no medicine.
April 12th.-The eruption continues, no other abnormal symptoms. Appetite. The patient rises.
April 13th.-Eruption the same.,, 14th.-The eruption disappears.,, 15th.-The patient is discharged cured.
This case seems remarkable both for the regularity
of the cholera-phenomena and for the efficacy of the
treatment. A theoretical difficulty, however, presents
itself. What part in the cure have the charcoal and the
white Hellebore respectively? they were administered
conjointly first every five, and then every ten minutes
in alternation. The simplicity of the phenomena during
the reaction, and the ease with which recovery took
place after such a well-marked cold period, are striking.
CASE IV.-by Dr. Guyton. —Epidemic Cholera;
galoping or black Cholera. —Death.
Feret, forty years old, nail maker, was brought to the
hospital on the seventh of April, 1849, at seven o'clock
in the evening. Ward St. Benjamin No. 37.
The patient was very small, awfully rickety and deformed; he had a most sickly appearance. Was habitually moderate in his diet, but lived in an unhealthy
house, on unwholesome food.
At nine in the morning, the patient had taken his
breakfast; no abnormal symptom existed previous to
this moment. After the meal he was suddenly taken




ASIATIC CHOLERA.                39
with diarrhoea and vomiting, the paroxysms succeeding
each other in uninterrupted succession.
Record of symptoms: Cadaverous face; eyes sunken,
surrounded with a blueish circle; livid color round the
lips, wings of the nose. Breathing rather full and
quiet; voice extinct, only a breath. Pulse very weak,
stopping at times, pretty regular, but more frequent
than in health. The beats of the heart are easily heard.
Marked cyanosis of the face, fingers, the dorsal surfaces
of the hands and feet. Intense coldness of the face,
neck, upper and lower extremeties; skin dry, cadaverous,
without elasticity.  Tongue moist, somewhat coated
white, cold; painfulness of the abdomen, when pressed
upon, or even without pressure; the abdomen is depressed, drawn-in, sinking, so to say, under the prominence of the deformed thorax. Frequent vomitings and
stools in the day-time; immediately after entering the
hospital the patient vomited up a clear liquid mixed
with a little green matter, that falls to the bottom of
the vessel. The alvine evacuations pass off against the
will of the patient; he is scarcely conscious of their passage. Intense thirst; the urinary secretion is suspended; no urine in the bladder. Understanding clear;
nevertheless the patient, who is prostrated and lying on
the back, looks rather stupid; he closes his eyes, has to
be urged to answer questions, answers by signs or in a
tone of voice that is scarcely intelligible, and without
opening his eyes. He thinks he is past cure. Painful
cramps in the lower limbs; they occur frequently; the
patient expresses his pain by moaning and distortion of
the features.
The distressing appearance of this patient can scarcely be described. He is deeply struck; the prognosis
suggested by these symptoms, is exceedingly doubtful.
During the last moments of our examination the patient
sinks more and more into this painful torpor, which we




40             T'HERAPEUTrIC ANALYSIS.
have described; a cold sweat breaks out on the face and
neck; these parts become icy-cold and feel sticky. The
pulse is collapsing, and life seems on the point of departing.
Warm cloths. Carbo-veg. 6, and Arsenicum 6, both
in solution, a tablespoonful of each, alternately, every
five minutes.
At ten o'clock in the evening, the whole chest, face
and upper extremities were covered with a cold and
viscid sweat; the lower extremities were cold as ice.
Only the abdomen felt a little warm. The pulse had
entirely disappeared.  The trunk was cyanosed; the
hands had a darik and livid appearance; on pinching up
the skin, it remained so. The anguish was excessive.
Painful cramps were experienced every moment, and
caused the patient to moan. He vomited. and passed
stool without knowing it. About midnight the agony
had reached its climax; he died at half past one in the
morning.
There was no post-mortem examination.
(Recorded by Dr. Guyton.)
This case shows that in the last stage of black cholera,
the treatment is inefficacious.
In this as in the former case of black cholera, there
were no precursory symptoms.
CASE  V.-Epidemic Cholera; ataxic variety;
a cure.
Balagnat, 38 years old, cabinetmaker, brought to the
hospital on the 13th of April, at half past seven in the
morning. Ward St. Benjamin, No. 3.
The patient had worked at his trade the whole of the
previous day, without experiencing any unpleasant
feeling; his health was good. In the middle of the
night he was taken with frequent vomiting and diarrhcea; cramps set in at 5 in the morning.
Record: Face emaciated, features elongated, eyes




ASIATIC CHOLERA.                 41
deeply sunken. Extremely sad expression of countenance; the patient is very uneasy about his condition.
Respiration normal as regards frequency, or extension,
voice feeble and as if hoarse. Pulse well marked, regular, hard, frequent, 120. The malar, region, the region
around the mouth and eyes are livid, lips violet-colored,
lower face and tongue blueish. The whole thorax, neck,
hands and forearms are livid. Cyanosis of the lower
extremities; a network of numerous veins, engorged and
raised on the skin, without circulation, is visible on the
insteps, legs, thighs. Upon entering the hospital, the
patient's skin was rather cool than cold, as it usually is,
some time after having been lying down, the heat of the
skin is restored; it was quite striking. At the same
time a hot sweat breaks out in the face, on the neck,
chest, arms. The pulse was very full.
Tongue coated white on the upper surface; moist,
rather cool. Thirst intense, pains in the epigastrium
very acute, like cramps, not much aggravated by pressure. Abdomen depressed, not painful. Scanty vomiting during the visit; shortly after, three or four other
attacks of vomiting of a clear liquid like water, with a
greenish tinge. Copious stool after the visit; a yellowish liquid without clots. No secretion of urine.
Mind clear, but spirits depressed, discouraged. Good
amount of physical strength, the patient turns about in
his bed with much firmness of will, helps himself. Uninterrupted and painful cramps in the hands and especially in the calves; the patient complains of them
very bitterly, this symptom troubles him more than any
other.
The disease sets in without any precursory symptoms.
Prognosis unfavorable; there does not seem to be any
regularity in the symptoms of the disease. For instance,
a marked cyanosis, and a stoppage of the capillary circulation and even of the circulation of the veins of a




42              THERAPEUTIC ANALYSIS.
certain size, co-exist with a certain force and even hardness of the pulse, warmth of the skin, and warm sweat.
Water sweetened with sugar of the ordinary temperature.  Veratrum 3 in solution. Warm cloths.
Evening. —Second visit three hours after the former.
The vomiting has ceased; the patient complains a good
deal of his cramps. Was ordered a solution of two drops
of the spirits of camphor. At 8 o'clock, the pulse is
down to 100, the cramps have ceased; the muscular
pains are much less.
At 11 o'clock the temperature of the skin is milder,
the sweating has ceased.  Pulse softer, down to 88.
General improvement.
Carbo-veget. 6, and the aforesaid solution of Camphor,
alternately every half hour.
April 14th, second day.-Several calm naps during
the night.  Respiration regular, voice firmer. Pulse
more natural, down to 80. The cyanosis is less, the
veins of the extremities are less swollen, the circulation
recommences. The hands, chest, neck and especially
the face are less livid. The warmth is of good quality,
but not uniform, no sweat.
Tongue moist, rather cool.  Two scanty vomitings
this morning, clear as water.  The pain in the epigastrium is much less; the patient complains rather of
a sensation of malaise and weakness. A stool in the
night, of more consistence and darker color, slightly
green. A scanty discharge of urine in the morning.
The patient continues very sad, the depression of
spirits remains the same. Some not very painful cramps
at long intervals.
Carbo-veget. 6, and Camphor in solution as above.
A few spoonfuls of broth.
Evening.-No stool since.  Two watery vomitings
after having tasted a little broth; was not given any
more.  Some nausea.  Warm  skin; face pretty full;




ASIATIC CHOLERA.             43
slight restlessness.  Pulse full, 76.  Same signs of
cyanosis. No more cramps. Depression of spirits continues.
Carbo-veget. without the Camphor.
Evening, 11 o'clock.-Watery vomiting mixed with
mucous flocks. No stool.
April 15th, third day.-Sleep during the night.
Vomits twice in the morning; has a grey-colored stool
with clots.
No more cyanosis. Pulse full, large, 80. Skin pretty
hot, face red, no sweat. The febrile phenomena have
been very marked from the first. Abdomen flat, not
painful. Intense thirst.
Nux-vomica 12 in solution.
Evening. —Vomiting with a pretty thick yellowishgreen deposit. Nausea.
Same solution.
April 16th, fourth day.-Warmth milder, more natural, uniform; better pulse. No pain, the patient only
complains of weakness. No vomiting; yellow stool of
pretty fair appearance. Two discharges of urine. Less
thirst.
Continue the Nux-vomica at intervals of two hours.
Evening.-Yellow stool of a very good color, with
thick, almost solid fbeces.
April 17, fifth day.-The patient feels pretty comfortable. Three bilious stools composed of solid faeces
that look sound and of natural weight. No vomiting or
nausea.
Gentle warmth of the skin, pulse quiet and easy.
The face recovers its natural expression and color.
Appetite: broth. Continue the Nux.
Evening.-No stool during the day.
April 18, sixth day.-Two stools composed of papescent feeces.
Gentle warmth, like the breath, pulse quiet. Breath



44             THERAPEUTIC ANALYSIS.
ing full and easy, the voice has a good sound. Still
some weakness, the secretions are restored.
Appetite: lean soups. Wine of Bagnolles.
April 19 and 20.-Progressive improvement.
April 21.-The patient is quite well; his spirits are
good, except a remaining touch of melancholy.
This morning the skin feels a little hot; slight stomacace, the tongue is covered with a thick yellowish
mucus, the edges are red and the papillae elevated.
Gums red with a greyish border round the teeth.
No stool. The patient walks about the room.
Aconite 12 in solution. Soups.
April 22.-Complete convalescence.
"  23.-The stomacace has ceased.
Discharged cured on the 30th of April.
This case is interesting in many respects; who, for
instance, would not be struck by the simultaneous existence of a marked cyanosis at the extremities'and trunk,
and of a large and strong pulse like that of a person
attacked with a rheumatism? This coincidence shows
how difficult and hazardous it is to explain the symptoms of cholera by each other.
In a pathological point of view this case is no less remarkable; the fever during the cyanosis, which existed
almost from the commencement of the disease is a very
strange anomaly. I have classed this case among the
ataxic cases of cholera, on account of the remarkable irregularity and violence of the symptoms. Is this arrangement correct? This case is certainly one of the
lightest cases of ataxic cholera that I have ever treated.
The remedies in this case acted with a precision and an
energy that are scarcely ever witnessed in the common
cases of ataxic cholera.  After the cyanosis and the
distressing cramps had ceased, the chief difficulty was
the derangement of the digestive organs. The cramps
yielded to Camphor.  Carbo-veg. hastened the disap



ASIATIC CHOLERA.               45
pearance of the cyanotic symptoms. Nux-vomica put a
stop to the vomiting which continued during the fever.
CASE VI.-By Dr. Guyton.-Epidemic Cholera;
simple or genuine Cholera.-Cure.
Gillet, 48 years old, carrier, was a patient in the ward
St. Benjamin, No. 4, when he was attacked with cholera
the 13th of April. The patient had had the asthma for
ten years past, and exhibited all the signs of an advanced
pulmonary emphysema. The attacks came on several
times in the course of a year; he had had two this winter. A fortnight previous to his coming to the hospital
the patient took a vapor-bath for some cutaneous disease
of which no trace remains visible; he took cold after the
bath; cough, dyspncea and fever sat in. On coming
to the hospital he had an acute inflammatory catarrh on
both sides of the chest.
April 13th.  Marked improvement; the paroxysms
of nightly dyspnoca were less frequent, the patient expectorated a well assimilated mucous sputa, when the
patient was suddenly attacked with a violent diarrhoea,
which had already run on for two days before the patient
mentioned it; he had kept it concealed lest his usual
allowance should be curtailed.  The discharges were
quite frequent and consisted of a clear liquid that flowed
like water, without effort or colic. Having taken Ipecac.
for some days past for his catarrh, it was supposed that
it might perhaps be the cause of his diarrhtea; this
drug was discontinued, and a solution of two drops of
the spirits of Camphor in a tumblerful of water was
ordered.
This evening the patient feels worse, he complains of
pain in the stomach, desire to vomit; cramps. Has
three stools of a greyish substance, having a sickly
smell, liquid, with a quantity of fibrinous flocks floating
through it. As yet no vomiting. No secretion of urine
since morning; bladder empty. At the same time the




46              THERAPEUTIC ANALYSIS.
breathing, which is generally quiet in the day-time;
becomes embarassed, the voice is altered, feebler, unequal, hoarse.
The skin is colder than in a normal state, the extremities, especially the lower ones, are cold, likewise
the neck, face and the upper portion of the chest likewise. Pulse frequent, small, compressible. Hands and
fingers are blueish.
The abdomen is flattened; the epigastric and umbilical regions are painful, whether touched or no. Tongue
white-coated, somewhat dry, cold; thirst intense.
Since the morning-visit the patient's features have
altered a good deal; the eyes are sunken, the orbits
surrounded with a blueish circle, the lips are rather
livid. The features are drawn up, expressive of suffering. Mind perfectly clear, is uneasy concerning his condition.
Carbo-veg. 6, in solution, every half hour, and Phosphorus 6, also in solution, every hour, warm cloths.
Water sweetened with sugar.
April 14th.-The warmth of the skin is more uniform
and somewhat raised. The pulse is a little higher, 100
beats. The cyanosis has almost disappeared.
No sleep last night, embarrassed respiration without
any acute paroxysm of dyspnoea. Mucous expectoration.
less abundant than usual, a few turns of cough at short
intervals; the characteristic symptoms of the former
malady are less marked. Voice continues feeble and
hoarse.
Since the Phosphorus was given there has been less
diarrhoea, only three evacuations in the night, whereas
before this, the evacuations took place without any interruption.  The last evacuation was still of a grey
color, mixed with fibrinous flocks, but more consistent
and more homogeneous. Pains at the epigastrium and




ASIATIC CHOLERA.               47
round the navel; had an attack of a clear substance,
mixed with mucous fldcks; frequent nausea.
Physiognomy the same as yesterday. Tongue coated
white, moist, colder than naturally. Painful cramps at
night.
Intense thirst, no secretion of urine.
Veratrum 3, and Carbo-veget. 6, in solution, alternately.
Evening.-Marked improvement.  No stool or vomiting this afternoon; nausea and pain in the epigastrium less. The abdomen continues very flat.
Warmth more regular.  Pulse frequent, 100.  No
cramps in the day-time. Same treatment.
April 15th.-Marked improvement. The patient had
several good naps.  The features look more natural,
and the eyes are less sunken. Natural warmth over
the whole body, pulse frequent, but more undulating.
Cough more frequent, moister, the patient spits up
round clots of mucus. The breathing is easier, and the
voice has a clearer sound.
The tongue is covered with a sooty, yellowish, thick
mucus. No vomiting, but occasional nausea. Unpleasant
sensation in the abdomen and stomach, not exactly painful. In the night, three thick papescent stools, coherent,
of a deep yellow color.
One discharge of urine in the day-time.
Veratrum 3, in solution, at long intervals.
April 16th. —Heat and circulation normal.  The
features are almost natural. No pain or nausea; less
thirst. Tongue warm, less coating.
Calm night, with refreshing sleep. Two dark-yellow
papescent stools, like feecal diarrhoea. Urinary secretion
restored.
Same treatment. Wine and water.
April 17th.-Complete convalescence, features perfectly natural, warmth and circulation likewise.




48              THERAPEUTIC ANALYSIS.
Stool in form this morning.
There remains a rest of catarrh; the mucous rattling
and wheezing is less, the expectoration looks good, dyspncea gone. The patient rises from bed.
Wine and water, broth.
Discharged cured on the 1st of May.
This case is an example of light cholera of the simple
kind. The asthma was not, as we we first feared, a serious
complication. We gave Phosphorus in consequence of
the continuance of the diarrhoea which seems to have
promptly yielded to this drug. Veratrum terminated
the treatment. The charcoal which was administered
together with the Phosphorus, was given for the purpose
of supporting the strength of the patient.
CASE VII.-Epidemic Cholera of the simple kind.
— Cure.-Reported by Dr. Guyton.
Ward Sainte Anne, No. 6 (female department.)
Uerard, seamtress, 29 years, entered the hospital on
the 14th of April.
Good constitution, looked strong; had enjoyed good
health previously.
The patient arrived in Paris from the country on the
evening of the 8th of April. Next morning was seized
with frequent attacks of painless diarrhoea. Last evening was taken with vomiting during the stool. The discharges upwards and downwards were very frequent all
night.
April 14th.-On entering the hospital the patient
showed the following symptoms.  Altered features,
deeply-sunken eyes, with livid circle all around; face
elongated.
Breathing more frequent than in health; voice altered
and feeble; pulse small, disappearing under the least
pressure, frequent, 105. Cyanosis of the fingers and
hands; blueish lips, and livid color of the face. Marked
coldness all over, especially on the extremities, in the




ASIATIC CHOLERA.               49
face, on the neck, on the upper portions of the thorax;
dry skin.
Tongue white coated, moist; intense thirst.  Abdomen flat, drawn in; pain in the epigastrium; nausea,
almost constant efforts to vomit. During the two or
three hours after her arrival at the hospital, she had
three attacks of vomiting of a clear watery substance;
four grey-colored stools, very liquid, interspersed with
clots.
Mind perfectly sound; good amount of strength; a
few painful cramps.
Prognosis unfavorable.
Water sweetened with sugar; Veratrum 3, in solution;
warm cloths.
In the evening, the warmth of the body is restored;
it is quite perceptible almost all over the body; the
tongue continues cold. Pulse larger, 120. Restlessness,
the patient changes her position all the time, and is not
comfortable in any.
Intense thirst. Pains in the whole abdomen; nausea,
repeated desire to vomit; pains, sensation of extreme
malaise in the region of the stomach. —Two attacks of
vomiting in the afternoon; a clear liquid containing a
few clots. Three grey-colored stools, resembling a decoction of crushed rice; discharges two dead lumbrici.
Stoppage of the urinary secretion.
Painful cramps in the calves. Continued lividity of
the hands, neck, face. Frontal headache.
Carbo-veg. 6 every hour. Arsenicum 6 every hour,
and, in the middle of the night, every two hours.
11 o'clock at night.-No more vomiting, the nausea
continues; same restlessness, marked emaciation.
April 15.-Less restless this morning, improved expression of countenance; cessation of the cyanosis.
General heat without sweat; warm tongue. Pulse larger,
120. The patient had only short naps in the night;




50t)''THER&PEUTIC ANALYSIS.
she complains of malaise, of uneasiness in the extremities. Slight abdominal pains, distress at the stomach,
frequent desire to vomit; several attacks of vomiting in
the morning; five evacuations at night, the last of which
looks rather better, and has a greenish tinge; it is accompanied with a slight emission of urine.
Arsenicum 6, in water, every three hours (tablespoonful doses.)
Evening. —Nausea, frequent vomiting in the afternoon; general state of the patient the same.
Nux-vomica 12, in solution, (same as Arsenicum.)
April 1G.-Evident improvement; the cholera-physiognomy continues somewhat. Flushed face, no cyanosis.'
Natural temperature; pulse less frequent. Nausea,
repeated but scanty vomiting. Warm tongue with yellowish-white coating.
Two good-looking stools, more consistent, of a greenish-yellowish color. Two discharges of urine.
The patient is better. Less restless; the sensitiveness at the epigastrium and the malaise continue; stirring about in the bed causes a return of the nausea.
The abdominal organs seem torpid; the cramps have
disappeared.
Nux-vomica 12, in solution, at long intervals.
Evening.-The patient had several naps in the daytime.  Warm skin, flushed face, frequent pulse; the reaction continues pretty violent.
The nausea. is less.
Same treatment.
April 17th.-The face looks again natural; the eyes
are less sunken; the livid margin around the eyes has
disappeared.  The tongue is covered with a mucous
coating, its edges are red; red gums with white border,
a certain degree of stomacace. This morning the patient
vomited a little watery substance, with green matter




ASIATIC CHOLERA.                51
sinking to the bottom. No stool, torpid bowels, nausea,
not very frequent.
No medicine; wine of Bagnolles.
Evening,-After taking wine twice, the patient was
attacked with nausea, malaise; some pain at the stomach;
she vomits. Aversion to wine; nausea, weakness, headache. Pulse 100; skin warmer; no stool.
Wine discontinued. Nux-vomica 12, in solution.
April 18.-Unrefreshing sleep, which is disturbed by
fatiguing dreams that cause the patient anxiety and
wake him. Same pulse, heat.
Physiognomy almost natural; the eyes are no longer
sunken. Breathing full and easy; voice has a good resonnance.
Tongue coated with mucus, with red borders and tip;
some sensitiveness at the epigastrium, now and then an
attack of vomiting this morning. No stool.
Pulsatilla 12, in solution; a few spoonfuls of broth.
April. 19.-Same condition. Bilious vomiting in the
morning, two in the evening, scanty. No stool. The
menses have made their appearance; it is at the regular
period.
Continue the Pulsatilla.
April 20.-Quiet night. Animated countenance; headache. Natural warmth; pulse 90; sensitiveness at the
epigastrium, some attacks of nausea. Slight vomiting;
no stool. The menses continue, but not very profusely.
Carbo-veget. 6, in solution; a few spoonfuls of broth.
April 21.-Sleeps in the night and in the day-time;
warmth like that of the breath; pulse soft and normal.
General condition satisfactory. The nausea has disappeared; thirst moderate.
Tongue moist; slightly coated white; no redness;
stomatitis gone; the menses continue.
Appetite: broth, a soup at supper.
April 22.-Decided convalescence; no pain at the




52             THERAPEUTIC ANALYSIS.
epigastrium, no nausea, vomiting or stool; the menses
cease in the evening.
Same diet.
April 23. —Broth, soup, a little chicken. A simple
injection for the constipation.
April 24.-Two stools yesterday evening, composed of
papescent fiecal matter, and containing several dead
lumbrici.
Cina 12, in solution.
Last night three mucous stools preceded by colic and
producing an intense burning sensation at the anus.
Scanty liquid discharge at each evacuation, without blood.
The abdomen is not painful to pressure.
The patient slept badly. In the day-time two stools
of the same nature. Several attacks of flushes of heat,
and sweat in the face. Thirst; warm skin; pulse 84.
No appetite.
Mercurius 6, in solution.
April 26.-Two liquid bilious stools; some colic; no
pain at the anus during the evacuation; torpid bowels;
general condition good.
The patient complains of lassitude and numbness in
the extremities.
Diet. Tincture of rhubarb, one drop in a tumblerful
of water.
April 27. —Two bilious stools containing two lumbrici.
Cina in solution.
April 28.-General condition good. A stool mixed
with pretty hard frecal matter, appetite returned. Broth,
soup.
April 29th.-One portion.
May 1. —The convalescence proceeds regularly.
Discharged on the 10th of May.
This case is distinguished by the gastro-intestinal inflammation that succeeded the cold period, or rather




ASIATIC CHOLERA.               53
continued after the cold stage had ceased.  The expulsion of lumbrici is also an interesting circumstance.
The first introduction of nourishing food into the
stomach excited the gastric affection, which was combated with perseverance. Of course the medicines had
to be given agreeably to the symptomatic indications.
Every drug having been administered singly, its action
was of course more precise and more distinctly perceptible, except during tlhe first night, when the Arsenic
was alternated with charcoal.
CASE VIII. —By Dr. Guyton.-Epidemic Cholera,
simple form.- Cure.
Lefevre, 22 years old, turner. Was brought to the
hospital on the 28th of April, ward St. Benjamin, No. 10.
Has had diarrhoea for four days past; yesterday it
was very copious. This day, April 28, the vomiting
has commenced. During the day, a stool, six attacks
of vomiting of a clear liquid with a greenish tinge; afterwards cramps, coldness, stoppage of the urinary secretion.
Eight o'clock in the evening.-First record of symptoms: Cholera-features, eyes sunken, somewhat livid.
Breathing easy, voice feeble and broken. Pulse small,
but perceptible and frequent. Cyanosis of the fingers
and of the backs of the hands; skin wrinkled, without
elasticity. Some coldness of the face, extremities; chest
and abdomen have preserved their natural warmth.
The lips and tongue are cold.
Tongue moist, slightly coated white; intense thirst.
Pain in the epigastrium, with or without pressure; occasional cramps at the stomach. No vomiting or stool
during the first examination.
No urine since morning.
Mind perfectly clear; muscular strength well preserved. Painful cramps in the hands and feet recurring
at short intervals.




54             THERAPEUTIC ANALYSIS.
Prognosis is favorable. Veratrine 3, in solution. *
Water sweetened with sugar; warm cloths.
April 29.-Sensible reaction; warm skin all over;
pulse full, large, frequent, 90.  Sensation of internal
heat; head somewhat heavy and painful.
Face flushed, eyes sunken. Tongue white, moist,
warm; thirst intense. Since last evening has had four
attacks of vomiting of a clear liquid, with a greenish
tinge.  Three grey-colored cholera-stools of a certain
degree of consistence, mixed with numerous clots; the
last stool contains a little bilious coloring matter. No
discharge of urine. The patient continues to complain
of cramps in the hands and feet.
For the reaction Aconite 12, in solution, every hour;
Veratrine 3, in solution, every three hours.
April 30.-Considerable improvement; the temperature of the skin is like that of the respiration; pulse
soft, regular, 60. Last night the patient had a nap.
Countenance better, the natural expression has returned,
the eyes are more prominent. The headache has disappeared. Tongue white-coated, moist; thirst moderate;
no pain at the stomach. No vomiting or stool since yesterday. Last night emitted urine, which is now secreted
again as in health. Last night had slight attacks of
pain in the hands and feet; they have ceased. Appetite.
The patient who coughed some time before the attack,
again commenced his coughing; there was no expectoration, and auscultation yielded no sounds.
Gum-water and broths.
May 1.-Decided convalescence. No stool.
Broths and soups.
May 3. —Convalescence is progressing all the time.
A regular allowance of food.
Discharged on the 6th of May.
* In several cases Veratrinc, 3d attenuation, was used instead of Vera
trum or the common white Hellebore.




ASIATIC CHOLERA.               55
This was a very mild case of simple cholera, as seen
by the shortness and light character of the reaction.
An improvement was obtained almost immediately after
using the remedies.
CASE  IX.-By Dr. Guyton. —Epidemic Cholera
of the diarrheeic variety.-Cure.
Ward Sainte Anne, No. 20. Entered on the 19th of
April, at midnight.
A woman, 68 years old, thin, weakly, of a worn-out
constitution; had been asthmatic for a long time. For
four days past the patient had had a profuse diarrhoea,
without colic; she passed a watery liquid. Her appetite
had been somewhat preserved, and she had continued
her work. This morning, after having taken a little
coffee with milk, she was attacked with vomiting and felt
weaker than usual; she was taken to the hospital.
Immediately after her arrival, she vomited up a liquid
with mucus; her face looked thin, with an expression of
anxiety; but without any marked lividity; the skin
looks dull and has an earthy color.
Respiration embarrassed; the voice is feebler and
more broken than usual; pulse perceptible, frequent;
nails and fingers slightly blue.
Tongue moist, cold; intense thirst.  Abdomen distended and soft; no pain on pressure.
Cold face and extremities. The patient has no cramps.
-Warm cloths; water sweetened with sugar. Phosphori-acidurn 6, in solution.
The prognosis does not seem unfavorable, but the
broken-down state of the patient is somewhat against her.
Towards evening the skin warms up; the pulse is
more perceptible; no vomiting; some nausea; no stool;
no urinary secretion.
April 20. —Pretty good night; the patient had several
naps. Warm skin; pulse pretty full, of normal frequency.




56             THERAPEUTIC ANALYSIS.
Tongue moist, coated white, rather cold; a good deal
of thirst. No vomiting or nausea. Had three liquid,
greyish stools in the night, interspersed with clots.
Another stool this morning of more consistency, containing green bilious matter. No urine; abdomen soft,
not painful. The diarrhoea is less; the day before the
discharges were quite frequent. No cramps.
Continue the Phosphoric-acid.
Evening.-The patient feels better; thirst continues.
No vomiting; another stool like the last; no urine.
April 21. —Quietnight. Skin feels cooler this morning.
Pulse 80. Tongue dry and coated white; intense thirst.
Last night had a stool composed of green bile and ropy
mucus, proceeding undoubtedly from the large gut; no
urine.
Mercurius 12, in solution.
Towards evening, the tongue became moist. Voice
continues feeble; skin cool. No stool or urine.
April 22.-Same general condition. Green papescent
stool, having a deep bilious tinge. A discharge of urine.
Tongue dry in the morning, moist in the day-time.
Regular secretion of urine.
Continue Mercurius.
April 23. —Sleep; general condition good; pulse and
temperature natural. The voice has recovered its resonnance; the patient feels stronger.  The thirst is
much less; no vomiting or stool; no pain; appetite.
Continue Mercurius; weak broth; wine and water.
April 24.-Convalescent; tongue naturally moist;
no stool. Appetite. Broths and soup.
April. 25.-Unexpected and strange change; coldness of the whole body, feeble voice and embarrassed
respiration; tongue cold and dry; no stool or vomiting.
Carbo-veg. 6, in solution.
April 26.-Marked  improvement; good night, no
stool, natural temperature and voice. Appetite.




ASIATIC CHOLERA.              57
Continue Carbo; wine of Bagnolles; broths and soups.
April 27.-Convalescent.
April 28 and 29.-Regular allowance.
May 2.-The patient complains of frequent cramps
in the hands and feet; diarrhea, had three or four stools
in twenty-four hours, composed of a thick, greenishyellow liquid.  No vomiting; tongue moist; thirst
moderate.  Urinary secretion natural.  The general
condition is not very unfavorable.
Ipecac. in solution; strict diet.
May 3. —Diarrhoea continues; less cramps, general
condition good.
Phosphori-acidum 6, in solution; broths.
May 5.-Cramps. —Camphor in solution.
May 6 and 7.-Formication in the hands.-Arnica
in solution.
May 8.-Convalescent, and continues so to the end;
discharged May 26.
This case shows that cholerine has a marked character
different from genuine cholera. Although less serious,
yet the liability to relapses which characterises this
form of cholera, and the frequent recurrence of certain
symptoms during the remission, require particular
watching.
CASE X.-By Drs. Guyton and I....- Epidemic
Cholera; galopping or black variety.-Death.
Regreney, 56 years old, cartman, ward St. Benjamin,
No. 29. The patient was struck in the sick-room.
April 29.-The patient had been in the hospital for
some time to be cured of wandering pains in the extremities, and of headache which was supposed to be of
syphilitic origin.  Except these symptoms, which, in
themselves, did not seem very important, the patient
who was a tall, stout and strong man, enjoyed good
health. For two days past he had had diarrhoea; he
said nothing of it lest he should have to diet; he even
3*




b8             TqIERAPEUTIC ANALYSIS.
ate some of the food that other patients left on their
plates. This morning, after having taken bread and
milk for breakfast, he went in the yard at 6 o'clock; in
a few moments he felt sick, and asked one of the male
nurses to help him up-stairs again.
An hour after we discovered the following symptoms;
Features altered, eyes sunken; dark and livid color
round the eyes, on the cheeks, at the ears, round the
mouth, especially the chin. Lips violet colored; tongue
moist and cold, quite blue; expression of anxiety.
Breathing superficial, embarrassed, hurried, with dilatation of the nasal wings; voice feeble and broken.
Pulse collapsed, a slight tremor is perceived from
time to time. Marked cyanosis; the skin, neck, thorax
and upper extremities are quite livid, the hands and
forearms are blue. On the lower limbs a thick veinous
network is perceived; the larger veins are engorged.
Skin without elasticity; cold all over; profuse, clammy,
cold sweat.
Pain in the epigastrium on pressure, acute, intensely
painful and frequent cramps.  Vomits a liquid resembling water. Rice-water discharges from the bowels,
with a few clots. Abdomen rather distended.
Mind perfectly clear, but great anxiety concerning his
condition; restlessness. Painful cramps in the hands,
calves, stomach.  They never cease, and cause the
patient to moan.
Dr. Tessier saw him at 9 o'clock. During the examination all the symptoms grew perceptibly worse.
Thinking that it was of the highest importance to restore
the circulation, Tessier applied Mayor's hammer four
times to the proecordial region. The pain was acutely
felt, but the pulse did not return.
Prognosis extremely unfavorable; the patient sank
lower and lower.
Arsenicum 6, in solution.-Warm cloths.




ASIATIC CHOLERA.              59
Two o'clock.-Puilse perceptible, pretty full even, but
the cyanosis is worse; the whole body looks livid.
Clammy sweat, skin somewhat warm. The hammer has
caused neither blister nor redness of the epidermis. The
breathing becomes more and more embarrassed, the
tracheal rattle is heard at a distance.
Vomiting, two scanty stools of clear water.
Alcoholic solution of Chamomile.
Nine o'clock. —The whole body looks livid and has a
blueish tinge, as if ecchymosed. Loss of consciousness
and speech, death-rattle. Died at two o'clock in the
morning.
Post-mortem excamination thirty hours after death.
-The external aspect of the corpse is that of a strong
man; broad shoulders, good muscular development of
the extremities, a certain stoutness.
The whole surface of the body has a blueish tinge.
Here and there large livid spots.-Excessive rapidity
of the extremities.
Abdomen.-Vascular engorgement of the coats of the
bowels. This vascular injection, although deep-seated,
imparts a red tinge to the whole surface of the circonvolutions.-No serum in the peritoneal cavity.
The intestinal canal having been opened, it was washed
in a quantity of water; the mucous membrane, from the
stomach to the rectum, presented a general inflammation,
of which we shall endeavor to furnish a detailed and
correct description.
Stomach: Injected state of all the vessels  clusters
of congested vessels composed of straight lines without
any curves; vessels along whose borders the blood had
oozed out; the whole mucous membrane had a reddish
tinge; numerous ecchymoses of various sizes, from that
of a point to that of a five-cent piece; these ecchymosed
spots are of a tolerably bright-redcolor. No ulcerations.
The inflammation is more distinct at the larger ex




60              THERAPEUTIC ANALYSIS.
tremity of the stomach, and along the small curvature
than in the pyloric region.
Duodenum. —Same alterations as in the stomach.
The inflammation was very distinct on the intestinal
surface of the symptoms, and more acute in the first
than in the second half of the duodenum.
Small intestine. —The inflammation extends through
the whole length of the small intestine: general congestion of the vessels, diffuse redness, numerous ecchymoses. The valvulke conniventes are very prominent.
Here and there a portion of the mucous membrane looks
healthy; but the same alterations which we have just
described, reappear a little further on.
Towards the middle of the jejunum a number of small
granulations are seen, which raise the mucous membrane
and form a sort of miliary eruption. These scarcelyperceptible granulations contrast with the remaining
mucous membrane by their pale-white color.  They
seem to consist of scattered follicles.  As they progress towards the extremity of the small intestine, they
become less numerous, but bigger and more prominent.
Several seem united and agglomerated, and form irregular elevations, whereas, in the other parts, they are
regularly rounded. Peyer's glands are prominent, and
the more the nearer they are to the ileo-ccecal valve.
They show no signs of vascular injection; no red points,
ecchymoses, or ulceration are perceived in any of them.
Their surface looks white and pale like that of isolated
follicles.
It should be observed that the inflammation is less
marked towards the end of the lesser intestine than
towards the duodenum; the same phenomenon presented
itself in the stomach where the inflammation was more
intense in the cardiac than in the pyloric region.
The upper surface of the ilco-ccecal valve is covered
with a large number of big isolated follicles of a regu



ASIATIC CHOLERA.               61
lar round shape, white color like that of the mucous
membrane, on which they constitute little prominences
and which, in this place, is neither red nor congested.
Large intestine.-The lower surface of the ileo-ccecal
valve exhibits symptoms of intense inflammation) striking analogy to the pyloric valve); this inflammation
extends throughout the ccecum and the large intestine,
but seems much more marked in the coecum than in the
colon or in the sygmoid flexure.
No ulceration.
We omitted to mention that the intestinal canal did
not contain a trace of f~ecal matter. It was full of a
clear, almost inodorous liquid, in which floated small
flocks of a whitish-grey color that imparted to it the
appearance of rice-water or soup-suds.
Compared to the remarkable alterations in the intestinal mucous membrane, the other organs were but triflingly affected.
The vena cava and all the abdominal veins were filled
with a black, thick, viscous blood.
The liver had a brown color; all the hepatic vessels,
especially the ramifications of the vena porta, were
filled with a black blood.
The spleen was flabby and pale. The kidneys did
not show any marked change. The bladder was contracted, empty and shrunk.
The right ventricle of the heart was distended with
a large quantity of very dark blood; the left ventricle
was almost empty, but not nMuch contracted.
The lungs were perfectly sound.
The brain was not examined.
This case of black cholera is exceedingly characteristic.
In 1832 I had often succeeded in rousing the vital forces
by applying Mayor's hammer, dipped in boiling water,
to the epigastrium and the region of the heart; in the




62             THERAPEUTIC ANALYSIS.
present case the application had no effect, although it
caused pain.
As regards the gastro-intestinal inflammation revealed by the post-mortem examination, we shall recur to
it again in our therapeutic analysis of these cases.
CASE XI. By Dr. Guyton.-Ataxic Cholera.Death.
Riquet, 39 years, entered the hospital on the first of
May, 1848, at two o'clock in the afternoon, ward St.
Benjamin. No. 3.
Had enjoyed good health previously, had led a regular life. While doing his errands in Paris, the day
previous, the patient had been taken with diarrhoea; in
the evening he complained of weariness, malaise, did
not want any supper. During the night discharges increased in frequency, and about nine o'clock, this morning, vomiting set in; the patient grew cold, was seized
with cramps in the extremities; the urinary secretion
had stopped.
On entering the hospital, we found his features altered, expressive of uneasiness and distress; eyes sunken, face elongated.
Breathing embarrassed, anxious; voice feeble, broken;
coldness of the extremities, face, neck, upper portions
of the chest; cold and clammy sweat; pulse almost imperceptible; from time to time a few feeble pulsations
are perceived.  On auscultating the  heart, only a
distant tremor is perceived.  Cyanosis of the hands,
forearms; blueish tint of'the arms, marked lividity of
the lips, tongue, interior of the eyes and mouth. Cyanosis of the lower extremities, a dense network of veins.
Tongue moist, cold, covered with a compact yellowishwhite coating. The abdomen is somewhat distended;
acute pain in the epigastrium, even without pressure.
The vomiting is quite frequent, and the nausea continues
uninterruptedly;  the alvine evacuations set in at short




ASIATIC CHOLERA.               63
intervals; they are composed of a clear, grey liquid
mixed with a few clots and are passed almost involuntarily. Complete suppression of urine. Bladder empty.
Mind perfectly clear; the patient is uneasy, anxious;
one of his relatives had died of cholera, he thinks he
cannot recover.
Painful cramps in the hands, legs and stomach.
The general appearance of the patient, and an analysis of the symptoms, lead to an extremely unfavorable
diagnosis. The patient is drowsy; the eyelids are only
half closed, the eyes are without any expression; the
head feels heavy, painful; prostration of strength.
Veratrine 3, in solution, a tablespoonful every 15
minutes, alternated with Carbo-veg. every half hour.
Mayor's hammer is applied four times; the pain is
felt, but the pulse remains unchanged.
Five o'clock in the evening.-Vomiting, two discharges
from the bowels, consisting of a clear liquid with clots.
Some coldness of the skin; pulse very feeble, but regular and perceptible; breathing superficial and anxious;
drowsiness, pain and heaviness of the head; cramps.
Eleven o'clock.-General condition of the patient worse,
drowsiness more marked, physiognomy unfavorable.
The patient answers only when urged, then falls asleep
again; the breathing is embarrassed, the pulse becomes
collapsed; coldness; increased cyanosis of the face,
hands, cold sweats.
Arsenicum in solution, every 15 minutes, alternated
with Carbo-veg. in solution every half hour.
May 2.-The general appearance of the patient is
somewhat improved; the eyes have more expression,
the face is a little more animated. Breathing freer;
the skin of the face, neck and extremities is cold; pulse
feeble but regular; head not so heavy.
Little vomiting; four rice-water discharges, the two




64             THERAPEUTIC ANALYSIS.
last of which have a slightly yellowish tint; abdomen
flat, not painful to pressure. Thirst intense. No urine.
Cramps not frequent.
Arsenicum 6, in solution, every hour.
The hammer raised a blister, which soon collapsed
again; there was scarcely a little redness round the
spot where the instrument had been applied; it soon
disappeared again. Scarcely any reaction.
Evening.-Skin cold, pulse very small; cold clammy
sweat in the face and on the neck. The cramps have
disappeared. The headache continues; no vomiting or
pain in the epigastrium.  Three liquid stools mixed
with yellowish clots; no urine.
Breathing embarrassed, sighing.
Arsenicum 6, in solution, every hour.
May 3.-Headache, countenance without expression,
drowsiness, eyes half closed.  The patient answers
questions as if yielding to entreaties, and then sinks
back again into a state of apathy. Tongue moist and
cold, slightly coated white; thirst moderate.  Voice
feeble, breathing embarrassed, sighing. The pulse is
small, frequent; skin cold, covered with clammy sweat
in the face, on the neck, upper extremities; the lividity
is less.
Thirst. No vomiting. Last night had several liquid
stools resembling in color a solution of ratafiia and depositing a few clots of fsecal matter. This color probably arose from the pressure of a little blood. No urine.
Nux-vomica 6, in solution. — Carbo-veg. 6, in solution.
Evening.-Same skin and pulse.  Breathing more
embarrassed; at every moment the patient utters deep
sighs.  Drowsiness and restlessness;  patient turns
about in his bed, uncovers himself, keeps changing the
position of his limbs all the time.
In the afternoon, good-looking evacuation mixed with
fiecal matter.




ASIATIC CHOLERA.              65
Midnight.-Increased coldness in the face, on the
chest and arms; the clammy sweat is colder. Increased
drowsiness, it is difficult to get an answer from the
patient. Pulse very small.
Arsenicum and Carbo-veg. in solution, every 15
minutes alternately.
May 4.-Same as last evening. Two stools of bilious
faecal matter of ordinary quantity and having a.good
appearance. No vomiting, no discharge of urine. Abdomen flat and drawn in.
The drowsiness continues; frequent sighing breathing; physiognomy without expression; cyanosis ceases.
Opium 12, in solution.
Five o'clock in the evening. —Same drowsiness, same
coldness; pulse filiform.
Distilled water of laurocerasus, two teaspoonsful.
Nine o'clock- -More laurocerasus water had been
given than had been ordered. The patient continued
to sink; the breathing became more embarrassed;
tracheal rattle set in; complete prostration and loss of
expression in the countenance, collapse of pulse. Towards
the end the temperature of the body rose again; the
chest and arms were covered with a warm moisture, but
the face remained cold, covered with a clammy sweat.
At 10 o'clock the patient died.
This case shows that the vomiting and cramps had
been stopped, the alvine evacuations had been considerably modified in their quality; but it was impossible to
restore the urinary secretion or to bring on a reaction
on the skin or in the circulation.
Post-mortem examination.-On opening the abdominal
cavity, the peritoneal surface of the bowels was found
red, injected; the circumvolutions are marked with
small, narrow streaks, arising from fine clusters of more
intensely-congested vessels of the peritoneum at these




66             THERAPEUTIC ANALYSIS.
points. The peritoneal cavity does not contain any liquid
or other abnormal secretions.
The small intestine was found to contain a yellow,
thick, coherent substance.
The stomach contained some of the beverage. The
internal surface of the stomach showed unmistakeable
signs of inflammation: redness, turgescence without
softening of the mucous membrane; dotted with fine
clusters of congested capillaries; numerous ecchymosed
spots of an intense redness within the thickness of the
coats; the mucous coat shows such lesions throughout
its whole extent.
Same condition of the duodenum; in the ileum similar
congestions and ecchymoses were seen; no peculiar alteration of the glands of Peyer; a few inches above the
ileo-coecal valve and near the opening of the ileum into
the ccecum a dense, grey-colored rash of the size of a
pin's head is perceived. In the coecum and at the commencement of the large intestine, the mucous membrane
exhibited clusters of congested capillaries, with a few intensely-red places, here and there, and red ecchymosed
spots more scantily disseminated, all pointing to an intense gastro-enteritis. The mesenteric ganglia looked
swollen and red.
No alteration of the spleen or liver. No urine in the
bladder.
The abdominal veins, and the trunk of the vena cava
were filled with a black, fluid blood, without coagula, and
containing scarcely a few thickened clots.
Brain. —A little clear serum in the meningeal membranes. At the union of the lower third of the lateral
surfaces of the brain with the two upper thirds, there
was on each side a well-marked, red semicircular streak
going from behind forward. This streak arose from the
injected condition of the meningeal membranes in that
region, and from a densely-dotted redness of the cerebral




ASIATIC CHOLERA.             67
substance penetrating to a certain depth. Round these
dots the meningeal membranes and the cerebral substance
are slightly adhering.
Lower surface: the cineritious substance is evidently
congested; the pia-mater in this region is redder than
the neighboring parts. Continuing the cerebral fissure
by an incision, the middle ventricle was opened, and the
annular protuberance and the rachidian bulb were divided in the middle. These parts exhibited a well-marked
persistent yellowish-white color, diminishing as it extended towards the rachidian bulb, where it disappeared
altogether. The surrounding parts exhibited no abnormal changes either in regard to consistence or color.
There was a little light-colored serum in the ventricles.
No other changes of consequence were noticed.
This case of ataxic cholera is remarkable on account
of the course which the disease ran, of the progressive
aggravation of the cerebral affection, the first symptoms
of which were seen from the very commencement of the
malady. The cessation of the actual cholera-symptoms
was not accompanied with a true reaction, and the patient
finally succombed in a state of coma, coldness and
cyanosis.
The inflammatory symptoms revealed by the postmortem examination, deserve the attention of observers.
We have seen that they existed in the black variety of
cholera, consequently during the cold stage; in this
case we find them to exist after the disease had run for
some days.
CASE XII.-By Dr. Guyton.-Simple Cholera.Cure.
Miller, 35 years old, mason, entered on the 3d of May,
in the Ward St. Benjamin, No. 6.
On the 19th of April, the patient was taken with
malaise and diarrhoea; nevertheless he continued his
work. On the 2d of May he stayed home, being weaker;




68             THERAPEUTIC  ANALYSIS.
he had a great many passages. On the 3d, at noon,
the diarrhoea was still worse; what he passed was said
to resemble flour-water; afterwards vomiting set in;
soon after coldness and cramps.
At eight o'clock in the evening, the following symptoms
had developed themselves: emaciation, prominence of
the cheek-bones, sunken eyes; marked lividity around
the eyes, mouth, chin. Frontal headache.
Voice feeble, broken; the breathing did not seem embarassed. Cyanosis of the hands. Pulse perceptible,
regular, frequent, small. Coldness all over, especially
in the face, at the neck, on the upper extremities; these
parts are covered with a cold, clammy sweat; coldness
of the lower limbs.
Tongue moist, icy-cold; intense thirst. Abdomen flat,
drawn-in, sensible to pressure. After entering the hospital, he was taken with copious vomiting which the
patient had taken to get a little warm. During the day
he had twenty-two stools. A few drops of urine were
passed.
Understanding perfectly clear; his strength was not
much less; cramps easier.
Veratrine 3, in solution, every half hour. Water and
sugar.
May 4.-No sleep; restless.  The skin is warmer;
pulse pretty full and frequent. Tongue coated white,
moist. still cold; abdomen drawn in. Thirst intense,
with nausea; two copious vomitings mixed with little
clots. Watery stool, precipitating a green deposit resembling chopped greens. No urine. Frequent cramps
in the calves and hands.
Continue the Veratrine every two hours.
In the evening the heat of the skin was less uniform;
the face, forearms, upper part of the chest, were covered
with a cold clammy sweat. The pulse was small and




ASIATIC CHOLERA.                69
frequent. Intense thirst; the patient had used several
times the chair standing by the side of his bed.
Face and hands livid; restlessness, headache; the
patient turns about all the time, uncovers himself.
Cramps.
Arsenicum 6, every half hour; afterwards every hour,
May 5.-General condition better, some sleep. Temperature more regular, improved in quality; pulse full
and frequent. The skin is less livid, assumes its ordinary appearance. Tongue white, moist, cool; thirst less
intense. Two stools: the first grey and thick, the second of a slightly-yellowish appearance. Scanty emission of urine this morning. The cramps have ceased
entirely.
Arsenicum in solution every two hours.
In the evening, powerful reaction; striking rise of
temperature, congested condition of the face, eyes;
pulse full, large, frequent. Tongue warm; rather dry;
thirst moderate. Headache. Every trace of the cyanosis has disappeared. Neither vomiting nor alvine discharges; discharge of urine.
Aconite 3, in solution, every hour.
May 6.-Skin cooler, of a good temperature: pulse
regular, soft, of middling frequency. The patient had
several naps.  Uneasiness rather than pain in the
bowels; no vomiting. A stool of a dark-yellow color.
The urinary secretion is completely restored. —Physiognomy natural; the sound of the voice likewise.
Continue the Aconite.
No stool during the day.
May 7.-General condition good; temperature of the
skin like the warmth of the breath. Pulse normal. The
headache has ceased.  No thirst, vomiting or stool.
Appetite.
Carbo-veg. in solution.




70            THERAPEUTIC ANALYSIS.
May 8.-Diarrhceic stool; no pain in the bowels; the
patient wants to eat.
Continue the Carbo-vegetabilis; a few spoonfuls of
broth; wine and water.
May 9.-Convalescent; neither vomiting nor alvine
evacuations. Appetite.-Broths, soups.
The convalescence goes regularly. The patient was
discharged cured on the 19th of May.
This was a very simple case. The symptoms which
did not yield to Veratrine, at once yielded to Arsenic;
Aconite promptly arrested the excessive reaction. Carboveget. was given for the purpose of supporting the
patient's strength.
CASE XIII.-By Dr. Guyton. —Simple Cholera.
-Cure.
Sainty, 28 years old, carrier, admitted May 4th, ward
St. Benjamin, No. 9.
This patient was habitually intemperate; had been
drinking all this week; for the last two days had had
diarrhcea, in spite of which he continued his work and
mode of life. This day, May 4th, at noon, the alvine
discharges set in uninterruptedly, accompanied by vomiting and cramps.
Three o'clock.-Cholera features; eyes sunken, surrounded with a blueish circle; lips and and tongue livid.
Breathing rather short and accelerated; voice very
feeble. Pulse imperceptible.  Cyorosis of the fingers;
veins swollen, no circulation on the dorsal surface of the
hands; the remainder of the skin had its natural color,
but had lost its elasticity. Marked coldness, especially of
the extremities, face, neck, upper portion of the chest,
these parts are covered with a cold and clammy sweat.
Tongue blueish, cold, moist, coated white; intense
thirst. Abdomen drawn in; pain on pressure in the
epigastric and umbilical regions; cramps in the stomach.
Renewed vomiting; after entering the ward he vomited




ASIATIC CHIIOLERA.             71
up a white-colored liquid, which was followed by a clear
watery stool, mixed with a few clots. No urine.
Understanding clear, good amount of strength. Frequent and painful cramps in the calves, feet, hands and
stomach.
Prognosis unfavorable; great disturbance of the vital
and natural functions; at the end of a few hours, intense
coldness, arrest of the circulation.
Veratrine 3, in solution, every 15 minutes; water and
sugar; warm flannels.
In the evening the patient had not warmed up; no return of the pulse. Cold, clammy sweat. Voice feeble;
breathing short and hurried. Frontal headache; buzzing
in the ears, drowsiness. The patient does every thing
in his bed without knowing it. Vomiting ceases; intense
thirst. Painful cramps succeeding each other at short
intervals.
Arsenicumn 6, in solution.
Midnight. —The cramps continue without intermission,
they cause the patient to moan and make him very
restless.
Camphor in solution.
May 5.-Improvement; the cramps are not frequent;
the temperature has risen, is cool and uniform; pulse
small, regular, not frequent. No vomiting; two stools;
a discharge of urine.
Arsenicum in solution, every two hours.
In the evening, violent headache, of which the patient
complains a good deal. The skin has a good temperature;
the pulse becomes fuller.  The cyanosis disappears.
Intense thirst; pain in the epigastrium; four vomitings
one after the other, composed of a white, watery liquid.
No stool; emission of urine.
Cessation of the cramps since four o'clock in the
afternoon.
Nvx-vomnica 3, in solution, every hour.




72              THERAPEUTIC ANALYSIS.
Midnight.-Two attacks of vomiting, with a slightly
greenish tinge.
May 6.-Same condition of the skin and pulse; no
cyanosis.  Headache, fatiguing buzzing in the ears.
Tongue moist, coated white; intense thirst; pain in the
epigastrium, green vomiting; no stool.
The patient had a little nap; return of the cramps.
Pulsatilla in solution.
In the evening, two cholera-stools, with little clots,
a slight bilious tinge. Vomiting. Headache.
Belladonna 3, in solution.
May 7.-Gentle warmth of the skin, without sweat,
good pulse. The physiognomy is improved; the eyes
are less sunken. Pain in the epigastrium; three vomitings, the two last of which were mixed with bilious
matter. Yellowish stool.
Less headache; return of strength.  The breathing
easy, and the voice has resumed its natural sound.
In the evening, intense thirst, sensitiveness of the
epigastrium. Neither vomiting nor stool.
Heaviness of the head, drowsiness.
Opium 3 in solution.
May 8.-Green vomiting; three bilious stools. Less
headache.
Ipecacuanha in solution.
During the day, the patient vomited once and had a
stool.
Aconite in solution.
May 9. —-Vomited once; three good-looking stools,
with fiecal matter. Appetite.
Pulsatilla in solution.-Broths.
May 10.-No headache; no pain in the epigastrium;
less thirst. Appetite.  General condition good.
Continue Pulsatilla.  Broths.
May 11.-No vomiting, a stool in form; appetite;
convalescence.-Broths; soups.




ASIATIC CHOLERA.               73
May 13.-Continued convalescence.  The last two
days the patient had three meals. Discharged cured.
In the previous cases I have purposely directed attention to the symptoms of gastro-enteritis revealed by
the post-mortem examination. This inflammatory condition has to be struggled against in simple cholera after
the actual cholera-symptoms have ceased, as was the case
in the case before us.
CASE XIV.-By Dr. Guyton. —Simple Cholera.Cure.
Tirfoin (a consumptive patient, who was attacked in
the ward while under treatment for phthisis), 52 years
old, doing errands, admitted April 21st, ward St. Benjamin, No. 16. Was in the last stage of consumption,
emaciated and very feeble.
Last evening, May 4th, he complained for the first
time of a diarrhoea that had set in the night previous;
frequent liquid stools without colic; the patient was
up a good part of the day, had only taken some broth.
At the evening-visit, was ordered to take Acidun-phosphoricum, 6.
May 5.-Altered features, lividity of the face, sunken
eyes. Frequent and embarrassed breathing, aphonia.
Pulse perceptible, very small, frequent; cyanosis of
the face, hands and legs. Coldness all over, especially
in the face, at the neck and hands; clammy sweat.
Tongue blueish, cold, moist, coated white; intense
thirst, sensation of internal heat. Pain in the epigastric and umbilical regions; abdomen hollow, drawn in.
No vomiting. A great many watery colorless discharges
from the bowels. A scanty discharge of urine towards
morning.
Prostration, weakness; no cramps.
Ipecacuanha 3, in solution; water and sugar; warm
flannels.
Evening.-During the day the temperature of the
4




74            THERAPEUTIC  ANALYSIS.
skin had continued to sink; the pulse is still weaker,
frequent. Intense thirst; no vomiting, nausea. Frequent stools, which the patient discharges involuntarily;
they are absorbed by the cloths, but leave no stain. No
urine.
The patient lies on his back, is prostrated, no cramps.
Arsenicum 6 and Carbo-veget. 6, in alternation, every
half hour.
Midnight.-General condition the same. —Vomits up
a clear liquid with flocks. Scanty emission of urine.
Now and then a little cough; during the day had not
raised the fourth part of the purulent matter which he
had raised previously.
May 6.-No sleep. The general condition is rather
better, the skin warmer, covered with a tepid sweat; the
pulse is stronger, the lividity less. Tongue cold, rather
dry; intense thirst. Abdomen drawn in, painful in the
epigastric region, no vomiting; three copious stools resembling a decoction of ground rice. Discharge of urine.
Arsenicumd and Carbo-veget. continued at long intervals.
Evening.-The temperature of the skin is improved;
no sweat; pulse rather full and regular. No vomiting;
three involuntary discharges from the bowels which
scarcely stain the linen.
May 7.-Perceptible improvement; the face has lost
its livid color, looks natural; the voice is firmer and
stronger. The patient coughs more, raises more. The
temperature of the skin is mild, uniform, like that of the
breath; no sweat; good pulse. Tongue moister, less
thirst. Some pain in the epigastrium; this morning
the patient had a stool of more consistence and yellow.
Two discharges of urine in the night.
Ipecacuanha and Carbo-veget. 6, in solution, alternately.
Evening. —The patient is better; stronger; he helps




ASIATIC CHOLERA.              75
himself, turns about in his bed. No stool, discharge of
urine; raises profusely, a thick matter.
May 8.-Good temperature of the skin; pulse normal.
No vomiting, some diarrhoea. The phthisicky symptoms
re-appear.
Carbo-veget. in solution. Broths, water and wine.
Evening.-No stool.  Frequent cough, and profuse
expectoration. The former condition has set in again.
He died a month after of his disease.
This case shows the efficacy of Arsenic and Carboveg. administered alternately.  The temporary suspension of the symptoms of phthisis during the violence
of the cholera is a phenomenon common to phthisis as
well as to other forms of disease.
CASE XV.-By Dr. Guyton. —Ataxic Cholera. —
Death.
Duhamel, 35 years old, fruit-merchant, admitted May
7th, in the ward Sainte-Anne, No. 16.
This woman who had enjoyed good health previously,
was taken with diarrhoea in the afternoon; the discharges were frequent; but she had no pain, and continued her work as usual, and ate prawns at supper.
During the night the diarrhoea continued; about twenty
stools in 24 hours. At 10 o'clock this morning the
vomitings set in, which were soon after followed by
cramps and coldness.
Record of symptoms at one o'clock in the afternoon:
Cholera-physiognomy, sunken eyes, elongated features,
lividity of the face and blueness of the lips.
Breathing easy, aphonia. Pulse very small, of normal
frequency. Intense cyanosis of the hand, lividity of the
forearms; the veins are swollen, blueish, cyanosis of the
feet, lividity of the legs and thighs. Marked coldness of
the whole body, especially of the neck, face, upper part
of the chest, arms; cold and clammy sweat.
Tongue maoist, coated white. Thirst moderate. Pain



76             THERAPEUTIC ANALYSIS.
fulness to pressure in the epigastrium; abdomen not
drawn in. Seven attacks of vomiting, one of which took
place immediately after admission in the hospital; a
quantity of liquid clear as water, coming up by mouthfuls without any effort.  Frequent stools, resembling
rice-water with a few little clots. Constant nausea. No
urine.
Mind perfectly clear. Headache, buzzing in the ears;
sensation of internal heat. Painful cramps in the feet,
calves and hands, recurring at short intervals.
Veratrine 3, in solution, every half hour. Water and
sugar, warm cloths.
Evening.-Return of warmth on the chest, abdomen
and arms; these parts are covered with a warm moisture.
The face and neck continue cold and are covered with a
clammy sweat. Tongue coated white, almost dry; thirst.
No vomiting, three liquid stools passed in the bed; no
urine.
Headache, restlessness; the patient changes her position all the time, moans a good deal, is uneasy. Breathing embarrassed, hurried. Painful cramps.
Arsenicum 6, in solution, every half hour.
May 8. —Extrem-ly restless all night; the temperature of the skin has sunk; cold moisture in the face, on
the neck, chest, arms.  Pulse very small, filiform.
Tongue cold, dry; thirst moderate. Acute pains at the
epigastrium, nausea, no vomiting in the night. Liquid
involuntary stools, scarcely staining the linen. No urine.
Breathing embarrassed, short, hurried; intense lividity of the face, neck, forearms, legs. Restless, uneasy,
the patient moans constantly. Frequent cramps. Prognosis very doubtful.
Continue Arsenicum.
Evening. —Same symptoms; temperature, sweat, pulse,
restlessness the same as in the morning. The breathing
is more embarassed; pains at the base of the thorax




ASIATIC CHOLERA.             77
caused by every attempt at drawing breath. Cramps
on moving the legs ever so little.
Tongue thick, dry, coated white; thirst moderate.
Vomiting, -several stools, one on the chamber; a white,
clear liquid, with little clots; tenesmus of the bladder
which causes much distress; a spoonful of colored urine
is drawn off by means of the catheter.
Camphor, in solution, every hour.
May 9. —Pulse imperceptible; dark cyanosis of the
face, marked emaciation; violet color of the hands, forearms and legs. Short and frequent breathing; acute
pains at the base of the thorax; painful tenesmus of
the bladder without intermission. No urine is obtained
by the catheter. Tongue white and dry. The patient
is sinking, scarcely answers any questions. Complete
stoppage of all the secretions.
Carbo-veget. 6, every 10 minutes.
During the day the breathing becomes worse, coma
sets in; hands and legs are covered with violet-colored
spots. The patient dies at 9 o'clock in the evening.
Post-mortem examination. —The stomach contains a
large quantity of a grey-colored liquid.  The mucous
coat of the large curvature presents a clustered and
dotted appearance arising from congested capillaries,
with a few well-marked ecchymoses; it is turgescent
and softened. Similar alterations here and there at the
lesser curvature and in the duodenal region.
The small intestine contains a quantity of a greycolored liquid, with little clots. Here and there the
mucous membrane looks red, owing to capillary congestion; no ecchymoses. In the lower third the glands
of Peyer are grey and prominent; confluent miliary
granulations, especially in the region of the ileo-ceecal
valve. No change in the large intestine; the mesenteric
ganglia are red and somewhat swollen.
The liver and spleen are sound.  Bladder empty.




78             THERAPEUTIC ANALYSIS.
Lungs sound; the parenchyma not congested, and crepitates throughout. The right ventricle and the venme
cavae were filled with a black, viscous, congulated blood.
Left ventricle empty and contracted.
Brain sound.
In this case, an incomplete remission set in, and soon
after all the phenomena got worse, amidst a restlessness
and an anguish, which were followed by coma and death,
without being in the least degree modified by treatment.
We direct attention to the ecchymoses of the cyanosed
parts, in order to justify our views concerning the congestive character of the cyanosis.
CASE XVI. —By Dr. Guyton.-Ataxic Cholera.Death.
Michel, 46 years old, blind, admitted May 7th, ward
St. Benjamin, No. 10.
Sound constitution; looks strong, is fleshy. This man
had worked hard all this time, but had lived moderately.
At 7 o'clock in the morning, he was suddenly taken
with diarrhoea without any precursory symptoms; in a
few hours vomiting set in, and lastly cramps and coldness.
Admitted at 5 o'clock in the evening. —The features
look almost natural; some lividity round the eyes which
look dull, empty and are sunken; lividity round the lips
and chin; lips blue. Frontal headache; buzzing in the
ears.
Respiration embarrassed; the patient complains of
pain and oppression. When drawing breath; voice perfectly natural. No pulse. Cyanosis of the hands; the
whole body is cold, only the chest is a little warm. The
skin is covered with a cold and clammy moisture.
Tongue cold, quite blue, coated white; thirst very
great. Pain at the epigastrium, with or without contact.
The abdomen which is covered with fat, is of a normal
size.  Vomited six times during the day; once after
coming to the hospital, only a little; nausea, constant




ASIATIC CHOLERA.                79
distress at the epigastrium. Frequent stools having the
usual cholera-appearance; no urine.
Mind perfectly clear; the patient walked to the hospital from the neighboring street, supported by two
friends. Frequent and painful cramps in the hands and
legs.  Restlessness; the patient turns in his bed all
the time; sensation of burning heat internally.
The attack is violent and sudden; the vital and natural functions are intensely effected. It is feared that
no reaction may set in in such a fat person. Warm cloths,
water and sugar.
Arsenicum 6 and Carbo-veget. 6, both in solution,
alternately every half hour.
Midnight.-Excessively restless, constant tossing
about. The patient uncovers himself, throws off the
warm flannels; he complains of much heat. Constant
moaning, embarrassed respiration, as if proceeding from
spasmodic suffocation; since this symptom set in, the
cramps ceased. Same skin and pulse. No vomiting;
three watery stools, with a few clots.
Camphor, in solution, every half hour.
May 8.-Same temperature, with clammy and cold
moisture. A few beats of the pulse. Less oppression,
but the respiration continues embarrassed.
Tongue dry, with a thick white coating; thirst. Pain
in the epigastrium when pressing upon it; the abdomen
has the natural size. No vomiting; nausea.  Three
liquid stools, with clots; the last stool looks yellow.
No urine.
Mind perfectly clear; the voice has a naturaX soun X
the features are not much altered, constituting a striking
contrast with a deep-seated derangement of the other
functions.
The restlessness continues; return of the cramps,
not very frequently.
Arsenicum 6, in solution, every half hour.




80             THERAPEUTIC ANALYSIS.
In the evening, the patient is cold all over, even the
chest and abdomen; these parts are covered with a
clammy sweat. No pulse. Increased cyanosis of the
face and hands. Breathing hurried. Tongue dry, coated
white; intense thirst. Pain in the epigastric and umbilical regions when pressing upon these parts. Three
attacks of vomiting; five green-colored stools.  No
urine.
Less restlessness and cramps.
There never was a single sign of genuine reaction;
the pulse remained collapsed, the skin cold, without any
appreciable change of temperature.  The discharges
looked better towards the end, but this had no effect
upon the disease.  In the night the patient became
comatose, sank, tracheal rattle set in, and he died at T
o'clock in the morning.
Post-mortem examination.-Considerable accumulation of fat in the sub-cutaneous cellular tissue, in the
mesentery, epiploon, and around the abdominal viscera.
The stomach contained a certain quantity of greencolored liquid. The small intestine was shrunk, of very
small volume, containing a thick, yellow pap of good appearance.  Clusters of very fine congested capillaries,
and dotted appearance; small red ecchymoses scattered
here and there over the mucous coat of the stomach; in
the congested portions this coat is turgid, but not softened.
Same condition of the mucous membrane of the duodenum and the superior portion of the small intestine; a
similar appearance of this membrane in the last third of
the intestine, where the glands of Peyer are moreover
grey and prominent, like a confluent miliary rash.
Red places scattered throughout the large gut.
Abdominal viscera all sound.
Lungs and brain normal.
The right ventricle and the venae cavem are filled with




ASIATIC CHIOLERA.              81
a blood that is scarcely coagulated, and is sticky like
pitch. The left ventricle is empty and shrunk.
This case is interesting on account of the irregularity
of the symptoms. The f:ace and voice remained almost
natural; complete cyanosis, with complete collapse of
pulse at the extremities. Restlessness, spasms, dyspnoea; lastly coma, stertorous breathing, preceded by
a marked improvement of the evacuations.
CASE XVII. —By Dr. Guyton.-Diarrhmoic Cholera. Cure.
Iliolle, 16 years old, admitted May 7th, ward St.
Benjamin, No. 32.
On the 6th he was taken with diarrhoea, without colic;
next morning, vomiting supervened. Was admitted in
the evening of the 6th.
No great change in the features; the countenance looks
less animated than in health; the eyes are sunken; there
is paleness, but no lividity. Breathing and voice pretty
natural. Pulse frequent, compressible.  Marked cyanosis of the fingers and back of the hands; skin cool,
but not cold.
Tongue moist, coated white; thirst. Abdomen not
drawn in, with painfulness of the epigastric and umbilical
regions with or without pressure.  In the afternoon,
frequent stools and vomiting. Voided urine once only
in 24 hours. No cramps.
May 8.-Same symptoms. Vomited three times, a
clear, watery liquid; four yellowish, liquid stools.  Urinated once.
Ipecacuanha, in solution
May 9.-Hotter than in health, the pulse is more
frequent; the backs of the hands continue to look livid.
Tongue somewhat dry, thirst. Green-colored vomiting,
yellow-liquid stools. Urinated once in 24 hours.
Veratrine 3, in solution.
May 10.-Temperature and pulse good; some traces
4*




82            THERAPEUTIC ANALYSIS.
of cyanosis on the hands. Tongue moist; thirst moderate. Sensitiveness of the epigastrium to pressure; two
attacks of vomiting, two bilious stools which are very
liquid. Discharge of urine. Appetite.
Broths. Nux-vomica 3, in solution.
In the day-time, the patient had eaten some chocolate
that had been given to him by his friends. In the evening he complained of distress, looked pale, had chills,
pain at the epigastrium, an attack of vomiting, and
several copious stools.
Nux-vomica, in solution, as before.
May 11.-Temperature and pulse good. The effects
of yesterday's excess have not yet disappeared entirely;
this morning had a clear liquid yellow stool, with deposits of little clots. No vomiting; discharge of urine.
Bryonia 3, in solution.
Evening.-Sensitiveness of the epigastrium, three
turns of vomiting, with a greenish tinge; two stools, the
latter rather thick, yellow, not very copious.
May 12.-Sensitiveness of the epigastrium, two attacks of bilious vomiting; no stool. General condition
good.
Continue Nux-vomica.
May 13.-Neither vomiting nor stool. Nose bleed in
the morning.
Appetite. Broths.
May 14. Nose-bleed.  Convalescence.
Discharged cured May 22d.
CASE XVIII.-By Dr. Guyton. —Simple Cholera.
Died in the cold stage.
Fugeon, 64 years, admitted May 9th, in the ward
Sainte-Anne, No. 22.
She was small, of a bad shape, thin and broken down
by age. During yesterday she was attacked with diarrhoea; this morning the vomiting set in, then the cramps,
and- the coldness.




ASIATIC CHOLERA.                83
Admitted at 10 o'clock in the morning.  Cholerafeatures; eyes sunken, dull; lividity around the orbits;
blue lips.
Breathing embarrassed, short, hurried; voice very
feeble. Pulse collapsed. Cyanosis of the hands, with
engorgement of the veins, without circulation on the
hands or forearms; cyanosis of the legs. Coldness of
the extremities; coldness of the face, neck, upper part
of the chest, forearms; all these parts are covered with
a clammy sweat.
Tongue violet-colored, without coating, dry; thirst
intense. Abdomen drawn in, painful to pressure in the
epigastric and umbilical region.  Nausea; vomiting
after admission, scanty and clear as water. Does in
her bed without being conscious of it; the discharges
are liquid, do not stain the linen. No urine.
Arsenicurn 6, in solution, every hour.
Prostration; frequent and painful cramps in the legs
and hands.
Evening.-Same coldness, same cyanosis; no pulse;
involuntary stools, no vomiting. Cramps which cause
her to moan. The patient is sinking.
May 10.-The patient has been sinking ever since
she came to the hospital; there never was a sign of
reaction.
In the morning the lividity was more marked; the
skin perfectly cold, moist, without elasticity. Involuntary stools.
In the middle of the day, the patient became insensible; grasping at flocks and coma set in, and she died
at 7 o'clock in the evening.
CASE XIX.-By Dr. Guyton.-Sirnple Cholera.
-- Cure.
Iolsch, 44 years old, mason, admitted May 10th,
ward St. Benjamin.
Three days ago he was attacked with diarrhoea without




84      ~       TH1'WERAPEUTIC ANALYSIS.
any apparent cause; frequent liquid discharges, without
colic. The first two days the patient was able to work;
yesterday he was taken with weakness, loss of appetite,
malaise. In the evening the vomiting set in, cramps at
night.
May 10.-Cholera-features; sunken eyes with lividity
around the orbits, lips and chin.
Breathing difficult, hurried; voice falsified rather
than weak. Pulse very small, frequent and disappearing under the least pressure. Coldness of the extremities, and more particularly of the face, neck, upper part
of the chest, covered with a cold and clammy moisture.
Cyanosis of the extremities; the veins on the hands and
forearms look blue, they are bloated, the circulation is
arrested.
Tongue livid, coated white, moist; intense thirst;
acute pain in the epigastric and umbilical regions with
or without pressure; abdomen drawn in.  Frequent
turns of liquid vomiting, the last is like water. Several
stools. No urine since last night.
Mind perfectly clear. Strength good; some restlessness, frontal headache; frequent and painful cramps in
the legs and hands.
Veratrine 3, in solution; water and sugar; warm
flannels.
Evening.-The patient has warmed up; a pretty
strong reaction has set in; the skin is warm, but not
uniformly; the face remains cool, the tongue cold; no
sweat.  Pulse pretty full, frequent. Thirst intense.
Constant and intense pains at the epigastrium, aggravated by pressure and by drawing breath; nausea; five
times the patient vomited up a rose-colored liquid, probably mixed with a little blood. No stool; no urine.
Breathing hurried, short, labored; the patient complains of painful constriction at the base of the thorax.
Headaahe, restlessness; cramps at short intervals.




ASIATIC CHOLERA.               85
Arsenicum 6, in solution, every hour, three spoonfuls
only; followed by Carbo-veg. 6, in solution, every hour.
May 11.-The patient feels easier this morning; the
breathing is still frequent, but easier; the voice is
sound. The cyanosis of the hands is less; pulse full
and frequent.  Tongue moist, warm; a good deal of
thirst. Acute pain in the epigastrium; nausea; five
times he vomited up a brown liquid with a red precipitate, evidently blood. No stool, no urine.
Nux-vomica 3, in solution.
Evening.-Marked improvement. Respiration fuller,
lees hurried; good temperature of the skin; no cyanosis of the hands; pulse full, not frequent. The eyes
are still sunken and surrounded with blue rings, but
the countenance has resumed its natual expression.
Some headache. Tongue moist, almost natural. Thirst
moderate; some nausea, no vomiting; sensitiveness of
the epigastrium, not exactly a pain. No stool, no urine;
every now and then the patient experiences an urging
at the anus. Had two or three naps in the day-time.
May 12.-Good sleep. Features almost natural. No
lividity round the eyes, which continue somewhat sunken.
Breathing easy, not frequent. Warmth and pulse normal.
Tongue coated white, moist; some thirst. Sensitiveness at the epigastrium; no nausea, vomiting or stool.
The urinary secretion is restored.  No return of the
cramps.
Continue Nux-vomica.
May 13.-Scanty bilious stool in the day-time. Appetite. Broths.
May 14.-Thick stool. Decidedly convalescent.
May 18.-Discharged cured.
This case shows a well marked gastritis during the
period of reaction; it yielded speedily to Nux-vomica.
CASE XX.-By Dr. Guyton. —Simple Cholera.
-Cure.




86             THERAPEUTIC ANALYSIS.
Toupin, 29 years old, a mason, admitted May 10thb
ward St. Benjamin, No. 11.
On the 5th of May the patient was taken with diarrhcea; next day continued his work.
May 7.-Was taken with vomiting, cramps, coldness.
May 8.-A physician was sent for; he ordered six
leeches at the epigastrium, Seltzers' water and an antiemetic. The vomiting and diarrhnea continue.
May 10.-The patient is taken to the hospital, and
arrived when the physician was making his rounds.
Marked emaciation, sunken eyes, livid complexion
and blueish lips.
Breathing anxious, frequent, voice feeble. The pulse
is small, hurried; the upper surfaces of the hands and
feet look spotted. The temperature is lower than in a
state of health, but not sunken to the coldness of cholera; a reaction is evidently approaching. Tongue cold,
rather dry, coated white; intense thirst.  Abdomen
drawn in, the epigastric and umbilical regions are pain.
ful with or without pressure.
Repeated vomiting and stools. No urine.
Mind perfect, weakness; restlessness, headache. Frequent cramps.
Veratrine 3, in solution; water and sugar; warm
flannels.
Increase of temperature in the evening; the skin feels
warm, the pulse is full, rather large, hurried. Tongue
cool, rather dry; thirst. Nausea; four turns of vomiting, with a greenish tinge. No stool since his admission;
pain at the epigastrium.
Breathing frequent; headache; continued restlessness. The cramps occur but seldom. No urine.
May 11.-General improvement; better temperature,
more uniform; pulse less frequent, fuller; no cyanosis.
Tongue moist, slightly coated white; thirst moderate
The pain at the epigastrium continues; nausea. No




ASIATIC CHOLERA.              87
vomiting or stool. Two emissions of urine in the night.
Less restlessness; the breathing is easier and the
voice has returned. Less headache; nose-bleed in the
morning.
Ca-rbo-veg. in solution.
May 12.-Sleeps in the night; no headache. Feels
generally  comfortable.  Breathing, temperature and
pulse natural.
No pain at the epigastrium; no vomiting, no stool.
Has some difficulty in urinating. Appetite.
Carbo-veg. in solution. Broths.
May 13. —No vomiting or stool. Nose-bleed.
Broths, wine of Bagnolles.
May 14.-Completely  convalescent.   Discharged
cured May 18th.
This was a very simple case of cholera.  No dangerous symptoms in the cold stage; no serious symptoms during the reaction; the convalescence was rapid
and easy.
We stated in the commencement that the treatment
of cholera can be established on a truly scientific basis:
we have given twenty cases of this treatment. This is
not sufficient to demonstrate'the proposition which we
have advanced. The method which had been followed,
has to be explained. By method we mean the general
principle which directed in each case the application of
positive remedies to particular diseases.  But, inasmuch as every body pretends to practice a rational
system of medicine, or to base therapeutics upon positive indications, it behooves us to show in what manner
a scientific system of therapeutics differs from one
that is arbitrary, or in what manner indications and
medications that are positive and based upon experience,
differ from such as are purely hypothetical. Both these
methods have been applied to'the treatment of cholera;




88              THERAPEUTIC ANAI.YSTS.
we are enabled to analyse, compare and judge them. It
is after having instituted such a comparison that we
determined to adopt the one in preference to the other,
and to treat our patients accordingly.  We shall give
our reasons for so doing. Let us first explain the method prescribed by the rational, hypothetic, classical
medicine. This method involves a variety of modes:
Some understand by indications the explanations which
they give of the disease; others have adopted certain
routine indications for every disease, which correspond
to five or six different forms of medication. Others prescribe a different medicine for every single symptom;
others again base their therapeutic indications upon the
essence or the unknown and inscrutable cause of the
disease, and seek for the specific remedy whose unknown
action is to triumph over the unknown nature of the malady. All these various forms of treatment have been
resorted to in the management of cholera.
According to Broussais cholera is gastro-enteritis;
every inflammation has to be combated by sanguineous
emissions; hence cholera, being an inflammatory disease, has to be treated by every kind of antiphlogistics.
According to others, cholera consists in a relaxed condition of the pores of the bowels; this view leads us,
therefore, to the use of astringents. The only trouble
is to find a suitable astringent that is willing to accomplish this use.
Some look upon cholera as a case of poisoning. If
this were true, the treatment would depend upon the
nature of the poison; but this is not so. According to
the adherents of this hypothesis, cholera results from
the action of some unknown poison upon the animal
economy. It is therefore unnecessary to trouble one'sself about the antidote; only, since the poison has necessarily entered the circulation, we have to drive it
out thence by every possible channel, and, to this effect,




ASIATIC CHOLERA.               89
excite all the secretions. In this respect it is supposed
that we simply imitate nature: do we not see nature
open the pores of the stomach and of the bowels, drive
out the poisonous matter by the mouth and the anus, &c.?
This system is the opposite of the preceding one, which
aims at closing the relaxed pores and arresting the excessive use which nature is making of her curative resources.
The modern hippocratist is no more embarrassed by
the cholera than by any other disease. According to
him there are no diseases; there are only patients.
If the patient exhibits signs of plethora, he is bled.
If he has too much bile, he is vomited and purged. If
his strength fails him, give him tonics. If an ataxic
condition sets in, he is treated with nervines. If there
is a certain intermission in the symptoms, do not fail
to give him quinine.
This method is so much the more positive that it applies to every form of disease, or rather to all sorts of
patients. He who has acquired the art of manceuvring
(this is the consecrated term) with these few remedies
is a practitioner of consummate skill, a man of positive
and sure mind, of sound judgment..... The pharmaceutic appliances may be varied a good deal. There is
a more or less well filled arsenal of antiphlogistics,
emetics, purgatives, tonics, nervines, antiperiodic medicines, &c.  Art, which  is an  imitation of nature,
ought to be as accommodating and varied in its proceedings as nature herself is disposed to modify the infinite
variety of her phenomena. It is by this sort of scientific jargon that they color the ordinary routine practice,
based upon half a dozen indications drawn from a hard
pulse, a coated tongue, &c. The symptom-practice is
that which is most generally in vogue. It consists in
treating each symptom separately by some particular
remedy. This leads to a therapeutic confusion, a sort




90             THERAPEUTIC ANALYSIS.
of chaos in the midst of which the physician becomes
entangled in a network of uncertainties, and the poor
patient is pulled about in every direction. If he gets
well, it is impossible to tell what cured him; if he dies,
it is equally impossible to determine what destroyed him.
In the management the symptom-practice is applied as
follows:
In the first period:
For the coldness: warm cloths, warm air-baths.
For the thirst: ice, cold water, or stimulating hot
drinks.
For the vomiting: Seltzer's water, anti-vomiting
medicines.
For the'diarrhcea: opiate-injections, astringents.
For the cramps: dry frictions, or frictions with various
liniments.
For the collapse of pulse: stimulating drinks, aromatics, cordials, tonics.
In the second period:
For the fever and the congestions: general bleeding,
cupping, leeches.
If the congestions continue: revulsives, vesicatories,
diuretics.
If some symptom of the former period should remain:
the same treatment that had been resorted to at first.
Moreover every physician has some favorite remedies
which he likes to make use of in every case.
As regards the specific treatment of cholera, its partizans, who.are as yet searching for the true specific of
this disease, employ alternately every thing which credulity or the thirst for lucre had brought into vogue as
a remedy for the most desperate cases of cholera, and
which had proved to be as infallible as any remedy for
a common cold. As soon as the cholera breaks out any
where, it is at once preceded by the announcement of
specifics. While the epidemic prevails, the specific remedies succeed each other. Every day some new specific




ASIATIC CHOLERA.              91
takes the place of one that had been abondoned.
Towards the close of the disease, the specifics are forgotten. This does not eradicate the mania for specifics;
for those who are affected with it, go in search of other
specifics.
This criticism of methods which are founded upon
arbitrary indications, seems severe; it is only just,
-however, as every one will admit who has a proper knowledge of the insufficiency of the remedial means with
which the cholera has been treated: indeed, the most
intelligent and the most experienced practitioners are
of my opinion. I am, no more than they, willing to
impeach without limitation the use of empirical or symptomatic indications.  With a little tact the errors of
these methods are not only avoided, but may be used to
some good purpose.'Instead of acting upon all the
symptoms simultaneously, the principal ones only might
be taken as leading indications; by this means contradictory medications would be avoided; nevertheless, this
kind of treatment would lack a positive basis, and the
mind would remain wavering and dissatisfied.
But to say, as Broussois does, that cholera is a gastroenteritis, is simply to take advantage of a few cases
where the.symptoms of gastro-enteritis are evident, in
order to declare that inflammation is the constant and
leading character of the disease.. Supposing even that
this inflammation is as regular a symptom in cholera as
it is in typhus, this does not show that the former can
be rightfully considered as a true form of inflammation,
for this reason: that cholera lacks the common characteristics of an inflammatory disease, such as result from
the relation of the fever to the local alteration, from the
condition of the blood, the course of the phenomena, &c.
And even, if cholera really were a genuine form of inflammation, this would not necessarily justify an antiphlogistic treatment.  The treatment adopted in one




92             THERAPEUTIC ANALYSIS.
form of inflammation, does not determine the treatment
to be adopted in another form. The treatment of pneumonia is no criterium for that of bronchitis, nor does
the treatment of bronchitis establish a precedent for
that of ophthalmia. Phlegmonous inflammation may
have to be treated differently from erysipelas. One of
the serious errors of our art consists in establishing a
general method of treatment for a whole class of diseases,
antiphlogistics for inflammations, astringents for blennorrhoea, antispasmodics for spasms. This is the most
deplorable abuse that could be made of the principle of
analogy; and it is still more absurd to designate by the
name of inflammation any disease that presents inflammatory symptoms, and to allow such a fanciful definition to lead one to the use of antiphlogistics in the
management of this malady.  Broussais' method is
therefore false in theory; in 1832 we have seen what it
was worth in the treatment of cholera. To say that the
cholera disease proceeds from a relaxation of the bowels
or the glands of the stomach, is to use a mere word in
the place of a scientific solution. In pathological anatomy, the term relaxation is synonymous with prolapsus. To say in physiology or pathology that the increase of a secretion depends upon a relaxation, and
then, under cover of this doctrine, to prescribe astringents, in other words, drugs, the effects of which are not
known, is simply to cover a fallacy by an absurdity, instead of treating, a disease by a remedy. Is it rational
medicine to inflict upon patients the consequences of a
double sophism 
I have been sufficiently explicit in speaking of the
hippocratic treatment of cholera, such as it was proposed and conducted by Double in 1832, to dispense with
all further criticism on this head. It matters little with
what apparent depth the theory of the morbid elements
of cholera may be expounded as a basis for therapeutic




ASIATIC CHOLERA.                  93
indications and methods: these elements are none the
the less fanciful creations which are just as dangerous
in a therapeutic as they are absurd in a pathological
point of view. This theory leads to a nosography which
is just as superficial as its corresponding method of
treatment. This is evident from the following passage
of the General Pathology of Professor Chomel: "If it
is impossible, as it would seem to be according to the
useless efforts of nosographists, to obtain a uniform
rule for the classification of all diseases* such a classification should undoubtedly be based upon the highest
possible considerations of usefulness, and the varieties
of every disease should be arranged with a view to securing the best possible treatment. In all acute disease
it is, in our opinion, the inflammatory, bilious, mucous,
adynamic or ataxic character which should determine
the treatment; for the character is just as important
to the treatment as the class to which the disease belongs.
Should a disease, no matter to what class it belongs,
present the general symptoms of an inflammatory fever,
bleeding and antiphlogistic regime have to be resorted
to; adynamic diseases should be treated with stimulants and tonics; simple diseases, which have neither
an inflammatory nor adynamic character, and are not
otherwise complicated with heterogeneous phenomena,
may not require any medicine; rest and a light diet
are sometimes sufficient to remove them; and even these
means are not always necessary, as we see in measles,
erysipelas, pulmonary catarrh, &c."
The result of this theory of the forms, indications and
modes of treatment of acute diseases, is an extreme
* Why insist upon a uniform rule to distinguish the forms of each
disease? Who says, that all diseases must have the same forms? Chemists even do not search for a uniform re-agens in all cases, nor a
uniform mode of combination. Why should physicians, instead of determining the form of every disease by observation, undertake to determine these forms by guess-work.




94              THERAPEIUTIC ANALYSIS.
simplification of the healing art.  The greatest use
would seem to consist in not studying acute diseases.
It is sufficient to be able to distinguish the inflammatory, bilious, mucous, adynamic and ataxic character, in
order to decide whether the disease with which the patient
is affected, has one of these characters, and to regulate
the treatment accordingly.  Indeed, if none of these
characters exists, rest and a light diet are most
generally all that is requiredfor a cure  of what use
are nosology and diagnosis?
This is what they term classic medicine. This kind
of medicine was applied to the treatment of cholera
as rational medicine! inflammatory, bilious, mucous,
adynamic and ataxic character, &c.! Is it too much to
say that the mind of the physician does not find any
thing in these common indications and methods that
could serve him as guide? I think not.
I shall say nothing either of the symptomatic or the
specific method of treatment.
If I am not mistaken, neither the rational system of
therapeutics nor the rational treatment of cholera sustain
a serious examination. If experience had confirmed in
any way these hypothetical and arbitrary methods of
treatment, experience might be appealed to as a witness;
but it seems to me that the last epidemic has left the
minds still more sceptical than the epidemic of 1832.
Is Hahnemann's method more scientific? I believe
this can be shown.
It is well known that, according to Hahnemann, the
totality of the symptoms determines the remedy to
be employed; and that this remedy must be capable of
producing in the healthy body a morbid condition that
* And if all these conditions should be insufficient, (which is generally
the case) it is doubtless unnecessary to trouble one's-self about the disease at all. How easy it is to simplify the healing art with a little more
or a little less!




ASIATIC CHOLERA.               95
is exactly similar to the natural disease. This correspondence between the remedy and the disease constitutes
the spirit and the foundation of the Hahnemannean system. Hence the resemblance between the drug-disease
and the natural malady cannot be too minute. There
might not be any thing arbitrary either in the observation of the symptoms or in the determination of the
remedy.
In order to establish scientifically the condition of the
patient, we have to know in the first place the nature
of his disease, and then proceed to individualize the case
before us. If we only consider the disease, the indication would be too general to enable us to adapt the
remedy to this particular case. If, on the other hand,
we lose sight of the disease, and only record the symptoms without reference to their physiological connection,
we only obtain a confused image of the malady, and can
at most only proceed empirically in the treatment. Indeed, all we can know of the previous condition of the
patient, in that which is related to us by himself and
those with him; and the future developments of the disease remain hidden from our reason. In this state of
affairs the physician is reduced to the necessity of improvising a certain group of phenomena, and connecting
them together empirically; for he has no means of classifying them according to their relative importance and
pathological bearing.  Even if a perfect resemblance
between the phenomena of the disease and the symptoms
of the remedy existed, this would not be conclusive; for,
shortly after, some of the symptoms might become worse
or disappear altogether, so that the physician, in order
to do justice to his patient, would have to remain by his
bedside all the time, watch every little change that might
occur, and modify the treatment accordingly.
If behooves us to follow the good sense of all ages, and,
recognising the truth of an essential principle of disease,




96                THERAPEUTIC ANALYSIS.
regard both the disease and the patient; neither believe with the hippocratists that there are only patients, nor with the partizans of the specific method,
that there are only diseases.*
From our standing-point the morbid indications are
based upon all the light that nosography, etiology,
semeiotics and pathological anatomy are capable of
shedding upon the character of the disease. Each of
the morbid phenomena, studied in itself and in its relations with the other phenomena, occupies its appropriate place in the whole series of symptoms.  The
present series is naturally connected with the past and
the prospective character of the disease. The disease
appears to us as an evolution of phenomena that was
known and foreseen. We are not exposed to the danger
of mistaking for drug-symptoms changes that are natural
developments of the disease. In one word, we treat disease scientifically instead of applying a mathematical
formula like a blind man.
In cholera we have distinguished four varieties. Each
variety has moreover various degrees, phases, periods;
each period is characterized by a peculiar group of symptoms; finally the cholera-disease may assume a peculiar
epidemic'type, and this type may manifest itself by distinctive phenomena.
As regards the patient, each patient exhibits peculiar
conditions of sex, age, constitution, habits, regime, idio* Hahnemann rejects as chimerical every indication which is drawn
from the essential nature of the disease; in my estimation, this is an
absolute error, and, in every respect, fraught with mischief. In proclaiming with certain adherents of the hippocratic method the doctrine, that
there are only patients, and that disease is not an essential state of the
organism, the author of homceopathy has rejected the only truth which
can secure a scientific basis to pathology. Inasmuch as not any one
truth can be opposed to any other, it is our belief that the doctrine to
which we vow allegiance, can be reconciled with Hahnemann's method,
and that his reform can be grafted upon a truly scientific system of
pathology.




ASIATIC CHOLERA.               97
syncrasy; and he may have contracted the disease under
the influence of some particular cause.
The two categories include every possible source from
which'we can draw our indications.
1. Indication drawn from the disease itself.
After having studied the cholera-disease in its various
forms and having discovered the leading character of the
disturbance, or the phenomenon which, on account of its
importance and constant recurrence, seems to constitute
the very centre of the disease, we arrive at this conclusion, that cholera is, in its fundamental nature, an
affection of the stomach and bowels, as its name indicates.
It is therefore of the utmost importance correctly to determine the nature of this affection, provided we understand by nature no more than is intended, namely: the
pathological character of the disease.
This affection of the digestive canal, in cholera, extends throughout the whole extent of its mucous lining,
from the mouth to the large intestine inclusively. The
pathognomonic signs of this affection vary, however, according to the various regions of the body where they are
examined.
In the mouth it is a catarrhal irritation, generally
affecting the whole cavity, and characterized by a
swelling and redness of the upper border of the gums,
the mucous membrane of the lips, of the edges and lower
surface of the tongue, and by a thick mucous coating on
the upper surface of this organ. In some cases we perceive a real inflammation of the buccal cavity from the
very commencement of the disease; it is known by an
inflammatory streak along the gums, by a pseudo-membranous layer extending over the convex surface of the
gums, by irregular patches on the dorsum of the tongue,
and by an acute redness and swelling of its edges. During the cold period the buccal cavity is moist; but as
soon as the reaction has set in, the dryness, the cracking,




98            THERAPEUTTC ANALYSIS.
the rhagades and the swelling of these parts leave no
doubt as to the inflammatory character of the affection.
In some rare cases the inflammation is intense, accompanied by diphtheritic patches, which extend even to the
mucous lining of the cheeks. In one case I have seen
this inflammation extend from the parietal mucous lining
to the parotid, with inflammation of this gland, as we see
it in the stomatitis of typhus, and in certain forms of
stomatitis, of old people. This mechanism of the development of parotitis is, in our judgment, one of the many
proofs of the truth of the theory which we have presented in our inaugural dissertation.  (Theses of 1836),
that an inflammation develops itself by vascular layers.
The fauces likewise exhibit an acute redness, which is
sometimes accompanied by thin and loosely adhering
membranous patches, sometimes extending low down in
the cesophogus. Is the aphonia of cholera-patients to
be attributed to this congested or inflammatory condition
of the lining membrane down to the vocal chords? I do
not pretend to say; I have thought of this too late to
verify this idea by post-mortem examinations.
I have purposely dwelt upon this buccal inflammation
because it is almost universally overlooked. The tongue
is still examined as it was at a period when its coating
was accounted for by the convenient theory of the
humors, and this loose examination is considered satisfactory, instead of exploring the buccal cavity in its
whole extent, which would probably furnish a clue to
the condition of the tongue.
The stomach, especially toward the cordia, is the seat
of an acute catarrhal irritation; I ought to add that
sanguineous infiltrations and a dotted appearance are
discovered in this organ, which only belong to a state
of inflammation. The pain in the epigastrium, the internal heat, the vomiting which is at first bilious, then
serous, then bilious and bitter during the reaction; the




ASIATIC CHOLERA.                 99
excessive sensitiveness of the stomach to the action of
natural excitants, such as a little broth at the commencement of the remission which precedes convalescence:
all these symptoms together go to show that the gastric
affection is something more than a hyper-secretion, and
that there is either a state of catarrhal or inflammatory
irritation of the gastric mucous membrane. I am well
aware that, if we mean to accommodate ourselves to the
prejudices of observers, we must not talk any longer of
inflammation of the stomach in acute diseases.  But
these observers having forgotten to define the signs by
which the presence or absence of an inflammation of the
mucous membrane can be known, we look upon their
assertions as purely fictitious, as pathological anatomy
of the sentimental order.'
The intestinal affection, which is very distinct in the
duodenum, generally diminishes in the jejunum, where
it ceases to be continuous, and is scattered over large
surfaces. In the ileum, the inflammation manifests itself by the development of the mucous follicles, and the
prominence of Peyer's glands, with or without swelling of
the corresponding mesenteric ganglions. In this portion
of the intestines the dotted appearance still continues,
together with softened points and little superficial ulcerations. The ccecum generally presents an appearance
of catarrhal irritation, seldom  of inflammation.  As a
general rule, the colon is not much affected; nevertheless, the lower part of this bowel is sometimes the seat
of superficial inflammation which manifests itself during
life by mucous stools of a dysenteric character.
I have no remarks to offer concerning the nature of
the alvine discharges. I may however point out the
progressive suppression of the bile in these evacuations,
and its reappearance after the cold stage is over.
* An observer in pathological anatomy should not content himself with simply saying no, where Broussais has said yes.




100            THERAPEUTIC ANALYSIS.
These are the characteristic signs of the cholera affection in the digestive passages: 1. general catarrhal
irritation: 2. catarrhal irritations and partial inflammations scattered all over the mucous lining of the alimentary canal.
This affection belongs to all the forms of the disease.
It is seen in every stage. This led Broussais to look
upon cholera as an inflammation of the stomach and
bowels. But there are cases where the inflammation is
wanting, and where even the catarrhal irritation is not
always proportionate to the intensity of the other symptoms. This shows that cholera cannot always be considered as an inflammatory disease without committing
a double error.
The first element in the indications of the disease is,
as we have shown, the affection of the digestive organs.
Another element consists in the ulceration of the phenomena of exhalation, secretion and nutrition. After
the physiological analysis which we have offered, it
seems unnecessary to dwell any further upon this point.
The third element of our indications is suggested by
the condition of the vital functions.
And the fourth, by the pains, cramps, restlessness,
and other subjective symptoms.
2. Indications drawn from the forms of the disease.
By classifying the phenomena of the various forms of
cholera, each agreeably to its own character, these forms
may lead us to establish with more correctness and precision the therapeutic character of the disease, and
the appropriate means of cure.
In diarrhceic cholera, commonly termed cholerine, the
gastro-intestinal affection constitutes pretty much the
whole disease; the therapeutic indications are principally based upon the condition of the alimentary canal.
The disorders in the reproductive system, or any other




ASIATIC CHOLERA.              101
symptom that may exist conjointly with the digestive
disturbance, should, however, likewise be noticed.
In simple cholera, the order of the symptoms is a
thing of importance; by means of it we are enabled to
trace the successive invasion of the organs performing
the functions of digestion, nutrition, circulation, haematosis, animation and co-ordination.
In ataxic cholera, we have to add to the totality of the
symptoms a new element, namely: the absence of all
regularity in the combination or succession of the morbid phenomena.
In black cholera, the simultaneous appearance and
the intensity of the symptoms constitutes a chief indication.
3. Every form has its periods which the physician
should not lose sight of, since the totality of the phenomena varies in the different stages of disease. The phenomena of the period of reaction differ from those of the
cold period. The febrile motion gradually takes the
place of coldness and vital depression: nevertheless, in
this stage, the gastro-intestinal affection continues to
act a prominent part; sometimes it is even the source
of new indications. Lastly, isolated phenomena may
develop themselves after the remission, and invite the
attention of the physician. This remark likewise applies to the secondary phenomena in the convalescent
stage.
These last-mentioned phenomena are on a par with the
precursory symptoms, the importance of which has been
pointed out with so much clearness by Dr. Guerin. In
this case the indications are almost entirely confined to
the digestive canal; nevertheless it must not be forgotten that the precursory symptoms sometimes consist
in some simple nervous derangement, which, however,
should be treated with the same care as the alvine discharges.
5*




102            THERAPEUTIC ANALYSIS.
4. It is useful to note the causa occasionalis of an
attack of cholera; nevertheless, the importance of such
causes is much less in epidemic than in sporadic cholera.
5. The sex, age, constitution, idiosyncracies, regimen
and habits of the patient, may furnish us special indications.
Having agreed upon the indications, we have now to
determine the corresponding treatment. This treatment
consists, according to Hahnemann in administering such
drugs as are capable of producing in the healthy organism a disturbance similar to the natural cholera-disease. Supposing this law to be true, it is evident that
it can only be applied on condition that we should possess a series of drug-symptoms exactly analogous to the
symptoms of the natural malady. In the present condition of the homoeopathic materia-medica there are still
considerable deficiencies, and not all therapeutic indications can be satisfied. Hahnemann's method, if applied to the treatment of cholera, seems as yet limited
and circumscribed in its sphere of action. This method
is brilliantly successful in cholerine and in simple cholera. In ataxic and black cholera it seems comparatively
powerless, because we have no drug in our materia-medica the effects of which upon the healthy organism correspond to the totality of the symptoms in either of these
forms. Inasmuch as either of them generally terminates fatally, it is easy to determine beforehand the
good or bad result of the homaeopathic treatment in a
case of cholera. The cures under this treatmeat are
generally cases of diarrhceic and normal cholera, excepting however a few cases of old persons who sink in
the period of convalescence, and such patients as are
brought to the hospital in a state of collapse.  The
number of deaths generally corresponds to the number
of cases of black and ataxic cholera. During the epidemic of 1849 I have only seen one case of either of




ASIATIC CHOLERA.                   103
these forms get well. All the other cases failed as I
had seen them fail in 1832; only the relative number
of cases was different; in 1832 the black cholera prevailed at the commencement of the epidemic; in 1849
ataxic cholera was more frequent than the black form.
This difference was sufficient to impart a distinctive
character to the two epidemics. The irregularity in the
course of the reaction, which is always incomplete in the
ataxic form, has surprized the physicians who expect
to see a consistent febrile reaction set in after the cold
period is terminated.
These relative differences are of very little consequence so far as the treatment is concerned, inasmuch
as these two categories of patients succomb almost always under any kind of treatment.'
In those forms of cholera where medical treatment
seems to have at all any effect, the itahnemannean method is preferable to the ordinary methods; and  is
both more scientific and more efficacious. May we hope
that therapeutic agents will yet be discovered that shall
produce a simile of the cholera-disease in the healthy
organism? This hope is legitimate, and we ought to
search for such agents.
The twenty cases which I have related, show what
medicines correspond to cholera and normal cholera.
The same medicines proved powerless in the other
varieties, except in one case of ataxic cholera, where the
vital forces, instead of sinking, were roused.
The attenuations which we have used, were generally
* It seems fair to treat the black and ataxic forms of cholera in the
usual manner, inasmuch as homceopathy fails completely in either of
these varieties. I had seen in 1832 that the ordinary methods were just
as powerless. In 1849 I again employed the same treatment after
having convinced, myself that the homceopathic treatment was inefficient
except in a very few cases. But the most powerful alloeopathic treatment did not produce any better results. This reveals to us an absolute want which is unfortunately common to all methods.




104              THERAPEUTIC ANALYSIS.
lower than those used in pneumonim.* The medicines
taken from the mineral kingdom, were used at the 6th
attenuation; those taken from the vegetable kingdom,
at the third. Of Camphor the alcoholic spirits were used.
When a medicine was given in solution, a drop of the
third or sixth attenuation was mixed in from 4 to 6 oz.
of filtered water (about half a pint,) of such mixtures a
tablespoonful was given every five, ten, fifteen or twenty
minutes, according as the symptoms seemed to be more
or less urgent. In proportion as the patient improved
the intervals between the doses were prolonged to one
or two hours.
Here follows a list of the remedies which correspond
to the indications that we have furnished.
In the precursory stage, when it is as yet impossible
to determine the true form of the disease, we have not
only to note the sensations and pains experienced by
the patient, but also the causes which may have more
directly occasioned the outbreak of the disease: such as:
excesses, moral emotions, &c.
According to the nature of the symptoms and the circumstances in which the cholera had broken out, the
following medicines will be found effectual:
Chamomilla-vulgaris;
Nux-vomica;
Pulsatilla;
Carbo-vegetabilis;
Ipecacuanha;
Phosphorus;
Secale-cornutum;
Phosphori-acidum.
Cholerine often gets well of itself, but it is better to
treat it medicinally. Besides it is sometimes very difficult to distinguish an attack of cholerine from the precursory stage of one of the serious forms of cholera.
* See Clinical Remarks on Pneumonia, by the same Author. NewYork, Wm. Radde




ASIATIC CHOLERA.              105
Agreeably to the indications, the first period requires:
Ipecacuanha;
Phosphori-acidum;
Veratrum.
The second period:
Aconitum-napellus;
Nux-vomica;
Pulsatilla;
China;
Sulphur;
Camphora.
Normal or simple cholera requires in the first period:
Ipecacuanha;
Phosphorus;
Phosphori-acidum.
In the period of growth or increase:
Nux-vomica;
Veratrura;
Arsenicum.
If Ipecac. or Nux-vomica are not sufficient to arrest
the disease, we must not lose any time in giving Veratrum; and if the phenomena still continue, resort to Arsenicumn. At the close of the epidemic I gave the Arsenic at once in simple cholera, and this treatment seemed
to me preferable to blind experimentation with Nuxvomica, Ipecacuanha or even Veratrum.  This last
named remedy was often found sufficient in mild cases.
Arsenic triumphed in the severer cases of genuine cholera.  So that these three drugs: Ipecacuanha, Veratrum and Arsenicum answer to three different degrees
of true cholera. At the commencement of the epidemic
I was in the habit of alternating either of these remedies with Carbo-vegetabilis, to meet the depression of
vital and natural strength. Afterwards I gave up this
alternating method, because it hides the genuine effects
of each drug, and I only gave vegetable charcoal when




100              THERAPEUTIC ANALYSIS.
it was indicated by the symptoms either in the first or
second period.
The period of reaction frequently proved to be a perfect remission of the disease, which often led to convalescence. If this was not the case, I gave, in accordance
with the perceptible phenomena:
Aconitum-napellus;
Ipecacuanha;
Camphora;
Carbo-vegetabilis;
Belladonna;
Mercurius;
Nux-vomica;
Pulsatilla;
Cina.
Secondary phenomena sometimes yielded to China, at
other times to Sulphur, to Calcarea or to Nux-vomica.
To understand the use of these drugs in cholera, their
effects upon a person in health have first to be known.
These effects may be studied in Hahnemann's Materia
Medica, and in Jahr's Symptomen-Codex.*
I will now mention the principal remedies which I
have found most frequently indicated.
As regards the black or ataxic cholera, I am sorry to
say that I cannot propose any effectual mode of treatment. We have no drug that presents in their totality
the phenomena of black cholera, no remedy that presents
at the same time the symptoms of cholera, and a condition of ataxy or malignity, that is to say, an incoherence
of the morbid symptoms, a depression of the vital and
natural forces, and a deep derangement of the animal
functions.
Wherever medical treatment is possible, Hahnemann's
method admits of a scientific determination of the thera* Translated by Charles J. Hempel, M.D., and published by W. Radde,
322 Broadway, New-York.




ASIATIC CHOIERA.            107
peutic indications and the treatment. of cholera. But
this method does not fill up the chasm formed by the
ataxic and black varieties.
This, at any rate, is my experience derived from the
treatment of about a hundred cases during the epidemic
of 1849. Hahnemann's method has seemed to me more
efficacious than any of the other methods of treatment.
So far as this can be shown by figures, figures do show
this. Under the Hahnemannean method about one-tenth
recovered more than under any other. Under the ordinary methods from 59 to 60 out of every 100 died in
each of the wards of the hospital Sainte-Margu6rite,
where cholera patients were received; and under the
Hahnemannean method only from 48 to 49 out of every
hundred. I mention these figures for the purpose of
refuting certain hazardous conclusions drawn from the
trial made of iahnemann's method by my colleague and
friend, Doctor Natalis Guillot, physician to the Salpetribre, in seven of the most desperate cases of his
ward, where indeed every case was desperate. He was
prevented from continuing his experiments, in consequence of a little vial labelled Arsenicum having been
seen, which gave rise to the report that he poisoned his
patients and which produced a terrible commotion among
the people. It would have been more honorable and
more scientific to study the effects of Hahnemann's method on the cholera-patients of my wards in SainteMarguerite than to distort the incipient experiments at
the Salpetriere which had to be given up by force. Even
if Hahnemann's method were absolutely false; its falsity
ought to be shown by candid and logical arguments.
Hahnemann's method enables us to establish the therapeutic indications and modes of treatment in cholera
upon a scientific basis. In the present condition of the
homoeopathic Materia Medica, we are as yet unable to




108               THERAPEUTIC ANALYSIS.
combat either the ataxic or the black variety of cholera
by adequate remedical agents. *
GENERAL CONCLUSION.
Between the physicians of different creeds and schools,
there-can only exist one bond in common, that of observation.' And this bond really does exist, for we all consider observation or experience as the sole legitimate
criterium in medical science. A public and authentic
application of this criterium has been so far denied to
the homoeopathic method. I have not wished to be implicated in such an act of injustice which would be an
everlasting dishonor to the medical body, if only a single
spark of truth were contained in Hahnemann's doctrine.
I have presented facts before my readers which are
well capable of freeing their minds from great prejudices
and removing thick scales from their eyes. I have as
much as possible acted the part of a historian, and have
contented myself with appealing to the intelligence of
my readers by facts. Will this lead physicians out
of the narrow and selfish ways of their professional
business to the nobler and generous platform of scientific observation? This is to be hoped.
The treatment of pneumonia and cholera is a severe
trial for a new system  of therapeutics.  I have said
perhaps too little  regarding the former malady; I
feel as though I had done injustice to homceopathy
by an exaggerated feeling of reserve.  Every day I
establish by new facts, the efficacy of phosphorus and
Bryonia in this severe disease, where, according to the
statistics of Dr. Louis, 32 die out of every 106 pa* It is possible that the nitrate of silver, concerning which Dr. Barth
has made some interesting investigations, may fill up a portion of this
gap in the treatment of cholera. The results of his inquiries were not
known to us until after the epidemic, so that it was impossible to put
them to the test of experience.




ASIATIC CHOLERA.             109
tients. I prefer however remaining within the bounds
of truth, than to go beyond them. I have avoided to
pronounce an absolute judgment on the merits of
Ilahnemann's system; my aim has been to convince
my colleagues of the necessity of not condemning this
therapeutic method in virtue of a pretended patentright in science, instead of studying it by careful observation. Man is not endowed with intuition; in the
natural sciences nothing is known with exactness except by observation. "Man," says Pascal, "is neither
an angel nor a brute; and it unfortunately happens,
that the man who wants to act like an angel, generally
behaves like an irrational brute." It is well to profit
by this advice.








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