xt77pv6b3299 https://exploreuk.uky.edu/dips/xt77pv6b3299/data/mets.xml Yandell, Lunsford P. (Lunsford Pitts), 1805-1878. 1833  books b92-129-29188526 English s.n., : [S.l. : Contact the Special Collections Research Center for information regarding rights and use of this collection. Cholera Kentucky Lexington 1833. Lexington (Ky.) History. Account of spasmodic cholera as it appeared in the city of Lexington in June 1833  / by Lunsford P. Yandell, M.D. text Account of spasmodic cholera as it appeared in the city of Lexington in June 1833  / by Lunsford P. Yandell, M.D. 1833 2002 true xt77pv6b3299 section xt77pv6b3299 




                   In June, 1s3t23.

             BY LUNSFORD P. YANDELL, M. D.
 Professor of Chemistry and Pharmacy in Transylvania University'

 CHOLERA, as is known to the readers of this Journal,
 appeared in this city in the early part of last November, and
 after prevailing very slightly for a few days, suddenly disap-
 peared. The winter which followed was as healthy as usual.
 Measles were epidemic during the first spring months, and
 scarlet fever, which had never entirely ceased since its first
 appearance the winter before, proved exceedingly fatal in a
 number of families. The entire subsidence of cholera in
 the fall, after manifesting so little malignity, created a gene-
ral feeling of security in the citizens. Very little fear of a
second ard more violent invasion had been felt, when, with-
out premonition, and while the city was enjoying its usual
health, it broke out in June with a virulence which but too
clearly proves how little the local situation and general good
health of a place are to be relied on, as affording an immuni-
ty from this epidemic.
  The weather which preceded the irruption of the epidemic
is worthy of note. The winter was generally mild and open.
though once in January, and a second time in March, the
thermometer fell to zero. About the 12th of April there


YANDELL on Spasmodic Cholera.

was a frost which threatened the fruit. The mercury was as
low as 27' at sun rise, a slight pellicle of ice was seen on a
tub of water in my yard, and the water in the calyx of an
apple blossom was found frozen in my garden. The fruit,
nevertheless, escaped uninjured. In a few days the weather
grew warm, and continued uniformly so throughout the month.
From the 12th of April to the 13th of May, but a few partial
showers of rain fell. Fires were not necessary even in the
morning and evening during most of this time. After the rains
set in, they were copious and protracted to a degree rarely
before witnessed by the oldest inhabitants. Fora month, but few
days passed without rain, which was generally accompanied
by much thunder and lightning. Engaged at the time in a
course of lectures on Chemistry, I found it difficult to collect
such an amount of electricity as was requisite in perform-
ing the common class experiments.  During most of the
period it was impracticable, by means of the powerful ma-
chine belonging to the Chemical Laboratory of the Univer-
sity, to charge a Leyden jar. The range of the thermome-
ter was from 78 to 85 in the hottest part of the day, and the
humidity of the atmosphere rendered the heat sultry and
oppressive. On one occasion it fell to 67' after a storm, but
rose again in a day or two to its former height with the
recurrence of the rains.
  This weather had continued three weeks when cholera
broke out. A few cases, with symptoms to excite suspicions
of this disease in the medical attendants, were rumored
through the city about the first of the month, and one occur-
red in a negro, on the 3d of June, which left no doubt of its
existence. The night following, a number of persons along
Main Street were attacked, and by morning seven were dead
or dying. In the course of the day cases were developed
in other parts of the city, and on the next day the list of
dead had increased to 27.  During the next three days
it progressed slowly but steadily. The character of the
weather was unchanged. Thunder storms occnrred almost
every day. Friday, the 7th of June, was a day of continued



YANDELL on Spasmodic Cholera.

storms. The glare of the lightning at night was terrific,
and the dismal effect was enhanced by the continual calls at
the doors of the physicians and apothecaries, which render-
ed it but too evident that the pestilence was increasing in
violence. In the course of that day and night, I am satisfied
that more rain fell, than is ordinarily allotted to a month.
After these storms the rains ceased, and the temperature of
the atmosphere fell. Sunday morning was clear, cool and
beautiful, and with the brightening of the heavens, cheerful-
ness and hope were restored, in a measure, to the minds of
the citizens. They flattered themselves that the epidemic
had begun to abate, and that under such genial skies it
would soon disappear. A few hours taught them how un-
founded was their confidence. About 12 o'clock it became
manifest that it was growing more violent, and before night
the cases had evidently been multiplied four fold. The fa-
tality along Main and Water Streets was appalling, but by
this time no part of the city was entirely exempt. Mon-
day it was evidently still increasing. On Tuesday, the 9th
or 10th day after the appearance of the first case, it was
believed to have attained its acme, and on this day it is com-
puted that from 50 to 60 persons died, and that 1000, some
physicians think 1500, were ill of the disease. There was
no great difference in the mortality of Monday, Tuesday, and
Wednesday, and there is scarcely a doubt that in those three
-days Lexington lost from 120 to 150 of her citizens. This
mortality is the more striking contrasted with that of
former times when it is considered that the annual mortality
of the city for many years, with a population nearly as great as
at present, did not exceed 50-its average number of deaths
for a year, being thus crowded into a single day!
  The weather remained dry and warm until the end of the
week, and after Wednesday the epidemic visibly declined.
It was evident that there were fewer cases on Thursday than
on the day preceding, and from this time it subsided about as
rapidly as it arose. A number of families were severely
afflicted after this time, and a few fatal cases continued to



YANDELL on Spasmodic Cholera.

occur up to the 10th of July, making more than a month
from the commencement of the disease to its final disappear-
ance. At this time (July 18th) not a case is believed to exist
in the city, and but little if any more (some physicians think
less) disease prevails than in ordinary seasons.
  I proceed next to mention a few causes which contri-
buted to the mortality of the disease in this place, not to
reflect upon the conduct of any one, but as a warning to oth-
er people who may be destined hereafter to feel the epidemic.
  So secure had we felt in what were deemed the advantages
of our local position, in the former proverbial healthfulness
of our city, and in the general comfort of the citizens, that
no provision was made for the epidemic. As a consequence,
it found our municipal authorities without the means either
of ministering to the wants of the indigent sick, or of taking
account of the progress of the disease. No Board of Health
was organized, and the Health officer being unable to obtain
information, no reports were made, and hence we are now left
to guess at the mortality. No available hospital was pre-
pared. When the disease had been a week in progress, an
attempt was made to open one, but it was then found impos-
sible to procure the necessary attendants, and the project was
abandoned. The result of this was, that as the sick were
scattered over the whole city, much unnecessary labor was
performed by the physicians, and as a necessary consequence,
they were soon exhausted. During the first ten days of its
prevalence Drs. Boswell, Challen, and Steele died, and near-
ly every other practitioner in the city experienced an attack
of the disease. To add to these misfortunes, Professors Cooke
and Short were absent during the first week, and Professor
Caldwell, who was in Boston when it broke out, did not
reach home until it had subsided. Thus was the city depriv-
ed of the services of six physicians, at a time when all would
have been inadequate to the demand, to say nothing of the
indisposition of many which seriously impaired their effi-
  The panic excited by the sudden irruption of the epidem-



              YANDELL on Spasmodic Cholera.           ;

ic, when all had been deemed so safe, was as great as could
easily be  conceived.  Many of the citizens fled from
their homes. Some believed it contagious, and kept aloof
from their neighbors. During the gloomiest period of the
epidemic, the streets seemed deserted. Even the market
house, on market days, presented a picture of desolation,
and but for the energy of the City Authorities, and the en-
terprize of some philanthropic citizens, famine must have
been added to the sufferings of many poor families.
  In this state of things, when there were in the city pro-
bably a thousand sick, dispersed in all directions, and
when the greater number of attacks came on at night,
many persons were inevitably neglected. At one period,
when the disease was most violent, and time, consequently,
most precious, it was almost impossible to End a physician
after night. Many were therefore obliged to wait until
morning, when too often they had reached a hopeless con-
dition. If to those who suffered in this way, we add the ig-
norant who were little acquainted with the early symptoms
or the danger of the disease, and the indigent who could
command neither nurses, nor messengers to send for a physi-
cian in time, we have a very large class for whom it may
be said the resources of the profession were as nothing.
In looking over the list of the victims of cholera, it
is impossible to resist the conclusion that this was one of
the chief causes ofits mortality; and I may add, that, with a
hospital, where the poor might have received prompt medi-
cal aid, and suitable nursing, and if the panic had been less,
and citizens had always stood by, and encouraged, and assist-
ed each other, the issue of many cases, perhaps the gene-
ral issue of the epidemic itself, might have been different
from what it was.
  Nevertheless, the influence of such causes may be exagger-
ated. The mortality of the disease probably depends more
after all upon its intrinsic virulence, than upon any such ad-
ventitious circumstances.


YANDELL on Spasmodic Cholera.

  It is common to speak of the epidemic as having, in this
city, disregarded character and condition, and invaded all
classes of the community indiscriminately. I have examin-
ed the list of those who died during the first three weeks
with special reference to this subject, and have come to a
different conclusion. The number reported by the gentle-
men who were at the trouble of visiting all the houses, is 381.
Of these, 25 were lunatics, at the Asylum, 168 blacks, and
188 whites. It is unnecessary to speak of the liability of
the first class to attacks of cholera. It is not too much to
say, that there is every thing in their situation to predispose
to it. The habits and condition of the black population in
every country are much alike, and well known. Bond and free,
they are generally filthy and careless, poor, and ignorant, and in
want of many of the comforts of life, and nearly always
live in low, damp, or ill ventilated houses. There are few
exceptions to this rule. Thus more than half the victims
were of the class who have been the great sufferers from
cholera in all countries. From their own neglect in the first
instance, and the difficulty of affording them the necessary
aid afterwards, a large proportion of them when overtaken by
the disease inevitably perish. Of the remaining number it
may be affirmed, that few were free from some of the causes
which strongly predispose to the disease. A great majority
were either infirm from other affections, or old age, intemperate
in the use of ardent spirits, or guilty of some excess, in eating,
exercise, S/c. immediately before their attack. The three
physicians who fell its victims had labored by night and by
day, as well as neglected the early symptoms of their dis-
ease. The few robust young persons who died were general-
ly able to trace their attack to some indiscretion. And with
all the general abundance of the land, it must be admitted
that many of the whites themselves were badly fed, and
miserably lodged-in low, crowded houses, surrounded by
filth, and supplied with few of the comforts which the sick
require. I saw an amount of squalid wretchedness during
the prevalence of the epidemic, which I could hardly have



YANDELL on Spasmodic Cholera.

believed to exist in the midst of such general affluence. If
we subtract from the above number those who were invalids
from other disorders, those who were peculiarly exposed
from the nature of their calling, those who were intemperate,
orgrossly imprudent in diet, as well as the aged,the excessively
indigent, and the subjects of inordinate fear, but a small
number will remain. That any should be left out of all
these classes, is evidence of the malignant character assumed
by the disease in this place.
  Few children died. The list referred to includes but 10
or 11. Of the sexes nearly an equal number suffered. The
small excess of males may be attributed, in part, to the hands
engaged in the various rope and bagging factories. It can-
not be said that the drunkards were principal sufferers, al-
though some of them were among the early victims of the
pestilence. It will not, however, be denied that they suffered
ina much greater proportion than the opposite classofsociety.
They were, perhaps, on a par with those whose systems were
enfeebled by any other cause.
  The symptoms of cholera have been so often described,
that no one can be at a loss in recognizing it. It is not
however, uniform in the manner of its access. In some cases,
perhaps a majority, patients felt indisposed for a day or so
before the disease, was fully developed. The head was of-
ten confused, and a feeling of giddiness was experienced.
In some, there were unpleasant sensations in the lower ex-
tremities, as of a tendency to cramps, c. The stomach and
bowels were flatulent, and many complained of a burn-
ing sensation in them, and of pains darting through the ab
domen. But in most instances these slight symptoms disap-
peared in a few days without being followed by any thing
more serious; and in very many instances persons in the
enjoyment of their usual health were seized with profuse
diarrhoea without the occurrence of any previous disorder.
Whenever diarrhoea came on, there was generally but little
doubt as to the character of the malady. It was not, as in
many other places, a premonitorty symptom, continuing a day



YANDELL on Spasmodic Cholera.

or two before the access of more formidable symptoms, but
the disease itself, in its first stage. It is true, that in a few
instances, it ran on for one or two days without the super-
vention of spasms, coldness and collapse. But this was not
the usual course of things. In nearly every bad case, after
a few copious discharges of water tinged with faeces, the
characteristic rice water passages appeared, which were
soon followed by spasms, more or less general, pulseless wrists,
cold, shrivelled skin, attenuated voice, and finally, death.
Such was the order in which the symptoms appeared when
the case had been trusted to nature-too often, in spite of all
the resources of art. Seized, as many were, at night, when
medical aid could not be procured, it was not uncommon to
find them in the extremity of the disease when visited by the
physician for the first time. It was hazardous to allow
the diarrhcea to run on for a single hour. Very often, in
that time, indeed, the patient was sinking, and hence the on-
ly safety consisted in treating every case of diarrhoea, as one
of cholera. If this truth could have been impressed early
upon the minds of all the people, there can be no doubt that
numbers, who perished through neglect of the disease; might
have been saved. In confirmation of this, it has been re-
marked, that few negroes, comparatively, died at the factories,
because masters and overseers were on the alert to detect
and meet the first indications of the disorder. And yet it
is known, that about such establishments there are all the
circumstances to excite the disease in its most malignant
  Vomiting was only an occasional symptom, occurring, in
my practice, about once in twenty times. In many of the
worst cases the stomach was not at all disturbed. The
tongue at first was generally natural, or covered with a white
slime. The pulse was most generally either small and fre-
quent, or slow and laboring, but inmany cases itwasbutslight
ly affected until the vital powers began to decline. In no in-
stance did I find it tense or hard, at the commencement of
the disease. The temperature of the skin was generally


YANDELL on Spasmodic Cholera.

below the healthy standard; the countenance pale and anx-
ious.  But one of the most striking phenomena in the
disease, was the natural appearance of the patient, and
the unaltered state of many of the principal functions,
there being often no complaint made of acute pain,
except of cramps, and little indication of disease, except in
the disturbance of the bowels. Where the suffering was
most acute there was often least danger; and those were the
most alarming cases where the patient complained only ot op-
pression about the prwecordia, frequent watery discharges with-
out pain, and rapidly declining strength. In negroes it was
not uncommon, after a continuance of such discharges for
five or six hours, without acute pain in any part, and
without any previous indisposition, for spasms to come
on suddenly, followed by cold sweats, shrivelled hands,
and all the symptoms of collapse. It was less common among
white persons. They generally made more complaint, and
were oftener affected with nausea. In a word, whatever the
cause may be, their sufferings in the disease seemed to be
more acute.
  It was a mistake often fatal to patients, that, while their
evacuations retained their fiecal character, however watery,
they did not labor under cholera. From the nature of the
case, the first discharges were filled with the contents of the
bowels, and it was not until they were washed out that the
peculiar rice water appearance was presented. By this time,
the disease had made considerable progress. The strength
had generally begun to sink, and the patient often fell into
collapse before medicine could change the nature of the dis-
charges. The issue, however, was often more favorable, for
although when the rice water discharges had appeared, the
disease was for the most part far advanced, the proper treat-
ment at this period often arrested the complaint. It was
always a stage of imminent danger, which might oftener have
been prevented had people been aware how closely it fol-
lowed the first intimation of diarrhoea.



YANDELL on Spasmodic Cholera.

  In laying down the treatment which I pursued, and should
recommend in cholera, 1 am aware that I shall differ from
many of the profession. Where plans have been so various,
and often so contradictory, it is impossible to give satisfaction
to the advocates of all. In no country, perhaps, have the
extremes into which practitioners have run, been greater
than in our own, and each party, as is natural, has the most
unbounded confidence in its own method. By some, the salt
emetic is recommended as almost infallible in the disease,
while others proscribe emetics altogether, as unsafe if not
injurious, and at the same time, indicate some other system
which they have found unfailing. Thus, it is not difficult
to find numerous infallible cures for cholera, announced in
the journals of the west, while the disease has been marked
in its progress by a frightful mortality. For myself, having
witnessed most of these plans, I am obliged to confess that
I have seen them all fail. That they have been attended
with better success in other places, I cannot for a moment
doubt, and this only confirms the truth of what has been of-
ten remarked of cholera, that it is an ever-varying disease,
in point of violence, sweeping over some places with
the fury of a tornado, while it passes over others with the
gentleness of a summer breeze. It is only in this way that
I can understand the various results of the same remedy in
different places. And it has at least impressed upon me this
useful lesson-to be slow in condemning a practice which I
have not tried, or which has not succeeded in my hands-a
lesson which the history of medicine ought long since to
have taught practitioners.
  Cholera may be divided into three stages, with refer-
ence to the treatment. Thefirstis the stage of fmcal diarrhiea;
2nd, that in which rice water discharges and cramps are the
prominent symptoms; and 3d, the stage of collapse. In
those cases where the disease does not progress with extraor-
dinary vehemence, these stages arepretty clearly marked:
but in its most malignant form, the patient is precipitated.
almost from the commencement, into the last fatal stage.



YANDELL on Spasmodic Cholera.

The diarrhoea has scarcely made its appearance before spasms
supervene, and the whole train of symptoms characterizing
collapse are ushered in. In these cases, it is scarcely neces-
sary to add, the issue is nearly always fatal.
  Treatment in the first stage. In this stage the only disorder
of which the patient complains is disturbance of the bowels,
with occasional nausea, and giddiness. This looseness of
the bowels has been often mentioned by writers on cholera,
as a premonitory symptom of the disease, which generally
preceded it from one to five days. As the disease prevailed
here, it constituted the initiatory stage, which was generally
followed in a few hours, or at most a day, by the more une-
qluivcacal symptoms. A premonition it was,so far as the mild
stage of an affection may be considered as warning of the
more aggravated stages which are about coming on. The
treatment in this stage consisted, first, in confining the patient
to his bed, and enjoining strict rest. This was an impor-
tant preliminary. Dr. Rush has said, "the quickest and most
effectual way of conquering fever, is by an early submission to
it;" and the remark is equally true of cholera. With rest,
and attention to keeping the skin warm, a single dose of
calomel was, in most cases, sufficient to effect a cure. I gene-
rally gave at the first dose 20 grains. If it was found that
the looseness grew worse after the first dose, I repeated it in
an hour or two, and then the dose was increased to 60 grains.
I never considered it safe to trust to the first dose beyond
two or three hours, if the watery discharges increased in
frequency or became more copious, and when the access had
been sudden and violent, I gave at once 60 grains of calomel,
followed by 120 in a few hours, if the first did not check the
discharges. This effect, I had the satisfaction to find, a
large dose of calomel generally produced, and hence only in
a few instances did I combine opium with it. In this way
I seldom failed to relieve the patient in a few hours, when
called in at this stage of the disease. The calomel promptly
arrested the watery passages in most cases, and dark green,
consistent matter followed in a short time. When this state



YANDELL on Spasmodic Cholera.

of things was brought about, the patient felt relieved, and
was considered safe, and if he did not expose himself too
soon to the sun, or commit some excess in eating, gave his
physician no farther concern.
  To a number of my first patients I administered an emetic
before giving calomel. I employed warm salt and water,
with the addition, occasionally, of ipecac, or mustard, a tumrn
bier full at a time, repeated every minute or two, until the
effect was produced. It was always desirable that free vom-
iting should take place in the course of fifteen minutes, and
that the operation should be soon over. Slow, imperfect
emesis produced not the desired effect. and the consequences
of a large quantity of salt water being carried into the bowels,
as they could hardly have failed to be injurious. were care-
fully avoided.  If the patient had just taken a meal the
emetic had the effect of dislodging the undigested food; but
the effect aimed at in the administration of this remedy was
beyond this. It has been mentioned that the pulse was uni'
formly below par, the skin cold, and bedewed with perspira-
tion, and the countenance pale and haggard, all which symp-
toms evidenced a deep-seated congestion. Whatever the
original injury done to other organs, the heart seemed strug-
gling with an unequal load. There was a disturbance in
the balance of the circulation. The blood had retreated
from the surface, and accumulated in the large veins of the
interior. Such, at least, was the condition of the system,
conveyed to my mind by the phenomena of the disease; and
as there was usually no irritability of the stomach to forbid
it, the emetic was given for the two-fold purpose of preparing
the stomach for the reception of calomel, and giving a salu-
tary impulse to the circulation. The skin generally grew
warm under its operation, a profuse perspiration broke out,
and the pulse became full and natural. When administered
at a more advanced stage of the disease, I have seen emetics
relieve the spasms promptly. I have given them with advan-
tage, upon the occurrence of spasms, several hours after calo-
inel had been taken, but before it had operated. I may



YANDELL on Spasmodic Cholera.

add, however, that I ceased to use them so generally after
the first weeks of the epidemic, without finding the result of
my practice less satisfactory.
  Upon the whole, therefore, while 1 regard emetics as sal-
utary in certain conditions of the system, my experience
does not warrant me in concluding that they are indispensa-
ble to the cure, much less, that they possess that perfect con-
trol over the disease which they seemed to have in the hands
of a few physicians in other places. Nor have I witnessed
any of those effects which are so much dreaded by many
others, and which are said occasionally to result from their
operation. I can only give my own experience. I have
found them often efficient, and always safe. That they have
always proved so, when administered indiscriminately, or by
ignorant persons, I do not venture to affirm. Cases have
been mentioned to me, I feel bound to confess, in which,
from being injudiciously given, perhaps, they operated slow-
ly, and with difficulty, producing great nausea and prostration,
and appearing to contribute to the rapid march of the disease.
  Every where, cholera in this stage has been consider-
ed a curable disease. The profession have labored to im-
press upon the people the importance of arresting it here.
And certain it is, that when allowed to go further,
all plans of treatment have been too often unavail-
ing. The success attending the treatment in this stage
will depend upon the disposition of the disease to hasten in-
to the succeeding one. If it lingers in this for a day or two,
there is comparatively little danger of a failure. If taken
at the onset, eight or ten hours may be a-sufficient period
for checking it. But where the transition is more sudden,
the patient may be in collapse before the medicine given has
had time to operate, and here, however promptly met, the
case generally issues in death. Such must be the general
result of those cases where collapse succeeds immediately to
diarrhcea-unusual cases it is true, but yet occurring so of-
ten, in the truly epidemic form of the disease, as always
greatly to swell its mortality. Every physician had more orI



YANDELL on Spasmodic Cholera.

less to do with such cases during the raging of the epidemic
in this place.
  2d Stage.-The first stage, it has been remarked, is one of
comparatively little suffering. The patient may feel some
burning or pain in his stomach and bowels, slight nausea, a
sense of oppression about the pracordia, giddiness, c. But
in most cases, he is able to go about, and would not consider
himself indisposed, but for the presence of the profuse diar-
rhoea. With the coming on of the second stage, the urgency
of all the symptoms is increased. The discharges have now
assumed the appearance, so often described, and so charac-
teristic of cholera-of dirty rice water. Spasms are felt in
the extremities, the skin is covered with a profuse perspiration.
and acute pains occur in different parts of the body.
"Called, for the first time, to a patient with these symptoms,
when I did not deem the salt emetic advisable, I gave, at
lirst 60 grains of calomel, and in an hour or two, according
to the urgency of the case, 120 more. In my own case,
when attacked with considerable severity, 1 took this quanti-
ty in less than three hours, after taking an emetic. And in
some very violent cases, I even transcended these doses. To
one patient, in whose case vomiting was a distressing symp-
tom, and who was cramped in almost every muscle, I gave
an ounce at three doses. I saw her at 1 o'clock, when she
had labored tinder the disease 24 hours. The rice water pas-
sages were copious and frequent. She was exhausted, and
nearly pulseless. I gave her 120 grains of calomel, ordered
cold drinks, with mustard to the epigastrium. At 6 o'clock
when I visited her again, all the symptoms were aggravated.
I then gave her 135 grains, and in a few minutes a similar
dose, as she almost immediately vomited, and it was suppos-
ed, probably threw up a portion of the -first. In the course of
the night the character of the stools was changed. She
continued to pass dark, green matter for 48 hours. and re-
covered rapidly, with scarcely a slight salivation. Besides
calomel, on account of the distressing vomiting, this patient
T-ook laudanum for a few hours. It did not. however, sensi-



YANDELL on Spasmodic Cholera.

bly check the discharges, or allay the vomiting. These were
only relieved by the operation of the calomel.
  In spite of our remedies, though given on the accession of
the first symptoms, the disease very often ran on into this
stage. Under these circumstances there was always cause
to apprehend the near approach of collapse, and hence it was
important to arrest it as speedily as possible. And as my
chief reliance was upon calomel, I gave it always in increas-
ed doses-from 60 to 120 grains, and repeated it according
to circumstances,every two or three hours. A frequent le-
petition was, however, not often demanded, the patient be-
ing either relieved or dead in a few hours after the access of
this stage. In a few cases I repeated the emetic at this
juncture, before administering calomel, with the effect of
relieving the spasms.
  By this course 1 generally succeeded, and my confidence
in it is such, that under the same circumstances, I should re-
sort to it again. As I kept no register of cases, I can only
state the result of my practice in general terms, and I may
add that where I failed, it was generally because application
had been too long delayed, or from age, or other infirmity
the patient sunk under the attack before medicine could
make an impression. This statement is made, without any
disposition to boast, as a part of the history of the epidemic
of which I am writing. The disease would be more appall
ing than it is, if the resources of our art, timely applied, did
not generally give relief. But owing to the causes specified
-the negligence, or ignorance, or feebleness of too many
of the subjects of the disease, a number were far gone in
collapse, and some in articulo mortis, before I saw them.
   In addition to the remedies already mentioned, I generally
directed mustard poultices to the extremities, where they
were disposed to grow cold. It was also necessary to employ
rubbing when there were spasms. If vomiting existed,
mustard was likewise applied over the epigastrium, and laud-
anum given, or ice, or iced water, or lemonade, which I
believe was more effectual than the opiate  It was a



YANDELL on Spasmodic Cholera.

most grateful remedy to the patient, and in my experience,
always h