Cholera is a disease whose causes are as inscrutable as are those of epidemic measles or influenza; and we might congratulate ourselves if its treatment was but half so well understood. It is our misfortune, and the misfortune of the world (for it is probable that ere long we may be obliged to search for the spot which it has not visited,) that its course is too rapid and too terrific, and its symptoms bear too great a resemblance to those which in all congestive fevers, immediately precede death, to enable us calmly to contemplate its characters. Our care is not to cure a disease, if I may so speak, but to snatch the patient from the jaws of a death which appears to be inevitable, by means the most obvious, or the most convenient to apply. That a disease which for twenty years has ravaged the fairest portions of the world; whose victims are as numerous as the sands on the sea-beach; whose march has been rapid as the shadow of the sun-dial, and which has clothed in sackcloth every city, village and hamlet through which it has passed, should at this day, and after such multitudinous experience, be as ruthless, as remorseless and as fatal as when it first appeared on the plains of India, is a problem the solution of which must stagger all the philosopy of medicine. Perhaps no epidemic which has ever afflicted the human family has received a larger share of attention from the medical professión. It may be reasonably estimated that more than a thousand different physicians in Asia, Europe and America have attempted to write its history, and transcribe their own experience, and to this hour, for all practical uses, the greater part are utterly valueless, certainly for all the purposes of prevention, and I had almost said, as guides in its medical treatment. Writers have been disposed to speculate on its remote causes în place of seizing on its proximate effects, although with the remote causes not only of this, but of all other general epidemics we can know nothing which we can apply to any practical use. This epidemic possesses a character which has hitherto defied all the researches of philosophy, and with our present measure of information respecting such diseases, it is scarcely to be presumed that we could possess the means to prevent it if our resources were so extensive as to be limited only by the measure of possibility. Who, in the exercise of his senses, would pretend to arrest the march of influenza or measles? and yet those diseases have been known and described two thousand years ago. We may as well confess our ignorance at first as well as at last; the most intelligent physician or natural philosopher knows no more of their causes

than the peasant or the artizan; the only difference between them is, that the one can conceal his ignorance in terms of science, while the other is obliged of necessity to confess it. It has been called an atmospheric disease, a disease arising from telluric exhalation, a disease resulting from a depraved state of the air we breathe, from a deficiency of electricity; and for all the information derived from these speculations, it might as well, and perhaps with as much propriety, be imputed to the influence of magnetism. In truth, we know nothing about its cause, and can know nothing with certainty, and we are compelled to confine our views to its effects. Our most accurate analysis of gaseous agents teach very little on the subject of marsh miasmata; we believe them to be causes of fever; but why these causes should produce fever of an intermittent type in one case, a remittent in another, a dysentery in a third and endemic cholera in a fourth, is still a secret to the wisest.

But if we are fated to be ignorant of its original, we are not devoted to destruction from its influence; that cause, be it what it may, is known to act with more or less intensity, as causes which we in a measure can control, co-operate with its agency. Heat, moisture and accumulations of putrescent materials are known to increase its malignity, either by adding to its virulence, or by inducing a predisposition to be affected by it; and against the known results of these any many other circumstances, subsidiary to the spread of epidemics, it is our business to guard rather than spend our strength in fruitless attempts to ascertain that which when known could add nothing to our stock of preventive measures.

Cholera is the most remarkable plague known in the annals of history, and although it is only within the last twenty years that it has attracted special attention, there is abundant evidence to prove that it is no new disease. More than two hundred years ago, (1629,) it, or a disease so similar as with difficulty to be distinguished from it, has been described as an epidemic in equinoctial India, (Java); and at various periods, according to the reports of the Bengal and Madras medical boards, it has been epidemic in almost every section of those extensive presidencies, where causes known to be favorable to the spread of diseases presumed to arise from marsh miasm most abound. Its course in some of its visitations, is described as inconceivably rapid, its victims submitting to the stroke of death "by hundreds and at an hour's notice;" the

time of its continuance in many cases being so short as to prevent the evolution of a train of symptoms by which it could be marked.

While its ravages were confined to India and its islands, and its range was restricted within limits which marked the natural home of pestilence; as it seemed to have no terror for the European, so it scarcely attracted any more attention than mere curiosity would excite; but when it assumed the character of a migrating epidemic; when passing over land in a northwestern direction it entered Europe, and following the course of the great rivers, left its pathway inarked by desolation and death, until it reached Petersburgh, and thence spread its terrors in almost every known direction; then it was that it became a subject of thrilling interest to all who by their contiguity, or by their commercial relations considered themselves endangered by its influence. England, France and Germany took the alarm, and sent special commissions to the various seats of pestilence in order to learn its history and the most successful method of its treatment, and the results which have been given to the world have been more calculated to create alarm than to calm the apprehensions which prompted these precautionary measures.

In the spring of 1832, it made its appearance in Quebec, in Lower Canada, and thence travelled in directions west and south, reaching this city in the latter part of June. The first case known to have the character of the disease terminated fatally on the 29th of that month, and although its existence was denied on the 2d day of July, evidence which neither skepticism nor interest could resist, was furnished on the 3d; and from that day onward till the first of September, was emphatically the reign of the most awful pestilence ever known in this city. In July the number of deaths was 1,797; in August, 1,232; in September, 451; and in October, 53; making a total of 3,513, in the short period of one hundred days.

It is a remarkable feature in the history of this disease, that although its worst form has been described a thousand times, and with an accuracy which defies criticism, it has not been in the least degree divested of its terrors: its treatment is as much now as at any former period empirical: physicians who are called to treat it, are in truth obliged to contend "with death on the confines of the grve," their only business being to arrest the march of the de

stroyer, by preserving life enough in the patient to give an opportunity for the exhibition of remedies.

I have said that the disease in its worst form has been frequently described. I should rather have said, in its worst stage; and it is needless here to detail the symptoms, "they are as familiar as household words." No man who has seen them can ever forget them, and none who have heard without having seen will require to have them repeated! The exhausting serous diarrhoea, the cold clammy sweats, the scarcely to be detected pulse, the cold tongue, the icy breath, the corrugated and blue-bleached hands and feet, and the painful spasms which precede and accompany them, are not more the evidences of disease than they are the premonitions of death, and especially mark the character of cholera in tropical climates, where causes auxiliary to the reigning agent, be that what it may, exist in a degree unknown in more northern and generally more salubrious latitudes. My own belief, and I trust that upon a full and calm examination I shall be found in a majority, is that the above symptoms, as they are the worst, so they are the last which make their appearance in this terrific plague. The cause ordinarily is operating in our latitudes for days and weeks. before disease manifests itself with these awful symptoms, and those conditions of the system which physicians have been pleased to term premonitory symptoms, is in truth the disease itself. Then it is that medicines may be remedial in fact, and strange to say, this stage is almost always overlooked, or treated as of little consequence. As the evidences of sickness are not generally in this early stage painfully present, being occasional unpleasant sensations in the muscles of the arms and thighs, a capricious state of the bowels, sometimes loose, at others costive, unattended by pain, they are readily explained by some irregularity in diet or regimen; they create no alarm, nay, they may from time to time be repeated without exciting any apprehension; there may be a constant disposition to sigh, and an occasional sense of fulness in the region of the chest, and still no alarm is manifested, for the patient is still able to attend to his or her ordinary business: these symptoms, notwithstanding, are sure evidences of diseased action, and their frequent recurrence may eventuate at an hour's notice in that awful condition of the subject which points with unerring certainty to the grave. If it be objected that in many instances there are no such symptoms as above described, I will readily allow it, knowing it to be generally true in tropical countries, and measura

bly so in this; but the reasons why they are not present may be the same in both. Asiatic cholera, and cholera as it has appeared in this country and in Europe, differ only in degree: the disease is essentially the same. In the first case, the auxiliary causes operate universally on all subjects: the exceptions are those in which premonitions exist, whereas in the last, the exceptions are those in which they do not obtain. In the one, the enervating influence of a tropical sun; the presence of marsh miasmata; the diurnal variations in the temperature of the atmosphere; the manner of living adopted by necessity, which in a great measure forbids the indulgence in animal food; and the excesses to which the rich are invited in some cases, by the restraints imposed upon them in others, all co-operate to create a predisposition to disease from epidemic causes, from which the inhabitants of more northern countries are exempt; and if the cause operates only with the same measure of intensity, it operates on constitutions so enfeebled as to be unable to resist its first attack, and by natural consequence it is followed by a train of symptoms which speedily terminate in death."

That the disease does frequently attack without warning in this country; that its access was occasionally as sudden and as violent in Petersburgh, in Paris, in Quebec, Montreal and New-York, as in India or any other tropical country, may be explained by the fact, that in all large cities, no matter where situated, there is always a large population who hold their lives on a very precarious tenure. The life of the destitute poor and the dissolutely vicious is of this character; their irregularity of living, to say nothing of the evils of intemperance, is calculated to make them the fit recipients of disease, let it present in what form it may; they are especially the first victims of all epidemics; and when we add the degrading and the debasing effects of ardent spirits in excess, the want of prudence, the want of cleanliness, their utter recklessness of consequence, and their contempt of or deafness to the dictates of common reason, is it to be wondered at that this disease should occasionally attack without warning? Are not such persons always predisposed? I hope that I may be excused for insisting on the position that the symptoms usually termed premonitory are those which mark the disease with as much certainty as those which immediately precede death, because I purpose to suggest a measure calculated to mitigate its severity, founded on this circumstance. The fact accords with my own experience and that of most of the