Report of the Committee of Internal Health on the Asiatic
Cholera, together with a Report of the City Physician of the
Cholera Hospital. Boston, 1849. 8vo. pp. 183.
The Report of the Committee of Internal Health, in Boston, is
a well written sketch of the condition of the city at the time it
commenced its labors, and of the measures adopted by it to pre-
pare for the visitation of the cholera, by a thorough investigation
of all the causes prejudicial to the public health, with the means
adopted for their removal. In this arduous work they W’ere ably
sustained by the physicians, and it is through their joint labors
that we are presented with a most complete and perspicuous ac-
count of the localities in which the cholera chiefly prevailed. A
number of excellent wood-cuts of the principal places in which it
exercised its ravages, and a ground plan of the city, accompany the
Report. We confess that, before reading this Report, we were
ignorant that, in so cleanly a city as is Boston, such abodes of
wretchedness as those described, could be found. We take the
following as an example ; it is a description of Half Moon Place,
“ probably the worst locality in the city.”
“ The houses are built around an area from which air is almost
totally excluded by the perpendicular wall of Fort Hill on one side,
and the lofty buildings of Broad street on the other. A large part
of the area is occupied by some twelve or fourteen privies, con-
stantly overflowing, and by ill-constructed and worn out sinks and
drains, into which are hourly thrown solid substances, of all sorts,
which choke them up, and cause the liquid parts mixed with them
to run over. Into the area there is a narrow entrance from Broad
street, whilst a steep and crazy stair-case affords a passage to Hum-
phrey place, some fifty feet above. Side by side with the stair-case,
and fully exposed, a large, square plank drain makes a precipitous
descent, conducting, half hidden, half revealed, not only the waste
water of the houses in Humphrey place, but also the contents of its
privies to the area below, which, as may be supposed, is redolent
of the fact.”
It can hardly be a matter of surprise, that the wretched tenants
of these filthy localities, were rapidly swept away by the merciless
epidemic. The City Hospital was established in this vicinity, but
it is stated that it did not itself become a focus of contagion, and
its immediate neighborhood having been completely purified,
escaped the epidemic entirely.
The medical report is drawn up by Dr. Clark, from the mate-
rials furnished by his colleagues and assistants ; the manner in
which it is executed, and the great number of interesting facts it
contains, reveal the most persevering industry on the part of these
gentlemen, especially that portion descriptive of the morbid ap-
pearances found after death. Too much praise cannot be awarded
them, for the great accuracy with which their autopsies were con-
ducted, in view of the all-engrossing duties of the staff of a
cholera hospital, and the negative results which it w7as anticipated
the examinations would yield. It must be owned that they afford
us little insight into the true nature of the disease, and still less do
they offer any indications for an appropriate treatment; neverthe-
less we would not undervalue the importance of any facts, fully
attested, however obscure their relations may at present be to us.
While, therefore, as is stated in the Report, the most remarkable
and constant appearances were, an unusual dryness and stickiness
of the serous membranes, a moderate tumefaction of Peyer’s
glands, and the “ glandulee solitariae,” and a shrivelled condition
of the spleen, and these may be probably regarded as characteristic
phenomena found only in cholera patients—we are not without
hope, that the mutual dependancy of symptoms and lesions may at
some day become more manifest than they are at present. It is
hardly possible that thirty-two carefully conducted autopsies of
cholera patients, shall not be of some value in the elucidation of
the disease, and have some indirect bearing upon its curative treat-
ment.
The results obtained by Dr. Clark and his colleagues agree
pretty closely with those arrived at by Dr. Gairdner of Edinburgh,
and which were quoted in the American Journal for October, 1849.
The absence of those appearances of congestion, so commonly
loosely assumed to exist in cholera, as well as of any viscidity of
the blood, the occurrence of ecchymoses in various parts, and par-
ticularly in the sub-mucous coat of the intestines, and the presence
of bile in the gall-bladder and sometimes in the intestines, as in
persons dying of other diseases, are all points which receive ample
confirmation from the reports of both observers. Dr. Clark differs,
however, from Dr. Gairdner, in his opinion that the abundance of
uninjured epithelium cells found floating in the intestinal fluids
after death from cholera, is due to a separation of the same by the
maceration of the mucous coat of the bowel. The only fact of
importance, alleged by him in support of this difference of opinion,
is, that the mucous surface of the vagina and of the bladder,
neither of which are, of course, subjected to maceration, are covered
uniformly with a “ thick white pasty or creamy secretion, which,
on microscopic examination, is seen to consist entirely of detached
epithelium cells, mostly perfect in shape and generally distinctly
nucleated.” While the question remains still sub judice, the im-
portant fact announced by Dr. Gairdner, “ that the true cholera
stools passed during life, contained so little perfect epithelium,
that it cannot be considered as anything more than an accidental
ingredient,” renders the idea very improbable, that the exfoliation
spoken of can play a very important part in the disease. The
reality of this exfoliation, (whether it be before or after dissolu-
tion,) is most clearly demonstrated by the injections of Dr. Neill,
presented to the museum of the College of Physicians of Philadel-
phia, with the Report of the Committee appointed by that body,
“ to examine into the condition of the mucous membrane of the
intestinal canal in persons dying of cholera.” In the language of
that Report, “ The epithelial layer of the intestinal mucous mem-
brane, was in all specimens either entirely removed, or was de-
tached, adhering loosely as a pulpy layer, mixed with mucous or
an albuminoid substance.” The tumefaction of the solitary and
Peyer’s glands was observed also by this committee as well as by
Dr. Clark. A very interesting case is related in Dr. Clark’s Re-
port, (p. 50,) of a patient who passed into the typhoid condition
so often following cholera, and died after it had lasted a week, or
from the invasion of the cholera, ten days. “ The patches of
Peyer, situated at the lower part of the ileum, were inflamed and
deeply ulcerated ; two of them showing an abundant deposit of
typhus matter, which projected into the intestinal cavity, like
loose, granular coagula.” The spleen, too, was engorged and
enlarged, and the remaining anatomical conditions were not dis-
similar from those found in spontaneous typhoid fever. If this
patient was really in health before he was attacked with cholera,
the case is certainly a most uncommon one, and deserved to be
given in more detail than it is presented to us.
The treatment pursued in the Hospital was very unsuccessful,
and that for the very evident reason which may be predicated of
all public hospitals in times of pestilence, viz. that the patients
were not brought in, until it was beyond the power of medicine to
be of any service to them. During a period of five months and a
half, two hundred and sixty-two patients were “ subjected to treat-
ment” of these one hundred and sixty-six died, and ninety-six re-
covered. “ Patients came in, so far gone in collapse, that we
expected them to die at any rate. With this feeling it was in
several instances judged best to give them no medical treatment,
but to let them follow their own inclinations. In no one case
where this practice was followed, did the patient recover.”
“ Apparent narcotism,” the Report says in another place, “ was
noticed in many of the fatal cases upon entrance. The patients
who exhibited this symptom had generally been many hours under
treatment before entrance, and from many of them we learnedJhat
excessive doses of opium had been taken. In most of these
patients there was a contracted pupil, not influenced by light or
darkness, stertorous breathing, difficulty of hearing, together with
the customary evacuations and occasional cramps. These appear-
ances were the more remarkable, because in the generality of fatal
cases, patients were decidedly active and intelligent until within a
short time of death, which in these cases was always the speedy re-
sult.
The Report gives a very discouraging view of the utility of
remedies. It condemns, either as useless or injurious, narcotics,
camphor, stimulants, calomel, emetics, quinia, astringents, aro-
matics and cathartics, ether, venous injections, external heat,
dry or moist, and “ packing” in the wet sheet. The only reme-
dies favorably spoken of, as palliatives, or useful at certain stages
of the disease, are the cold sponge baths, cold affusion, bleeding,
wood naphtha, and saline medicines. There is unfortunately no
comparative tabular or other statement given of the remedies
used in the cases which recovered, and those which died. The
medical staff of the Hospital must have been reduced to the verge
of despair by the inefficiency of their treatment, when they seri-
ously thought of trying the homoeopathic practice. But fortunately,
we think, “ no one of our number understood it, and notwith-
standing offers were made to several homoeopathic practitioners,
we could not find among those any who were willing to come
into the Hospital, upon equal terms, and take charge of an equal
number of patients with ourselves.” If the homoeopathic practi-
tioners have faith in their doctrine and are not afraid to reveal the
mysteries of their practice to the eyes of physicians, let them build
their own hospitals and practice their system on as many as may
voluntarily submit to it; but for our part, we must protest against
the spirit of weak liberality shown in the above instance. We
cannot but feel that it is derogatory to that love of truth which
should characterize the medical profession, to entrust human life
in the hands of those who practice an ephemeral folly, equally
irreconcileable with truth or common sense.
The numerous facts contained in these Reports, render them ex-
tremely valuable, and we therefore heartily commend them, especi-
ally to those interested in the study of the history of the late
epidemic.	M. S.