Note: When this article was written, the author was convinced that natural conditions at Lexington coupled with vigilent medical supervision would save the city from a true cholera epidemic. The following year, cholera swept through the city, killing a large number of residents.
Art. IV.--Notice of the Diseases of the Summer and Fall of 1832. By
Lunsford P. Yandell, M.D.
Transylvania Journal of Medicine, 1832, V. 5: No. 4, pages 500-506.
Transcribed from Microfilm Series S-2, University of Kentucky Libraries, Lexington, Fayette County, Kentucky by Pam Brinegar, September 1999.
During the present year a greater variety of diseases than usual have prevailed in Lexington. Influenza and measles were epidemic in December and January, as mentioned in a former number of this work. In April three fatal cases of scarlet fever occurred in a family on Hill street; and in July and august this disease became general, attacking and killing many children here; and in the country and neighboring towns. A few adults also dies of the complaint, with symptoms, in some cases, resembling cholera. It has not yet* entirely disappeared.
When the disease terminated fatally it did so generally in three days, and in most instances as the result of gangrene of the throat. Inflammation of the brain supervened in some cases.
The remedies which succeeded best in the treatment of the diseases were emetics and calomel, preceded by bloodletting where the arterial excitement was high. Ipecacuan, administered in such doses as excited vomiting, and repeat-
ed occasionally through the day, produced the best effects. The calomel was repeated from day to day, so as to keep up free purging. Cold water was applied to the head and face with the mitigation of fever and restlessness in some instances; and the tepid bath was used in a majority of cases with marked benefit. The usual stimulating gargles evidently increased the inflammation of the throat, and in some instances, probably, hastened mortification.
Towards the latter end of June a disposition to bowel complaints manifested itself among the citizens, and for several weeks almost everyone complained of a want of appetite, indigestion, and other signs of gastric and intestinal derangement. In some instances vomiting attended, and such other symptoms as required medicine, but generally they yielded to abstinence and rest. Early in September these affections disappeared. They were generally regarded as precursors of cholera, which at the time was raging in New York and elsewhere, and consequently occasioned much uneasiness.
During the prevalence of these complaints the weather was peculiar. In all the month of June it rained but twice. July was dry until the 20th, when there was a copious fall of rain. But during this whole period, and throughout the month of August, there was very little thunder and lightening. When the rain came on, it was not preceded by the usual electrical phenomena. the clouds seemed dead, and although they frequently hung over us for days together, but little rain fell.
On the 9th of October Dr. Drake announced in the public newspapers that cholera had appeared in Cincinnati. At first it was discredited by the Sanitary Board and the citizens generally, but a few days removed all doubts. The disease spread with terrific rapidity, and in a short time was in every quarter of the city. It was attended with a fatality which had not been equalled in any part of our country, and in but a few places in the world. "It attacked indiscriminately persons of all grades, temperaments and habits of life; and if the rich and temperate suffered less than the poor, the drunken and the exposed, it was not from any immunity
against the disease, but from their more carefully watching its first approaches, and from the first stage being milder in its character, and of longer duration."*
On the 26th of October Dr. Drake writes, "Twenty-seven days have now elapsed since the onset of the pestilence, during which period the whole number of deaths, as far as it has been ascertained is 351. The greatest number of deaths was from noon on the 19th to noon on the 20th, and amounted to 42, or one out of every six hundred inhabitants actually in the city at the time. Since that day, the mortality has slowly diminished."
About the same time, the disease appeared in Louisville, but did not spread to the same extent, nor commit such ravages. It was confined to the banks of the Ohio, and the Beargrass, (a creek which empties into the Ohio at this point,) not extending to the healthy portions of the city. In a letter to the writer, Dr. Declary remarks, "On Bear-grass, at the point where the Bardstown road crosses it, out of three families consisting of seventeen persons, nine fell victims to its ravages in a few days. At Farmington the seat of Judge Speed, I attended a number of his negroes and several white men under his employ. In front of his house the ground was low and wet, through which a ditch had been cut. Upon the margin of this ditch a stable had been erected, but later this had been converted into a dwelling house for some of the work hands. Two dissipated labourers had occupied it, both of whom had diarrhea, the first neglected himself and became the victim of cholera, the other soon followed. Two negroes who waited upon them as well as a young gentleman of the family, were seized, the two former of whom died. Three other deaths followed in the space of thirty-six hours; and a whole family of eighty persons, were more or less under a cholera predisposition, but were cured by timely attention. In Portland, near Louisville, its ravages were
*Western Journal of the Med. & Phys. Sciences, Vol. 6, p. 267.
great. Along the river, and Bear-grass, in one or two points of the Pond settlement, its fatality was truly appalling."
The mortality of this city never became great, seven a day being about the average number of deaths reported by the Board of Health, while the disease was at its height.
The pestilence made its appearance in Frankfort about the 6th of November, and in a population not exceeding 2500, five died in the first forty-eight hours. The severity of the onset induced a belief that it would rage in that place with uncommon violence; but at abated almost at once, and disappeared in a few days without doing much farther mischief.
Lexington was visited by the disease about the same time. A negro died on the 6th with what was considered by his physicians cholera spasmodica. Other cases occurred on the 8th and 9th, of which two terminated fatally. On the morning of the 9th, William Hutchinson, an engineer by trade, of laborious habits, but very poor, was attacked with diarrhea immediately after breakfast. The morning was cold, and he had been exposed, after being heated over the engine, n this clothing. After having had a number of very copious rice-water passages, he set out to get medical advice, and walked more than half a mile. He was ordered 20 grs. calomel, with a grain of opium, and to take to his bed. At 2 o'clock I saw him, when he seemed comfortable, having had but a few passages after taking the calomel, his skin being warm and moist, and the slight spasms, with which he had been seized, having left him. About an hour afterwards he had a most copious evacuation of dirty rice-water, after which he was greatly exhausted, and the spasms returned with increasing violence. The discharges continued from his bowels, and when I visited him at 5 o'clock I found him in a state of collapse, with pulseless wrists, purple, cold skin, and complaining of blindness. wine was administered freely, and calomel given in 60 grain doses, repeated at intervals of two hours, till 12 o'clock. His pulse as restored at his wrist, and the warmth of his skin returned. He died the next morn-
ing at 8 o'clock. One or two men died on this day and the next, when the disease abated. No fatal cases occurred after the 11th, and in a few days even mild cases ceased to be presented. In all, but five persons died of the disease--two white men and three negroes.
The pestilence has showed itself in most of the towns along the Ohio, from Pittsburg to the mouth, as well as in St. Louis, on the Mississippi, and has traveled down that river to New-Orleans, where the reported mortality has been truly appalling. As many as two hundred a day are said to have died for several days, out of a population not exceeding at this time, forty thousand souls. The latest accounts state that the scourge is subsiding.
Such is a brief outline of the epidemic as it has appeared in the West.
1. The disease has appeared only in places favorable to the production of malaria, and in which bilious diseases occur. In Cincinnati, owing to the extensive inundation during the winter, it was predicted that the disease would make its appearance. In Louisville it confined itself to the banks of the river and the creek. Frankfort is situated in a deep valley, surrounded by hills, and immediately on the banks of the Kentucky river. In Lexington all the cases originated in one quarter; namely, near the margin of the small stream which runs through the city, into which all the sewers empty, and along which the rail road runs, the hands of which furnished two of the cases. Maysville is subjected to the same causes, in a milder degree, which operated so disastrously upon Cincinnati; and Vicksburg, Natchez, and New-Orleans are proverbially subject to bilious diseases.
2. It was preceded, remotely, in all places where it has appeared, by diarrhea and other forms of gastric and intestinal derangement, and each individual attack followed in the wake of similar affectations, continued for a longer or shorter period. These premonitory symptoms preceded every case that occurred here--in most instances, several days--in a few, but five or six hours. The same is said to have been
the case in the neighboring cities where the pestilence has raged. And these symptoms were easily subdued. It rarely happened that those were attacked with spasms and the more aggravated symptoms of the disease, who took medicine shortly after being seized with diarrhea. Taken in its incipient stage, (which the diarrhea unquestionably is,) the experience of every place where it has appeared in America proves, it is cured with ease, and the utmost certainty. It is believed that one cause of the sudden and entire subsidence of the disease in this place, is to be found in the promptitude with which the citizens met and combatted these premonitory symptoms.
3. The treatment has not varied materially in any of the places where it has prevailed. The profession in the west, have relied upon calomel, emetics and blood-letting. Other remedies have been employed as auxiliary, and a few physicians may have adopted a different course, but these have constituted the leading articles in the plan of the most intelligent part of the profession. By some, calomel and bleeding have been relied on almost exclusively, while others have depended upon calomel and emetics, and a few upon calomel alone. External applications--warmth, blisters. &c. were used by all, in particular stages of the complaint.
Prof. Dudley generally gave emetics, and his experience was that they relieved the spasms, and recalled the pulse to the wrists, and restored heat to the surface. It some cases it was found necessary to give4 ipecac--the emetic employed--in very large doses to produce free vomiting.
4. With the appearance of cholera, it may be proper to remark, the bowel affections, which had been so general in the summer, but which had ceased on the approach of cold weather, returned, and were prevalent in every part of the city. But with this disease they also disappeared. A catarrhal fever has followed them, and scarlatina, after a partial subsidence has again broken out with perhaps as much violence as marked it during any time of the summer.
5. By the different practitioners of the city upwards of twen-
ty cases of cholera were reported in the stages of collapse, of which five or six only terminated fatally. This was treating the pestilence with uncommon success. In most places where it has appeared, nearly all the first cases were fatal ones. The first ten or fifteen who were attacked in Cincinnati, all died. Such was the fate of the first sufferers in Louisville. And it will be believed, which is no doubt true, that our marked success is attributable to the mild character which the disease assumed in this place. It never spread--it never got firm footing. The few well marked cases which presented, were traceable to the same origin, and were brought on by the same imprudence or exposure, and rendered fatal by similar neglect. With timely attention, we have reason to believe, the fatal issue in every instance might have been prevented.
6. In one case which the writer attended, the premonitory symptoms terminated in bilious fever, which lasted two weeks.
7. Much additional light has been thrown upon the character of cholera during its progress through the United States. the belief in its contagion, which had at one time a strong hold on the mind of the profession, has been utterly subverted. The stage of collapse (which is in truth a dying state) continues to be as unmanageable, perhaps, as it proved in India, but the premonitory symptoms have come to be so well understood, and are so easily removed, that this hopeless state of things may generally be prevented. In conclusion, those places which are exempt from the sources of miasm, and experiences little of bilious disease, have no great cause to apprehend the invasion of cholera, and when it has established itself in any place, the experience of the profession, now peculiarly full, may avail its citizens in mitigating its violence.