1452. This species of the disease is certainly a peculiar one, both in respect of its cause and its effects; but, as to the first, it has been lately so much the subject of investigation, and is so well ascertained by the learned physicians, Sir George Baker and Dr. Hardy, that it is unnecessary for me to say any thing of it here.

With respect to the cure of it, so far as it ap pears in the form of a colic, my want of expe. rience concerning it does not allow me to speak with any confidence on the subject; but, so far as I can learn from others, it appears to me, that it is to be treated by all the several means that I have proposed above for the cure of colic in general.

How far the peculiar effects of this disease are to be certainly foreseen and obviated, I have not properly learned; and I must leave the matter to be determined by those who have had sufficient experience in it.

CHAP. X.

OF THE CHOLERA,

1453. In this disease, a vomiting and purging concurring together, or frequently alternating with one another, are the chief symptoms. The matter

rejected beth upwards and downwards appears manifestly to consist chiefly of bile.

1454. From this last circumstance I conclude, that the disease depends upon an increased secre tion of bile, and its copious effusion into the ali mentary canal; and, as in this it irritates and excites the motions above mentioned, I infer that the bile thus effused in larger quantity is at the same time also of a more acrid quality. This appears likewise from the violent and very painful gripings that attend the disease, and which we can impute only to the violent spasmodic contractions of the intestines that take place here. These spasms are commonly communicated to the abdominal muscles, and very frequently to those of the extremities.

1455. In the manner now described, the disease frequently proceeds with great violence till the strength of the patient is greatly, and often suddenly, weakened; while a coldness of the extremities, cold sweats, and faintings, coming on, an end is put to the patient's life, sometimes in the course of one day. In other cases the disease is less violent, continues for a day or two, and then ceases by degrees; though such recoveries seldom happen without the assistance of remedies.

1456. The attacks of this disease are seldom accompanied with any symptoms of pyrexia; and

though, during the course of it, both the pulse and respiration are hurried and irregular, yet these symptoms are generally so entirely removed by the remedies that quiet the spasmodic affections peculiar to the disease, as to leave no ground for supposing that it had been accompanied by any proper pyrexia.

1457. This is a disease attending a very warm state of the air; and in very warm climates, it may perhaps appear at any time of the year; but even in such climates it is most frequent during their warmest seasons; and in temperate climates, it appears only in the warm seasons. 1: Dr. Sydenham considered the appearances of this disease in England to be confined to the month of August; but he himself observed it to appear sometimes towards the end of summer, when the season was unusually warm; and that, in proportion to the heat, the violence of the disease was greater. Others have observed that it appeared more early in sum, mer, and always sooner or later, according as the great heats sooner or later set in.

1458. From all theses circumstances, it is, I think, very evident that this disease is the effect of a warm atmosphere, producing some change in the state of the bile in the human body and the change may consist, either in the matter of the bile being rendered more acrid, and thereby fitted

to excite a more copious secretion; or, in the same matter its being prepared to pass off in larger quantity than usual,

1459. It has been remarked, that in warm climates and seasons, after extremely hot and dry weather, a fall of rain cooling the atmosphere seems especially to bring on this disease; and it is very probable, that an obstructed perspiration may have also a share in this, though it is also certain that the disease does appear when no change in the temperature of the air, nor any application of cold, have been observed.

1460. It is possible, that, in some cases, the heat of the season may give only a predisposition, and that the disease may be excited by certain ingesta or other causes; but it is equally certain, that the disease has occurred without any previous change or error, either in diet, or in the manner of life, that could be observed.

1461. The Nosologists have constituted a Genus under the title of Cholera, and under this have arranged as species every affection in which a vomiting and purging of any kind happened to concur. In many of these species, however, the matter evacuated is not bilious; nor does the evacuation proceed from any cause in the state of the atmosphere. Further, in many of these species

also, the vomiting which occurs is not an essential, but merely an accidental, symptom from the particular violence of the disease. The appellation of Cholera therefore should, in my opinion, be confined to the disease I have described above; which, by its peculiar cause, and perhaps also by its symptoms, is very different from all the other species that have been associated with it. I believe that all the other species arranged under the title of Cholera by Sauvages or Sagar, may be properly enough referred to the genus of Diarrhoea; which we are to treat of in the next chapter.

The distinction I have endeavoured to establish between the proper Cholera, and the other diseases that have sometimes got the same appellation, will, as I judge, supersede the question, whether the Cholera, in temperate climates, happens at any other season than that above assigned?

1462. In the case of a genuine cholera, the cure of it has been long established by experience.

In the beginning of the disease, the evacuation of the redundant bile is to be favoured by the plentiful exhibition of mild diluents, both given by the mouth, and injected by the anus; and all-evacuant medicines, employed in either way, are not only superfluous, but commonly hurtful.

1463. When the redundant bile appears to be sufficiently washed out, and even before that, if