Cholera consists in the vomiting and purging of bili ous matter, attended with painful griping, and with cramps of the legs. It is sometimes difficult to draw the line between this disease and Diarrhoea, although, when it exists in an acute state, it is easily distinguished by the nature of the evacuations. It seldom occurs in this country, except in the aututnnal months, and it is then found to be the most prevalent in the hottest sea sons; but is generally observed to come on rather after the period of the greatest heat than during its continu ance.
The leading symptoms of the disease seem to mark it as arising from some peculiar condition of the bile, and the time of Its invasion favours the idea, that ex ternal temperature has an important influence in its production; but we are scarcely able to explain the na ture of the connexion between these circumstances, or to spew in what manner the heat of the weather pro duces the change in the state of the bile, or indeed what is the exact nature of the change which it expe riences. Cholera is a violent disease, and one which is very rapid in its progress ; reducing the patient in the space of a few hours to a great degree of debility, and, if not checked by the appropriate remedies, proving suddenly fatal.
Its cure is to be effected, by completely evacuating the intestinal canal of the irritating matter which ap pears to be the exciting cause of the disease, and this is generally accomplished merely by the exhibition of mild diluents, which may be taken as copiously as the stomach will receive them. When the acrid bile has bean entirely removed, we then endeavour to allay the irritation by opiates, and afterwards to recruit the ex hausted powers of the system by gentle stimulants and excitants. To allay the griping pains fomentations may be applied to the abdomen, and sometimes immersion in warm water will be found highly grateful to the feel ings of the patient, when it can be commodiously appli ed. After the violence of the disease has subsided, the patient is left in a state of great weakness and langour ; but by the proper regulation of the diet, and by avoid ing all unnecessary causes of excitement, the strength is generally restored with more rapidity than might have been imagined from the degree of exhaustion. Bitters and tonics of various kinds arc generally administered for the purpose of strengthening the digestive powers, and of these colombo is the one which is found to be the most useful.
'We have placed calculous complaints as forming a genus under the order of the Apocenoses, because they depend upon the formation of certain substances in the urinary organs, which originate, in the first instance, from an irregularity in the action of the secretory ves sels of the part. The disease is characterized by unea siness in the region of the kidney, the bladder, or some of the passages connected with them ; by a difficulty and pain in passing the urine ; frequently by a depo sition of calculous matter from this fluid ; or by the presence of a calculus in the bladder, as ascertained by the introduction of the sound.
The exciting or predisposing cause of the disease is probably, in all cases, a derangement of the digestive organs, by which the fluids undergo some change in their nature, so that, in passing through the kidney, certain substances are secreted that concrete together into solid masses. These, according to their form, and the situation where they are deposited, produce various distressing symptoms, that are immediately to be at tributed to their mechanical bulk, either pressing upon the contiguous parts, or obstructing the discharge of the natural excretions. Very minute attention has been paid of late years to the chemical analysis of urinary calculi ; and, according to the most accurate experi ments, we may arrange them under the following heads: 1st, The lithic calculus ; 2d, The bone earth calculus, consisting principally of phosphate of lime ; 3d, The ammoniaco-magnesian phosphate; 4th, The fusible calculus, consisting of a mixture of the two former ; 5th, The mulberry calculus, composed of oxalate of lime ; 6th, The cystic, consisting of the peculiar sub stance called cystic oxide. To these we may add the
alternating calculi, those that are formed of different substances arranged in alternate layers ; and the com pound calculi, composed of different ingredients mixed together without any regular order.
As urinary calculi are properly extraneous bodies, and do not possess any vital properties, it has been al ways considered a most important point to discover some chemical agent, by which they might be render ed soluble, and in this way discharged along with the urine. Until very lately all the attempts that had been made of this kind were entirely empirical, and, not withstanding various flattering accounts which, from time to time, had been laid before the public, were al together abortive ; but since the greater accuracy of modern chemistry, their nature has been thoroughly investigated, and we are well accquainted with means by which most of them may be readily dissolved out of the body. It still, however, remains a doubtful point, vs nether, while they are in the bladder or the urinary passages, any re-agent taken into the stomach can be carried along the circulation so far, unaltered, as to be capable of acting upon the calculus through the inter vention of the urine; and, upon the whole, we are dis posed to think that but little can be expected from this mode of proceeding. But, although we may fail in this object, there are still two methods of relieving the dis ease ; one indeed, which is extremely painful, and af ter all merely palliative, viz. by cutting into the blad der, and removing the calculus ; the ether, which, if it can be accomplished, must be regarded as the more de sirable plan, is by counteracting that state of the diges tive organs which gives rise to the disease. Upon the whole we may conclude, with respect to this latter point, that whatever remedies would, in other circum stances, tend to improve the process of digestion, and establish the healthy action of the intestinal canal, will be equally serviceable in preventing the formation of calculi. But, besides this general view of the subject, it will be necessary for us to examine the state of the urine in the individual cases of Lithiasis that present themselves ; because in most of them we can distinctly perceive the existence of two conditions of the system, which are very different from each other, produce dif ferent effects, and may probably require different reme dies. In one of these a calculus is formed of an acid nature, which it may therefore be supposed will re quire alkaline medicines for its prevention; while in others there is a tendency to the formation of a calcu lus in which an alkaline earth predominates, and which may therefore be supposed to indicate the employment of acids for its prevention. Upon this principle, we have been directed, in the treatment of Lithiasis, first to examine into the state of the urine, and into the na ture of the calculous deposition, or of any solid matter which may have been discharged, and to administer either the carbonates of the fixed alkalies, or diluted muriatc acid, according to the result of the examina tion. Besides these, we are to give purgatives freely; to enjoin a plain diet, especially abstaining from fer mented and spiritous iliquors; and, in short, to adopt that system of regimen which is the best calculated to induce a healthy action of the stomach and bowels--.a circumstance which we are inclined to think is much more important than any direct chemical effect that can be produced on the fluids. The propriety of an opera tion will depend upon the urgency of the pain, or the other symptoms arising from the mechanical bulk of the stone. We shall only remark, that sometimes a large calculus in the bladder may be borne with tolerable ease, when, by the use of the proper remedies, it can be pre vented from increasing in size ; this probably arises from its more prominent and irritating parts being mounded off, and the organ becoming accommodated to its reception.