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diff --git a/old/53728-8.txt b/old/53728-8.txt deleted file mode 100644 index 0f16c83..0000000 --- a/old/53728-8.txt +++ /dev/null @@ -1,4365 +0,0 @@ -Project Gutenberg's Asiatic Cholera, by Elijah Whitney and A. B. Whitney - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: Asiatic Cholera - A treatise on its origin, pathology, treatment, and cure - -Author: Elijah Whitney - A. B. Whitney - -Release Date: December 14, 2016 [EBook #53728] - -Language: English - -Character set encoding: ISO-8859-1 - -*** START OF THIS PROJECT GUTENBERG EBOOK ASIATIC CHOLERA *** - - - - -Produced by Iris Schröder-Gehring and the Online Distributed -Proofreading Team at http://www.pgdp.net (This file was -produced from images generously made available by The -Internet Archive) - - - - - - - - - - ASIATIC CHOLERA - - - _A TREATISE_ - ON ITS - _ORIGIN, PATHOLOGY, TREATMENT, - AND CURE_. - - - BY - - - E. WHITNEY, M. D., - AND - A. B. WHITNEY, A. M., M. D., - - LATE PHYSICIAN AND SURGEON - - To Diseases of Women in the North-Western Dispensary, - Visiting Physician, Etc. - - - - - NEW YORK: - M. W. DODD, PUBLISHER, - NO. 506 BROADWAY. - 1866. - - - - - Entered according to Act of Congress, in the year 1866, by - - A. B. WHITNEY, A. M., M. D., - - In the Clerk's Office of the District Court of the United States, - for the Southern District of New York. - - - - E. O. JENKINS, STEREOTYPER AND PRINTER, - 20 NORTH WILLIAM ST., N. Y. - - - - -DEDICATION. - -TO PROFESSORS POST, VAN BUREN, METCALF, AND BEDFORD. - - -For those lucid Clinic illustrations and faithful instructions during -a three-years' course in the New York Medical University, particularly -the critical Pathological knowledge there inculcated, and consequent -professional success, the youthful author is indebted. - -Knowing they will agree with him, that his appreciation of their valued -services, and his gratitude for the same, can be best acknowledged -in his attempt to benefit suffering humanity, he would here publicly -acknowledge the pleasure and benefit received from their instructions -during his College course, and beg their acceptance of his sincerest -gratitude and affection. - -TO THESE ABLE INSTRUCTORS THIS VOLUME IS CORDIALLY DEDICATED BY THE -JUNIOR AUTHOR. - - A. B. WHITNEY, M. D. - - - - -PREFACE. - - -The following pages are the result of investigations and the collection -of facts and arguments from a great variety of sources, originally made -and presented in aid of the discussions on the subject during the past -six or eight months. - -The most eminent and reliable authorities for nearly half a century, -that is, from 1832 to 1865, including the late reports from India, -have been carefully examined, and such late discoveries, facts, and -arguments collected, as seemed to throw light upon the subject, or in -any degree to indicate or direct to a general principle of practice. - -The various experiments instituted for the cure of the disease have -been carefully investigated, and the principle evolved explained -whenever any advantage was derived from the same. - -In all these we have diligently searched for the cause of the failure -of "remedial agents," so uniformly admitted, and have endeavored to -present the results clearly and fully in the body of the work. - -Our statistics are collected from reliable sources, are very brief, -and introduced in aid of the main object,--the establishment of a -general principle of practice. - -The different modes of practice are from the most distinguished authors -of the different Schools of Medicine, and non-professional gentlemen; -condensed and exhibited mainly in their own language, to show their -conformity or non-conformity to the Pathology of the disease. - -In all we have kept constantly in view the pathology of the disease, -whose "dictates" have governed us in the exhibition and establishment -of a general principle of rational practice, confirmed by observation -and experience, which, if accepted and carried out by the profession, -we hope and trust will save a very large proportion of those attacked -by "this most acute of acute diseases." - - AUTHORS. - - - - -CONTENTS. - - - CHAPTER I. - - SEC. I. ORIGIN AND DEVELOPMENT. 7 - - SEC. II. PROGRESS AND FATALITY. 20 - - SEC. III. CAUSES--PROPAGATION. 34 - - - CHAPTER II. - - SEC. I. PATHOLOGY. 45 - - SEC. II. PHENOMENA, OR SYMPTOMS. 55 - - - CHAPTER III. - - SEC. I. UNSUCCESSFUL MODES OF TREATMENT.--VENOUS - TRANSFUSION EXPLAINED. 64 - - SEC. II. PHYSIOLOGICAL CONDITION OF THE BLOOD, ITS - NON-AERATION, OR NON-OXYDATION. - MAXIMS OF RATIONAL PRACTICE SUGGESTED. 91 - - SEC. III. DIFFERENT MODES OF TREATMENT. 130 - - SEC. IV. STATISTICS. PERCENTAGE OF LOSS. VARIABLE - RESULTS--THEIR CAUSE. 166 - - - CHAPTER IV. - - SEC. I. GENERAL PRINCIPLE OF RATIONAL PRACTICE, - DICTATED BY THE PATHOLOGY OF THE DISEASE, - CONFIRMED BY OBSERVATION AND EXPERIENCE. 178 - - SEC. II. REMEDIES, RECIPES, ETC. 188 - - SEC. III. PROPHYLAXIS, OR MEANS OF PREVENTION. 203 - - SEC. IV. FORMULĘ--PREPARATIONS, ETC. 213 - - - - -ASIATIC CHOLERA. - - - - -CHAPTER I. - -SECTION I.--ORIGIN AND DEVELOPMENT. - - -Epidemics have occasionally prevailed in all ages. Sometimes they -have been circumscribed in their influence, and limited to particular -localities; while at other periods they have taken a wider range and -extended over larger sections, inflicting the most lamentable results, -and augmenting the bills of mortality to an incredible degree. - -The earlier writers have given some account of these diseases, which -have occasionally prevailed as very fatal and devastating epidemics; -surpassing all other diseases in their mysterious origin, in their -rapid extension, and in the duration of their prevalence. In the -East,--in Egypt, and on the eastern border of the Mediterranean, -fearful epidemics have prevailed from time immemorial. They have often -proved very destructive, especially in the Middle Ages, and as late -as the sixteenth and seventeenth centuries. During the prevalence of -the "Pestis," which raged throughout Europe between the years 1347 -and 1350, according to computation, a fourth part of the inhabitants -of this part of the globe was carried off. The estimates of the vast -numbers swept away by its repeated occurrence and prevalence appear -quite incredible. - -During the time it raged at Marseilles in 1720, it is reported that in -the Charity Hospital there were admitted from October 3d to February -28th, 1,013 patients, of whom 585 died; and during the same period, in -another hospital, there were admitted from October to July 3d, 1,512 -patients, of whom 820 died. The population of Marseilles previous to -the occurrence of the disease was estimated at about 90,000, of whom -40,000 died; leaving only about 10,000 of the whole population who had -not been attacked or in any way affected; so that the record shows the -appalling mortality of fifty per cent. of those who were attacked. - -The bills of mortality in 1770 and 1771 were as appalling as any -arising from epidemics of a later day. A very extended notice of -the "Pestis" as it raged in Moscow in the year 1771 is given by M. -Gerardin, who, quoting from the published statistics, observes: "In -April, the deaths were 744; May, 851; June, 1,099; July, 1,708; August, -7,268; September, 21,401; October, 17,561; November, 5,235; December, -805"; making a total in nine months of 56,672, which is considerably -less than the estimate given by De Mertens, who thinks the whole -number carried off by this pestilence, from the city alone, cannot -be less than 80,000. These statistics bear a striking resemblance to -those of the Epidemic Cholera, whose fatality is materially varied by -the seasons of the year; the greatest being usually at the close of -Summer or the beginning of Autumn. There are, in short, many points of -resemblance in this and former epidemics to that of the Cholera, which -naturally lead to the supposition that all have had a common origin, -if, indeed, they be in many respects dissimilar. - -Their pestilential character, their extended influence, and their great -fatality, rendered their appearance and progress a special terror to -physicians, and melancholy apprehension to the people. They seem to -have been regarded as the manifestation of an invisible power, which -directed and guided "the pestilence that walketh in darkness" and "the -destruction that wasteth at noon-day;" a visitation or chastisement -over which human ingenuity and medical skill had little control. Under -these impressions, the earlier physicians labored and endeavored to -satisfy the great mass of mind that these occasional and special -developments of disease arose from natural causes, and were subject to -certain natural laws. They ascribed their origin to the commingling of -some specific poison in the food, and drink, and air, which, through -these "media," was received into the system. - -Subsequently, they seem to have made some advance on this theory, and -considered the extreme Summer heat--especially the intense heat of the -sun in a dry season--the emanations from stagnant waters, and the miasm -exhaled from the soil, and from putrid bodies of animals, as the chief -causes of all epidemics. These views prevailed for a very long period, -and have undergone no very remarkable change from the observations and -discoveries of centuries. - -Modern and quite recent writers have advanced nearly the -same doctrines, embracing, however, the principal sources of -insalubrity--the malarious and miasmatic influences; and have assigned -as the cause of epidemics, especially that of Cholera, a peculiar -constitution of the atmosphere, and certain predisposing causes -combining with each other, so that an association or union of these two -independent and individual causes are necessary and essential to the -production of the disease. - -Eminent scholars and pathologists have, during the century last past, -patiently searched for its final cause, without arriving at any better, -wiser, or more satisfactory conclusion than the earlier writers, who -regarded it a poison, commingled with the food they ate, the water they -drank, and the air they breathed. The modern writers, according to the -more popular views, almost universally adopt the hypothesis that the -remote or final cause of the Cholera is a specific poison; for at no -period has a person in good health in this or any other country been -known in a few minutes to be shriveled up, his face and extremities to -turn purple, his whole body to become of an icy coldness, and with or -without vomiting a peculiar fluid, like rice-water, to die in a few -hours, except under the influence of poison. That this disease, so -appalling and destructive in its effects, and so mysterious in its -wanderings, should spread over countries in respect to climate, soil, -geological formations, and as to the moral and physical habits of the -population, so utterly opposite to those where it first originated, is -only explicable on the hypothesis of its propagation on the principle -of a specific disease-poison. - -How and in what manner it travels has not been satisfactorily -determined. Whether independent of any and all human agency, or -absolutely dependent on ordinary communication and intercourse of -tribes, and peoples, and nations, is as yet unsettled. It is, however, -a matter not of so much consequence as the fact that, in all its -nomadic life, it retains unchanged its youthful disposition, vigor and -energy. It seldom shows any inclination to associate, or coalesce, or -even adopt the milder habits and manners of others. - -Perhaps some idea of its character may be obtained from a microscopic -view of its birthplace and its surroundings. Whether the locality -of its irruption in 1629, or that of 1817, whence it spread over the -greater part of the globe, be entitled to the unenviable distinction -of fostering its gestation, concealing and protecting its birth, and -nursing its infancy, is immaterial;--since the similarity of these -localities strikingly illustrates its cause and ultimate development. - -On the north side of the island of Java, about 6° S. lat. and 107° E. -long., near the mouth of the river Jacatra, is situated Batavia, in -the midst of swamps and marshes, surrounded by trees and jungle, which -prevent the exhalations from being carried off by a free circulation -of the air, and render the town peculiarly obnoxious to marsh -miasmata. Besides this, all the principal streets are traversed by -canals, planted on each side with rows of trees, over which there are -bridges at the end of almost every street. These canals are the common -receptacles for all the filth of the town. In the dry season their -stagnant and diminished waters emit a most intolerable stench, while -in the wet season they overflow their banks and leave a quantity of -offensive slime. From these united causes, it is not surprising that -Batavia has been considered the most unhealthy spot in the world, and -has been designated the store-house of disease. According to Raynal, -the number of sailors and soldiers alone who died in the hospitals -averaged 1,400 annually for sixty years, and the total amount of deaths -in twenty-two years exceeded a million of souls. The city was inclosed -by a wall of coral rock, with a stream of water on each side within -and without. Few Europeans, however, sleep within the town, as the -night air is considered very baneful. The inhabitants, possibly, as -an antidote against the noxious effluvia arising from the swamps and -canals, continually burn aromatic woods and resins, and scatter about -a profusion of odoriferous flowers, of which there are great abundance -and variety. During the prosperity of the Dutch East India Company, -Batavia obtained the title of Queen of the East, as the resources of -all other districts were sacrificed to its exclusive commerce. Here, -in this noted locality, was the Cholera bred and reared in 1629, under -circumstances of great significance, admirably adapted to convey some -idea of its cause and character. - -A learned professor, speaking of the diseases of India, observes: -"CHOLERA is the most acute of acute diseases. It seems to have existed -in Batavia as far back as 1629; and it has been known to prevail as an -occasional epidemic in India at different years and places from 1774 -to 1817. Since then it has been endemic, and is a disease whose germs -are essentially maintained in, or upon the soil. It annually recurs at -many of our large stations, commencing generally at the beginning of -the hot season, but sometimes occurring in the rainy and cold season. -Its greatest proclivity to propagation is amongst populations living -in low, damp, crowded, and ill-ventilated situations, especially if -the water supply is impure. Nearly all the diseases fatal in India are -accompanied by profuse discharges, with which the air, water, linen, -bedding, closets, walls of hospitals, and barracks become more or less -infected; so that the 'Materies Morbi' come into contact with all the -inmates of buildings where the disease prevails." - -Its origin, or reappearance in 1817, is not in any respect essentially -different from its earlier development on the Jacatra. The River -Ganges, in India, like the Nile in Egypt, flows for a long distance -through a low, level country, which it annually inundates. Dividing its -waters about 200 miles from the sea, the Delta of the Ganges commences -and continues its variegated and checkered surface, till, approaching -the borders of the sea, it presents a peculiar aspect, being composed -of a labyrinth of creeks and rivers, called "The Sunderbunds," with -numerous islands, covered with the profuse and rank vegetation called -"jungle," affording haunts to numerous tigers and other beasts of prey. -This large river, "a Deity of the Hindoo," is subject to an annual -freshet, often rising to the height of 32 feet in the month of July; -when all the lower parts of the country adjoining the Ganges, as -well as the Burrumpooter, are overflowed for a width of one hundred -miles; nothing appearing but villages, trees, and sites of some places -that have been deserted. Here in this vast pest-house, where every -conceivable vegetable and animal substance is left upon the soil by -the retiring inundation, exposed to the heat and dews of a tropical -climate--where, too, noisome and infectious diseases have prevailed for -centuries, the Epidemic Cholera is said to have arisen and acquired its -strength and full development. A fit origin for a fatal and devastating -pestilence. - -To this low, insalubrious, and festering locality, this vast -pest-house, where so many noxious and noisome diseases are generated, -and where so many epidemics have arisen and so often swept over the -surrounding regions with most fatal and desolating effects, is ascribed -the birthplace of the Epidemic Cholera of 1817. Here it is said to have -first made its appearance at Jessore--a populous town in the centre of -the Delta of the Ganges; whence attaining its growth and power, it has -extended its influence as from a common centre, and marked its progress -with hecatombs of victims in the direction of almost every point of the -compass. - -Here we may remark, that it is not our intention to travel over the -whole ground embraced by the subject under consideration; but, on -the contrary, to present in this treatise only a cursory view of a -few prominent features which may interest and aid in the important -object of deducing from the pathology and the varied phenomena of the -Cholera some general principle of practice. For this, and to this, -our labor and our investigations are directed. Availing ourselves of -every source of information within our reach, and relying in part on -the observations and experience of others, we shall aim to present -such facts and arguments as will shed light upon the subject, and aid -in the accomplishment of this desirable object. However difficult this -may appear, it is nevertheless believed to be within the province of -science and unbiased reason. - - -SECTION II.--PROGRESS AND FATALITY. - -The disease in 1817 appeared on the Delta of the Ganges, and gradually -extending its influence, swept over various countries with terrible -severity. Having here acquired its full development, and manifesting -an indomitable determination to itinerate, it starts upon its lethean -errand, and soon shows a capacity and power to overcome every obstacle -opposed to its progress, and to pursue its course unchecked and even -unretarded by any natural or artificial barrier. It soon traversed -India, and in the succeeding season spread over adjacent countries, -visiting in 1818 the Indian Peninsula, the Burmese Empire, the Kingdom -of Aracan, and the Peninsula of Malacca. In 1819 it reached Sumatra, -Singapore, and various other islands situated along the coast on either -border of this vast peninsula. - -During the year 1820, pursuing steadily its progress eastward, it -reached Tonquin, Southern China, Canton, the Philippine, and numerous -other places and islands in that direction. In 1821 it visited -Java--the place of its earlier nativity--Madura, Borneo, and many other -places in the Indian Archipelago. During the years 1822, 1823 and 1824, -it continued to spread over the vast and populous regions of Central -and Northern China and the numerous islands upon the coast, and in 1827 -prevailed in Chinese Tartary, leaving few places in all these different -countries on the continent, or even on the islands bordering on the -eastern coast, unscathed by its terrible ravages and depopulating -influence. - -During the same period, its progress westward has been uninterrupted, -and attended with results no less remarkable. It has baffled all -attempts to check or even retard its onward course, or mitigate its -appalling effects. In July, 1821, it had reached Muscat in Arabia, and -thence extended its influence to the populous cities and villages along -the Persian Gulf. During the same season it appeared in Persia, and -continued to ravage the principal cities and towns of that empire for -four successive years. At Bassorah and Bagdad it broke out in July, -1821, and thence extended its desolating influence westward to the Red -and Mediterranean Seas, carrying off vast numbers of the inhabitants of -the populous cities of Mesopotamia, Syria, and Judea. - -In 1822 it prevailed among the nomadic and Tartar tribes in Central -Asia and in the northern Persian Provinces, and in 1823 broke out on -the Georgian frontiers of Russia, at Orenburg on the River Ural, and -at Astrachan on the Volga. Here its western course was apparently -interrupted. There was, for a short period, an interval of complete -immunity from its presence. Along the border of the Russian Provinces -the disease had entirely disappeared, and seemed inclined to retrace -its course and return to the home of its birth. But the fond -anticipations of Europeans were disappointed; the destroyer was not to -be arrested and turned back in his progress over the earth; his march -was onward, his demands imperative. - -Hence, in the month of June, 1830, the disease reappeared in a Persian -province on the southern shore of the Caspian, and again at Astrachan, -on the Volga, in July, where it prevailed with such unwonted violence -that, before the close of August, more than 4,000 persons had died -of it in the city, and 21,270 in the province. From its interval of -repose, it would seem to have recuperated its strength and vigor for -the lethean work awaiting its progress. Ascending the Volga, it reached -Moscow, became prevalent there in September, and continued with great -severity till February, 1831. Here it attacked, in the city, about -9,000 persons, of whom more than one-half died. Continuing its advance, -it reached Riga about the middle of May, and St. Petersburg on the 26th -June. - -From Astrachan it also directed its course towards the northern coast -of the Black Sea, and thence along the course of the rivers into -the central parts of Russia. It reached Poland in January, 1831, -accompanied the Russian army in its various marches and encampments -during the subjugation of that country, and proved very destructive -in Warsaw and many other places during April and May. It appeared at -Dantzic in May, and in June at Lemburg, Cracow, and various other -places and sections of country, extending through Gallicia, Hungary, -and reaching Berlin and Hamburg in August and September, and Vienna -about the same time. - -Smyrna was visited in September, and Constantinople soon afterwards. It -is reported that the pestilence was conveyed by a caravan from Mecca -to Cairo in August, 1831, some thousands having died on the road; -and, by the middle of September, 10,400 Mohammedans, besides Jews and -Christians, had died of it in this latter city. - -Passing from the western coast of the continent, on nearly the same -parallels of latitude, it found its way over the Northern Sea to the -British Isles, and made a lodgment, first, on the northeastern coast -of England, in October, 1831, at Sunderland, situated in latitude -55° north, whence it prevailed and extended its influence over this -section, evincing the same malignant and lethean character it had -manifested in its progress over the continent. Its course thus far has -been marked with unparalleled fatality. - -It made its first appearance in Scotland, at Haddington, in December, -1831, and at Edinburgh in January. In these and various other places it -prevailed for some months, and, as warm weather came on, increased in -severity, and carried off a large percentage of those attacked. After -spreading thus over the northern section, and rioting for months in the -more populous cities and towns, it made its appearance in London on -the 14th February, 1832, where it found an abundance of material for -recuperating its strength and multiplying its forces, and soon after -spread over various other places in the United Kingdom, inflicting -the most appalling bills of mortality. In short, its progress over -this country has been attended with the same destructive influence -and the same lamentable consequences as on the continent. No change, -modification, or softening of its disposition or character has arisen -from its passage over the Northern Sea, nor from the refreshing -influences of a purer atmosphere. - -It appeared in Calais on the 12th, and at Paris on the 26th of March, -1832, where it continued in these and other cities and villages for -some months with its accustomed severity. During the season it raged -throughout the vast empire, and swept away an immense number of its -inhabitants. During the succeeding years, 1833 and 1834, it traversed -Spain, and proved very destructive in many of its larger cities and -villages. - -In the mean time, continuing its course from the British Isles -westward, unchecked by the prevailing western winds and the broad -expanse of the Atlantic Ocean, over which it passes a distance of -nearly three thousand miles, and makes its first appearance on the -American continent at Quebec, Lower Canada, on the 8th June, 1832, and -reaches Montreal on the 10th of the same month. From these cities it -rapidly spread in all directions, prevailing in the towns and villages -on the St. Lawrence and its tributaries, and soon extended along the -chain of lakes, dividing the Provinces from the United States, visiting -the principal ports on either shore. It exhibited in all these places -its peculiar epidemic character, and proved excessively violent and -fatal wherever it appeared. - -Its first irruption in New York was on the 24th June, 1832, sixteen -days after its appearance at Quebec, and at Albany, midway between -the two former cities, on the 3d July. From New York it extended its -influence to Flatbush and Gravesend, Long Island, where it appeared on -the 5th July, and on the same day and date at the city of Philadelphia. -It broke out at Rochester on the 12th and at Buffalo--July. - -Thus, while it was making its way westward along the great chain of -lakes, towards the arteries of the Great West, it was, at the same -time, steadily pursuing its uninterrupted course along the coast, -visiting the main cities, and spreading from these as from common -centres over the intermediate towns and villages. In its progress it -reached Baltimore on the 22d August, and the City of Washington on the -28th of the same month. - -Thence it continued its course to Richmond, Norfolk, Edenton, and -various other cities along the Atlantic and Gulf coast. - -It appeared at New Orleans in the Autumn of 1832, during the existence -of a severe epidemic of yellow fever, and apparently subsided on the -disappearance of the fever. Sporadic cases, however, occurred during -the Winter, and in the opening of Spring it broke out with unwonted -vigor and severity, and thence spread, according to its accustomed -laws of itineracy, along the rivers into the interior of the States -bordering upon the Mississippi and the Gulf coast, and raged throughout -Louisiana and Texas with unusual violence and fatality. - -In 1832, 1833, and 1834 it prevailed throughout the Mississippi Valley -with great fatality, especially in the principal cities, villages and -towns situated upon its navigable waters. Here, after intervals of -entire immunity from its presence, it occasionally reappeared in some -of the larger cities with renewed vigor and power, and swept off vast -numbers of the inhabitants. In no section of the States have greater -numbers, compared with the whole population, fallen victims to it than -in the fertile and sparsely settled prairies of the South and West. - -Thus, from the North, and at a later date from the South, extending -its influence along the principal rivers into the interior, it swept -over the States, prevailing in some places in the Valley of the -Mississippi as late as 1836. In short, it reappeared in 1834 in many -cities and places where it had before prevailed, and again spread over -a considerable portion of the country with unprecedented fatality. - -In 1833, the disease appeared at Havana and Matanzas, and prevailed on -the island for several months with great fatality, especially among -the colored people. During the same season it appeared in August -at Tampico, Campeachy, Vera Cruz, and the city of Mexico, proving -especially violent and destructive in these and other cities of the -Republic. In Central America it is said to have attacked the army, and -in a very short period to have swept away a very large proportion of -its officers and men. - -Thus, it appears that the epidemic or Asiatic Cholera, from its first -irruption on the northern coast, spread over the greater part of the -North American Continent in the space of two years, and has several -times reappeared in different sections in its peculiar malignant -character, spreading on each occasion over a greater or less extent -of territory with the same uniform and destructive influence. Neither -time, nor science, nor professional skill has thus far appeared to -soften its character, or mitigate its severity. - -When the disease had fully assumed its epidemic or malignant type in -India, in 1817, its rate of mortality was everywhere in that vast -territory excessively high. - -According to the most reliable reports, the cases occurring in the -earlier period of an irruption were generally fatal, few only surviving -the attack; while of those occurring when the disease was on the -decline, a greater proportion recovered. We read of numerous instances -where one-third, one-half, two-thirds, and even nine-tenths of those -seized with Cholera perished, and again of some places where one-fifth, -one-fourth, and in some instances one-third of entire populations were -cut off in a very short period by this disease. But without attempting -to give the statistics of cholera in this part of the world, or even in -Europe or America, we may present a few instances of mortality, going -to show the great percentage of loss by this singular disease during -its ravages from 1817 to 1837. - -In Siam, it is said 20,000 persons fell victims to it in twelve days. -The inhabitants are remarkable for their uncleanly habits, and crowded, -ill-ventilated tenements. - -In Sicily, 16,000 died of cholera in 1832, at Catania; in Palermo, -40,000. These cities are represented as being filthy in the extreme, -and the personal habits of the people so uncleanly, and the houses so -crowded, that it is a matter of surprise the mortality was not greater. - -In Bassorah and Bagdad, situated in low, unhealthy localities, and -exposed to a damp, insalubrious atmosphere, which, in the warmer -season, is often essentially impregnated with miasmata and offensive -exhalations from animal and vegetable decomposition, both within and -without their inclosures, it is affirmed that more than one-third of -their entire populations were carried off in less than one month. - -In the Province of Caucasus, out of 16,000 attacked by the disease, -10,000 died. In Russia, out of 54,000 attacked in 1830, it is said more -than 31,000 died. - -In Hungary, it is reported that the whole number affected by the -disease was about 400,000, of whom more than one-half died. - -It is officially stated that the total number--the military -excepted--of those affected with cholera in France, from its first -appearance at Calais, March 15, 1832, to January 1st, 1833, is 230,000, -and the deaths 95,000. - -In England, the whole number of cases of Cholera is reported to be -49,594, and the number of deaths 14,807. In London there were 11,020 -cases, of which 5,274 were fatal. In Wales there were 1,436 cases, of -which 498 proved fatal. In Ireland, from its first irruption in 1832 -to March, 1833, there had occurred 54,552 cases of cholera, of which -21,171 were fatal. - -In Quebec, from June 9th to September 2d, 1832, there had occurred in -that city alone no less than 5,783 cases of cholera, of which 2,218 -were fatal. In Montreal, from June 10th to September 21st, there were -4,440 cases, and 1,904 deaths reported. - -In New York, from July 4th to August 28th, in 1832, there had occurred -5,814 cases of cholera, and 2,935 deaths by the same disease. In -Philadelphia, from July 4th to August 28th, 1832, there were reported -2,314 cases of cholera, of which 935 were fatal. - -In many of our Southern and Western cities and villages the percentage -of loss from the prevalence of cholera is considerably higher than the -general average, compared with the data given above. The mortality -varies materially in different localities, and, indeed, becomes very -much augmented by the prevalence of those influences which particularly -favor the vegetation, and are especially concerned in the production of -zymotic diseases, whether in the lower or higher latitudes. - - -SECTION III.--CAUSES--PROPAGATION. - -The remote or final cause is essentially of miasmatic origin, developed -under certain atmospheric and terrestrial local conditions, not well -defined or fully understood. In its nature and essence, it constitutes -a peculiar disease-poison, which is now generally admitted to be, in -one way or another, absorbed, and infects the blood, inducing a primary -disease of this vital fluid, and directly depressing and deranging -the ganglionic system of nerves. To its general character, and the -circumstances under which it is generated and in which it operates in -producing the disease, we have alluded in speaking of its origin. - -The predisposing causes are as numerous as the varied influences -which operate to depress the general health. The insalubrity of the -atmosphere may be regarded as a general, and, perhaps, the most -extensive predisposing cause. In this state, its vital element becomes -diminished or impaired to such an extent as to render it incapable of -sustaining the normal and healthy functions of the system in their -most vigorous condition. Hence, the foul and noisome air of close, -ill-ventilated apartments becomes very depressing and baneful; a direct -and effective element, often, in constant operation in generating and -producing the cholera, typhoid fever, or other deadly maladies. This -is not unfrequently the case on board some of our emigrant ships, -when hundreds of human beings are stowed away between decks without -the means of efficient ventilation, disinfection, or other mode of -expelling the noxious principle. Though the germ of disease may be -ever on board, it does not vegetate and come forth and rapidly acquire -its activity, vigor and power, unless the localizing influence vivify, -foster and nurture its development. This is fully confirmed by the -recent arrival of two steamers with cholera on board. - -The _England_, and a few days later the _Virginia_, with crews and -passengers all in perfect health, departing from a healthy port where -no cases of cholera were known to exist, and after being out at sea six -or eight days under the influence of a cool, invigorating atmosphere, -were surprised by the sudden irruption of cholera on board. It breaks -out among the steerage passengers who are crowded and packed together -between decks like sheep for the slaughter, in a confined atmosphere, -daily becoming more noisome, without the means of ventilation or -disinfection. Can any sane man say the disease--the cholera--was not -here, on board these ships, generated and produced? - -This is also confirmed by the occurrence of an isolated case on -Ninety-third Street, near Third Avenue, the first case in this city -this season. Though the cholera exists at Quarantine, the patient had -not been in any way exposed to the disease, except to the exhalations -from the overflowing and drainage of a privy and the foul atmosphere -arising from the cellar of her own tenement. On Monday, it is said, -she partook of her dinner, feeling a little indisposed; at 4 P.M. she -called in her physician, and died the next morning, May 1st, at 11 -A.M., in a state of collapse. - -Take another instance: the second case in this city occurred in one -of the tenement dwellings of the Sixth Ward, No. 117 Mulberry Street. -The patient was a woman about thirty years of age, who had not -been exposed, except to the noisome atmosphere of her own dwelling -and its surroundings, which must be regarded, under the peculiar -circumstances, as a true, genuine cholera atmosphere. In these cases -the evidence is conclusive that the disease was generated and produced -within, and on these premises. - -The exhalations from low, moist, and marshy localities, from -the offensive cesspools, water-closets, sinks, sewers, and the -decomposition of animal and vegetable substances, from the refuse or -garbage which so often befouls the sidewalks and gutters of streets, -are all effective, predisposing causes, that directly facilitate the -production of the cholera. Whatever tends to depress the vital powers, -impair normal action, or relax in any degree the tone of the nervous -system, favors the operation of the final cause. So, too, the low, -underground, damp, unventilated apartments, the crowded and uncleanly -tenement houses, in which multitudes of the poorer class live, in a -confined, foul, and noisome atmosphere, not only favor, but actually -invite, the active operation of the infecting agent. - -Habits of intemperance, profligacy, impurity, and late hours, have a -powerful influence to depress and prepare the system for an invasion -of the disease in its most malignant form. In a neighborhood of this -description, when the cholera in 1832 was raging in the adjacent city, -from which it was separated by a very small creek, the uncleanly -multitude escaped entirely, not a case occurring there at that time; -but when, after an interval of several weeks, all danger seemed to have -passed, and the people were rejoicing and congratulating themselves -on their good fortune, the fearful disease suddenly appeared in their -midst with greatly intensified effect, and in a very few days swept the -place so clean that few were left to tell the sad story of its ravages. - -There are some other predisposing causes of no inconsiderable -influence, which not only favor the operation of the infecting agent in -the production of the disease, but even awaken its latent power, and -stimulate its activity and development in the system, once exposed to -its invasion. Among these, excessive fear of an attack, great anxiety -and depression of mind, constitutional debility, deranged condition -of the digestive organs, accompanied with a relaxed state of the -bowels, exhaustion arising from fatigue or disease, semi-starvation -and unwholesome diet, neglect of personal and domestic cleanliness, -irregular habits, and excesses of every description, are all direct -incentives and stimulating agents in the production of the cholera. Any -one of these may be sufficient to induce an attack; but when a number -unite and act conjointly the danger is vastly greater, as the infecting -agent or disease-poison becomes thereby more intensified. - -When the cholera first appeared in Europe and in this country in -its epidemic form, the majority of medical men, as well as the -people, believed it to be contagious, and to be propagated solely -on this principle. But when the disease appeared in 1848 a decided -change of opinion occurred, which led to a full discussion of the -subject, without any definite result; and the great question as to -its contagious character and its mode of propagation remains still -unsettled. The higher authorities, says an eminent author, concurred in -the opinion of the Board of Health, "that the disease was not in any -way contagious, and that no danger was incurred by attendance on the -sick." - -A large body of evidence, however, has been exhibited, going to show -that human intercourse has, at least, a share in the propagation of the -disease, and that it, under some circumstances, is the most important, -if not the sole means of effecting its diffusion. On the other hand, it -is affirmed that though it may be communicated, in some cases, by the -agency of human intercourse, it does not follow that the material cause -spreads by true contagion, that is, by reproducing itself in the bodies -of men, and there only. - -The disease may be carried by healthy persons in their clothing, -in their ships, and in their caravans. That instances of this kind -have occurred there can be no question, for numerous records present -some undoubted instances of the occasional communication of the -cholera-poison through human intercourse; still it is no less certain -that its general extension over the world cannot be accounted for on -this principle alone. "Its propagation by this means seems to be the -rare exception, its spread over the earth from other causes being the -common rule." - -Dr. Hamlin, writing from Constantinople, in reference to the recent -irruption and prevalence of the cholera in that city, observes, "The -idea of contagion should be abandoned. All the missionaries who have -been most with the most malignant cases, day after day, are fully -convinced of the non-contagiousness of the cholera. The incipient -attacks which all have suffered from are to be attributed to great -fatigue, making the constitution liable to an attack." - -It is a very singular fact, that the medical profession in India, -the birthplace and home of the cholera, almost universally reject -the doctrine of contagion. If those most observant and familiar -with its history, its prevalence, and its annual recurrence as an -endemic disease, which they are called to treat in all its varied -phases, have discovered no contagious character by which it can be -propagated, it may be safely inferred that it is not contagious in the -common acceptation of the term, and that its extension over the earth -is governed by some other principle, and that the predisposing and -localized causes which are always in operation in India exercise no -small share in its diffusion, in directing its course, aggravating its -severity, increasing or diminishing its fatality, and determining the -duration of its prevalence in particular localities. When its infecting -germs have gained a lodgment in any city, section, or country, they may -be stimulated and become exceedingly active in the production of the -disease through these influences. - -As to its introduction into different countries, it is quite evident -that the germ, or latent principle of the cholera-poison, exists in -such a state as to be capable of transportation, and may in this way -be diffused to almost any extent when the localizing influences are -sufficient to develop its energies. - -In this, as in all other zymotic diseases, some persons are more -susceptible of an impression and more liable to an attack than others. -Though no class can be considered exempt, yet there are some whose -organization, or innate protective principle, seems to render them -impervious to its influence. The cholera, however, is no respecter of -persons, or rank, or condition. The anęmic and cowardly in all ranks -and conditions are peculiarly liable, and are the most defenceless and -unresisting when invaded. In Europe, the probable numbers attacked in -that part of the world appear from statistics to be, in France, as 1 -in 300; Russia, as 1 in 20; Austria, as 1 in 30; Poland, as 1 in 32; -Holland, as 1 in 144; Germany, as 1 in 700. "The circumstance of one -attack by no means protected the individual from a second in the same, -or any subsequent year; still a repetition of the disease in the same -person in the same year was rare." - - - - -CHAPTER II. - -SECTION I.--PATHOLOGY. - - -The doctrine now universally accepted and prevailing regarding its -Pathology is, that a poison, virulent, subtle, and unknown, has been -absorbed, and primarily infects the blood, so that, after a longer or -a shorter time, a primary disease of this vital fluid is produced, and -that the poison undergoes an enormous process of multiplication in -the living body of the cholera patient, as the direct result of this -morbific process so established, and that changes are induced in the -function of respiration directly consequent on this alteration of the -blood. - -This altered condition and rapid change in the life-sustaining -principle of the blood, the loss of nerve-power, the impaired -circulation and tendency to congestion, are the proper and -distinguishing features of the disease; and the term "Algide," first -used by the French Pathologists, very happily describes one of the -most remarkable and constant symptoms, namely, the diminution of animal -heat. The loss of temperature and its consequent effects upon the -circulation, depressing and prostrating the nervous power, impairing -and paralyzing the respiratory organs, suspending the functions of the -liver and kidneys, enfeebling the action of the heart, and causing -the capillary vessels of the mucous tissues to expand and pour off -the serous fluid from the blood and every muscle and tissue of the -system, with great rapidity, essentially constitute the phenomena of -the Cholera. The constantly increasing augmentation of the poison and -its intensified effects measure the malignity, the violence, and the -rapidity of the disease. - -It is this multiplication, and the disturbance which attaches to it, -that in each case constitutes the disease and destroys life. Of this -fact the circumstantial evidence is abundant and conclusive, and may -account in part for the violence of the disease in its first irruption -in any particular locality. The vomiting, purging, and cramps are now -generally considered as secondary and non-essential phenomena, for -numerous cases of cholera have occurred in every section where it has -prevailed in its more violent and malignant form without exhibiting -these symptoms. The poison was so potent, and its progress so rapid, -that life was extinguished in a very short time. In its first irruption -at Muscat, cases are reported in which only ten minutes elapsed from -the first apparent seizure before life was extinct. Dr. Milroy, -speaking of the violence and rapidity of the disease as it occurred in -1817, and again in 1845 and '6, at Kurrachee, observes, that "within -little more than five minutes hale and hearty men were seized, cramped, -collapsed, and dead." Instances of death taking place in two or three -hours are extremely common. When it broke out at Teheran, in May, 1846, -Dr. Milroy observes, that "those who were attacked dropped suddenly -down in a state of lethargy, and at the end of two or three hours -expired, without any convulsions or vomitings, but from a complete -stagnation of the blood." In many places during its prevalence in -1832, and subsequently in 1834, and in 1848 and '9, the rapid fatal -character of the earlier cases was observed and reported as the most -severe and hopeless. In various cities and villages in our own country, -cases of this description were not unfrequent. In all these the -destructive nature and rapid process of the disease was so depressing -and overwhelming as to prevent any effort of the "vis naturę" to resist -its progress. - -Hence, from the autopsy of those who have fallen victims to its baneful -influence in the first stage, or within forty-eight hours of the -attack, no alteration of structure in any organ or tissue has been -discovered. But in those cases where death has occurred at a later -period, some lesions and slight changes in the appearance of some -tissues have been traced. The more important of these, illustrative -of the characteristic effects of the disease, are, in brief, the -following: - -The follicular structure of the intestinal canal has been found -slightly swollen, and the intestine partially filled with a -turbid, inodorous, semi-diaphanous fluid, resembling thin starch, -or rice-water, and is supposed to be the remains of that peculiar -secretion which had taken place during life. This fluid is sometimes -acid, and sometimes alkaline. In the small intestines it is found in an -unmixed condition. It consists of two liquids of different consistency; -the one thick, the other thin. The latter constitutes the rice-water -stools, and may be passed off without admixture with the thicker -substance. The colon has been found generally much contracted, and the -mucous membrane and the sub-mucous cellular tissue of the digestive -canal presenting evident marks of congestion, in some cases approaching -to a sub-inflammatory state, generally in spots or patches of various -sizes, the color of these varying from a very dark congestion to a more -roseate hue. The glands of Brunner and Peyer, as well as the solitary -glands, are greatly enlarged. The stomach and bowels are frequently of -a paler color than natural, both in their inner and outer surfaces. The -liver, the spleen, and the kidneys have been found engorged with blood. -The urinary bladder is always contracted, and empty. The gall-ducts -are sometimes contracted, at other times not. The vena porta and all -the other abdominal veins are loaded with black blood, resembling tar -in its color and consistency. The membranes of the brain and cord are -generally found congested, and the substance of the brain more or less -dotted with small points or specks of blood than usual. - -"The most common appearances in the lungs," says an eminent -pathologist, "are the presence of blood in the large vessels, chiefly -or solely; the collapse and the deficient crepitation arising from -the more or less complete absence of air and blood, and from the -approximation of the molecular parts of the pulmonary substance. -In other cases there is more blood in the minute structure, a -corresponding dark color of the lung, and a variable amount of frothy -serum. The right side of the heart and the pulmonary arteries were -generally filled, and in some cases distended with blood; the left side -and aorta were generally empty, or contained only a very small quantity -of dark blood; the left side evidently had received little or no blood, -but had continued to contract, in some cases even violently, on the -last drop of blood which had entered it." - -Such are some of the prominent appearances which the body has presented -when the patient has died in the first, or pulseless stage of the -disease. But in other cases, where the premonitory stage has been -definitely marked, and attended with diarrhoea or other depressing -disorder affecting the alimentary canal, and where the patient has -continued under the influence of the disease for a longer period, and -has passed through the usual successive stages of it, other additional -appearances have been noticed, which are here omitted, as they are of -a secondary importance, and belong especially to the more protracted -cases. - -The _post-mortem_ appearances, the phenomena of the disease, the -Algide, or diminished animal heat, and the loss of nervous power, all -tend to show an obstructed circulation and consequent embarrassment -of respiration resulting in the non-aeration and non-oxydation of the -blood, from which a long train of secondary and non-essential symptoms -arise. For it is affirmed that the mechanical part of respiration -remains in a good degree perfect, and that the heart evidently -continues to beat in many cases till stopped by the want of blood in -the left side and by its accumulation in the right side. Hence, for the -cause of this arrest of the circulation of the blood through the lungs, -we are forced to look to the condition of the blood itself, and the -deranged action of the ganglionic nerves. - -Attempts have been made to trace out from analysis the exact chemical -changes in the order of their occurrence which attend the period of -transudation from the blood into the intestinal canal. "The most -prominent phenomena of cholera," says Dr. Aiken, "during this period -of transudation, consists in separation of the water and of the salts -of the intercellular fluid (of the blood) through the mucous membrane -of the intestinal canal, and the retention in the blood of an important -excess of albumen and of blood-cells, with apparently less, but in -reality with great diminution of the salts and fibrin." - -"The inorganic constituents," continues the same author, "if compared -to the water, are during the first four hours increased, because at -this time the water is passing off with great rapidity; afterwards, as -the salts pass off, the disproportion is lessened, and after eighteen -hours or so, the proportion of salts is greatly diminished, and, if -compared with the organic constituents, the diminution is enormous. -With respect to the individual salts, there is in the blood a relative -preponderance of phosphates over chlorides, and of potash salts over -soda salts. By the end of eighteen hours or so, the blood-corpuscles -are left in a most abnormal condition; the great loss of water and -of salts, especially of the chloride of potassium--a most important -constituent of the blood-cells--at once leads to the conclusion that -their functions must have been greatly impaired. Accordingly, Dr. -Schmidt found that the amount of oxygen contained in them was lessened -by one-half." Dr. Robertson affirms that the "fibrin of the blood is -usually in large amount and coagulable with great firmness;" while -Dr. Parkes, speaking of the same condition of the blood, and relying -on the accuracy of his analysis, observes, "The presence of fibrin -in the blood was not indicated by any coagulation either in or out -of the body; and whether coagulated or not, the blood has usually a -dark color; but it generally acquired an arterial tint when brought -into contact with the air in thin layers." * * * "When we remember -the great share taken by the blood-globules in the respiratory and -heat-furnishing processes, it is scarcely possible to avoid concluding -that their loss of salts is connected with the characteristic cyanosis -and lowered temperature in cholera." "The diarrhoea coincides with -the first chemical changes in the blood--the transudation of some of -the constituents of the serum." Hence the phenomena of the disease -may thus be traced from this process as the starting-point. All other -chemical changes in the blood, and the most marked symptoms, such as -the abnormal respiratory process, follow as a matter of course. Such -is the theory of the nature of cholera, now advanced and sustained by -the most eminent pathologists, which embraces the doctrine previously -advanced that the blood is the primary seat of the disease, and becomes -contaminated by the absorption of a specific poison. - - -SECTION II.--PHENOMENA, OR SYMPTOMS. - -The attack of this fearful disease is most generally sudden, the -patient being at the time apparently unconscious of any depressing -influence, or derangement of the system. It is not unfrequent, however, -that some slight irregularity of the bowels, loss of animation -and general vigor, or other apparently trifling indisposition, -have preceded it. In some instances there are definite and decided -premonitory symptoms which continue for a longer or shorter time -prior to the attack, commencing usually with a pallor or collapse of -the countenance, depression of spirits, slight pain in the forehead, -noise in the ears, occasional or transient turns of vertigo, slight -nausea, heat and pain in the epigastrium, oppression at the chest, -with frequent sighing, nervous agitation, some loss of muscular power, -general uneasiness, flatulence, with slight diarrhoea, sickness at -the stomach, occasional twinges of the nerves, or cramps in the -extremities, oppressed, small, feeble, and sometimes intermitting -pulse, coldness, clamminess, or humidity of the surface, and general -lethargy. Such are some of the premonitory symptoms which more -frequently occur in the lower latitudes, where the general vigor -becomes depressed by the long-continued and excessive heat of the -climate. Their duration, whenever any of them do occur, varies -materially; sometimes one, two, or three days--sometimes longer but not -often. - -According to the observations and descriptions given by those who have -had the best opportunities for becoming familiar with all its various -phases, the symptoms attending its invasion and general course are -too distinctly marked to be ever mistaken for any other disease. In -the minds of many who have been called to witness the developments of -cholera, they undoubtedly exist with such distinctness and vividness -as to render the most labored and accurate description tame. In this -treatise, however, a description of the leading and more prominent -phenomena will be given, and so far as a general principle of practice -is concerned, this might be very appropriately limited to its first or -cold stage. - -The commencement of the disease is often so insidious as to pass -unnoticed till the system is fully prepared for the sudden and violent -attack. The slight, painless diarrhoea, depression of the nervous -power, and occasional vertigo may all pass unheeded, and the patient -be apparently in perfect health. He may retire to rest entirely -unconscious of approaching danger, and after enjoying a sound and -undisturbed sleep for hours, be, on awakening from his slumbers, seized -with a remarkable sickness, perhaps vomiting, accompanied with most -remarkable and profuse discharges from the bowels. These inordinate -evacuations are usually attended with severe pains, extending down the -thighs, and a sense of complete and almost perfect exhaustion. The -physical powers and vital energies are immediately prostrated. The -temperature rapidly sinks below the normal standard--the body becomes -benumbed with an icy coldness--the skin becomes shriveled up, and -almost insensible to hot and stimulating fomentations--the breath, -too, as it comes from the lungs, appears to partake of the same icy -coldness, indicating the rapid elimination of heat, or caloric, from -the body. The patient complains of being greatly oppressed, throws off -his clothing--calls for cold water, which he eagerly and copiously -drinks; though it afford no relief to his insatiate thirst, it ought -not to be withheld. This peculiar icy coldness and loss of temperature -is also further shown by the livid, blue, or purple appearance of -the hands and feet, extending sometimes over the greater part of the -body. The skin becomes, even in a few minutes after the seizure, not -only shriveled up, but often curiously wrinkled, as in extreme old -age. Severe spasms in the fingers, toes, legs, and abdomen, cause the -patient to groan and writhe under their influence, and to call on -his attendants, if fortunate enough to have any around him, for aid -and relief from his agonies. As the disease proceeds, there may be -noticed a peculiar, sharp and contracted state of the features, and -a wild and terrified expression of the countenance, arising from the -impression and fearful apprehension of rapidly approaching dissolution. -These important changes may all take place in a very few minutes. To -these most obvious and singular symptoms there is superadded constant -vomiting--incessant purging--low, feeble pulse, though occasionally -natural and sometimes rapid, yet in some instances, from the very -first moment of attack, cannot be discovered either in the large -superficial arteries or at the wrist. The voice is altered, becomes -low, feeble, unnatural in tone, or sinks even to a whisper. Respiration -becomes quick, irregular, laborious and imperfect. The inspiratory -act being performed with difficulty, and expiration being quick and -convulsive. The flow of bile into the intestines is suspended, the -urinary secretion and micturition entirely suppressed. Almost the -only organ which seems to preserve in any good degree its powers is -the brain--the mental faculties in some cases being retained till -the close of life;--in other cases feeble, weak, and much impaired. -On the accession of the spasms, the vomiting--and the purging--the -disease may be considered as being fully developed, and the crisis at -hand, which, in a few hours, must decide the fate of the patient. Its -progress is now rapid, and must speedily terminate either favorably -or unfavorably. If the result be unfavorable, the patient may die with -all these symptoms distinctly and strongly marked. If the termination, -however, be favorable, these violent symptoms soon yield, and seem -to be materially relieved; yet, though these indications favor the -return of normal power--the weakness, the cessation of the pulse, the -coldness and blueness of the surface, and the sepulchral expression of -the countenance, clearly show that a few hours must close the scene. To -many death thus often comes calmly and quietly, without any struggle to -mark the precise time of this life's departure. - -"If the patient," says an eminent author, "should happily survive the -cold stage, the disease may terminate by a rapid recovery, or it may -pass into the second or febrile stage." The former is the more usual -course in India, the latter in Europe. The first symptom of returning -health is shown by the patient falling into a sleep of unusual -soundness, during which the respiration becomes light and easy, -the pulse freer, while a gentle, warm perspiration bedews the whole -body. This grateful pause in the disease appears to be the result of -the returning powers of life, uninfluenced by medicine, for it often -occurs where none has been given. After this balmy slumber the patient -awakes refreshed, and often recovers so rapidly, that in the natives -of India it almost resembles a restoration after syncope. In all the -Presidencies, indeed, and especially in Bengal, the recovery of the -European has, in general, been followed by a stage of reaction, usually -slight, but in some cases assuming the form of the bilious remittent -fever of the country, which has occasionally terminated fatally. -In most cases, however, the reaction is more considerable, and the -patient, in a few hours after the subsidence of the cold stage, labors -under a severe form of fever, resembling the typhoid. During the first -few hours after the febrile reaction commences the tongue is white, -but it quickly becomes brown and dry, while black sordes incrust the -teeth and lips. The eye becomes deeply injected and red, the cheek pale -or flushed, the pulse rapid, and the temperature of the body a little -above the natural standard. The patient, either delirious or comatose, -then lies in a state resembling the last stage of the severest typhoid -fever of this country. This struggle usually lasts from four to eight -days, when the symptoms either gradually yield, or death ensues. In a -few mild cases the fever assumes an intermittent type, or sometimes a -quotidian, sometimes a tertian form: all these cases usually recover. -Such is, in brief, a summary of the more important symptoms of the -Epidemic, or Asiatic Cholera, especially in its earlier or cold stage. -The phenomena, especially developed in, and belonging to, the stage -of reaction, being of minor importance, they have received only a -very brief consideration; sufficient, however, to show the general -character and tendency of the disease in this stage of its progress and -termination. - - - - -CHAPTER III. - -SECTION I.--UNSUCCESSFUL MODES OF TREATMENT--VENOUS TRANSFUSION -EXPLAINED. - - -In this discussion we shall avail ourselves of the researches and -investigations of eminent Professors, whose observations, experience, -and position give their views the highest authority. The latest and -most deserving record on this subject is from the pen of Professor -Aiken, of Edinburgh, who observes, "There are few diseases for the cure -of which so many different remedies and modes of treatment have been -employed as in Cholera, and, unfortunately, without our discovering an -antidote to the poison. In Moscow it is said that the mortality was -not greater among the destitute of medical aid than among those who -had every care and attention shown them. It may be fairly inferred, -therefore, that in the severer forms of the disease, the action of -this poison is so potent as to render the constitution insensible to -the influence of our most powerful remedial agents. When, however, -the disease is mild, or on the decline, much may be done by obviating -symptoms to promote the recovery of the patient." - -"The heroic remedies that have been employed in Cholera are bleeding, -and calomel and opium, either separately or conjointly. With respect -to bleeding, it may be stated, that in every country the patients -bore bleeding badly in any stage, and that the practice in Europe was -at length limited to a few leeches occasionally to the head. As to -calomel, that medicine was used to the greater part of an ounce in the -twenty-four hours, but with so little success that many patients have -been seized and have died under the full influence of mercury. On the -appearance of cholera in Europe, opium was administered in the doses -recommended by the Indian practitioners to the greater part even of an -ounce of laudanum; but it was soon seen that in the cold stage it was -inefficient in controlling the vomiting or purging; that it did not -allay the spasms, and, moreover, hardly produced any narcotic effect. -The action of the accumulated doses of opium, however, though suspended -during the cold stage, was often fully developed in the last stage, -and occasioned so much affection of the head that most practitioners -either abandoned its use or limited it to a mere fractional dose of -that usually given in India, namely, from three to twelve minims of the -tincture of opium, or half a grain to a grain of solid opium every four -or six hours." - -Let us now turn to a paper by the justly celebrated Professor Maclean, -whose observations and experiences have been more extensive than -perhaps those of any other professional gentleman either in Europe or -America. Unlike many of his brethren, he holds on this subject the -safer doctrines of practice, and very frankly and earnestly expresses -the same in the following language: "Opium in cholera should be given -only in the premonitory diarrhoea. At this stage, in combination with -a stimulant, it is of the highest value. If persevered in, particularly -in the strong doses (justly reprobated), it is a dangerous remedy, -inducing fatal narcotism, or, at the least, interfering with the -functions of the kidneys, and so leading directly to uręmic poisoning." - -"Urgent thirst is one of the most distressing symptoms in cholera; -there is incessant craving for cold water, doubtless instinctive, to -correct the inspissated condition of the blood, due to the rapid escape -of the liquor sanguinis. It was formerly the practice to withhold -water--a practice as cruel as it is mischievous. Water in abundance, -pure and cold, should be given to the patient, and he should be -encouraged to drink it, even should a large portion of it be rejected -by the stomach; and when the purging has ceased, some may, with much -advantage, be thrown into the bowel from time to time. - -In the stage of reaction, the fever may be moderated by cold sponging, -or by the wet sheet; the secretion of urine may be promoted by dry -cupping over the loins by the use of chlorate of potash, and the like. -But suppression of this secretion is most to be dreaded where opium has -been too freely used in the treatment. In men of intemperate habits, we -often see, during the stage of reaction, obstinate vomiting of thick, -tenacious, green, paint-looking matter, probably bile pigment, acted -on by some acid in the stomach or alimentary canal. It is a symptom -of evil omen, and often goes on uncontrolled until the patient dies -exhausted, and this although all other symptoms may promise a favorable -issue. I have known it last for a week, resisting all remedies, and -proving fatal when the urinary secretion had been restored and all -cerebral symptoms had subsided. Alkalies in the effervescing form, free -stimulation of the surface, and chloroform in small doses offer the -best hope of relief. The patient should be nourished more by the bowel -than the stomach when vomiting is present. Ice should be not only to -dissolve in the mouth, but to swallow in pieces of convenient size." - -"Another heroic plan," says Dr. Aiken, "peculiar, perhaps, to this -country, which was practiced when the inefficiency of medicines was -generally admitted, was an injection of a solution of half an ounce of -muriate of soda, and four scruples of sesquicarbonate of soda in ten -pints of water, of a temperature varying from 105 to 120 Fah., into the -veins of the suffering patient. The solution was injected slowly; half -an hour being spent in the gradual introduction of the ten pints, and -the immediate effects of this treatment were very striking. The good -effects were rapid in proportion to the heat of the solution, but a -higher temperature than what is stated could not be borne. After the -introduction of a few ounces, the pulse, which had ceased to be felt -at the wrist, became perceptible, and the heat of the body returned. -By the time three or four pints had been injected the pulse was good, -the cramps had ceased, the body, that could not be heated, had become -warm, and instead of cold exudation on the surface, there was a -general moisture; the voice, before hoarse and almost extinct, was now -natural, the hollowness of the eye, the shrunken state of the features, -the leaden hue of the face and body had disappeared, the expression -had become animated, the mind cheerful, the restlessness and uneasy -feelings had vanished, the vertigo and noises of the ear, the sense -of oppression at the precordia had given way to comfortable feelings; -the thirst, however urgent before the operation, was assuaged, and the -secretion of urine restored, though by no means constantly so. But -these promising appearances were not lasting; the vomiting continued, -the evacuations became more profuse, and the patient soon relapsed into -his former state, from which he might again be aroused by a repetition -of the injections; but the amendment was transient, and the fatal -period not long deferred. Of 156 patients thus treated at Drummond -Street Hospital, Edinburgh, under the direction of Dr. Macintosh, only -25 recovered; a lamentably small proportion; and, small as it is, it -seems doubtful if the recoveries were final or complete." - - * * * * * - -But let us turn to another page, whose beauty is especially marred by -unreasonable expedients: "The warm bath," says the writer, "was at -first tried, but discontinued from the uncontrollable nature of the -vomiting and purging, and the oppressive sensation of heat it produced -on the patient's feelings. Mr. Dalton's vapor bath and Turkish baths in -the Hospital at Scutari have been used, but without benefit, and to the -disappointment of the hopes which had been entertained of them." - -"Other methods of restoring warmth were had recourse to, such as -frictions with the hand or by the flesh-brush, or rubbing the body with -some strong stimulant embrocation, compounded of garlic, capsicum, -camphor, cantharides, or other powerful irritants. Mustard poultices -also were often applied to the feet and abdomen, blisters with or -without an addition of oil of turpentine, the part having been -previously rubbed with hot sand; and in cases supposed to be urgent, -the mineral acids, and even boiling water, were employed for the -purpose of producing instant vesication." - -"And, again, we read of those who tried to stimulate the waning powers -of life by galvanism, acupuncture of the heart, issues, setons, moxas, -actual cautery along the spine, and, lastly, by small pieces of linen -dipped in alcohol distributed over the body and then set fire to!!!" -Such are some of the means which have been used in the treatment and -cure of cholera. - -"The failure of such powerful means at length caused most practitioners -to confine themselves to checking the diarrhoea, which so frequently -precedes cholera, and subsequently, to obviating symptoms as they -arose," and for this purpose, returned to and adopted a very simple -stimulating mixture, recommended by the Board of Health: - - Rx. Pulveris Aromat., dram iij. - Tinc. Catechu, " x. - Tinc. Cardamom, C., " vj. - Tinc. Opii, " j. - Mixt. Cretę Preparat., ounce xx. - M.----S., j ounce, as necessary. - -Tinc. Kino, or the decoctum Hęmatoxyli, were sometimes added. - -These remedies, it is said, frequently arrested the attack altogether. -If, however, the disease proceeded and the cold stage of cholera -formed, the same remedies were prescribed in an effervescing draught. -"To promote reaction in cholera and diarrhoea, the following formula -has met with most universal approval in this country and in India. So -highly is it valued, indeed, that it is ordered to be always in store, -and in readiness in the _Medical Field Companion_ of the army when on -the march: - - Rx. Ol. Anisi, } - Ol. Cajeput, } [=a][=a]. dram ss. - Ol. Juniper, } - Ęther, ounce ss. - Liquor Acid. Haleri,[I.] dram ss. - Tinc. Cinnam., ounce ij. - -M.----S.: ten drops every fifteen minutes, in a table-spoonful of water. -An opiate may be given with the first and second dose, but should not -be continued." - -The learned author to whom we have referred, after detailing some of -the various expedients employed in the treatment and cure of cholera, -sums up the whole under the common term--failure--and, in effect, -declares the most powerful remedial agents ineffective and useless in -controlling and subduing this disease. - -This declaration is made in reference to the general result of the -remedies and the various expedients adopted mainly by one class of -physicians, to which special reference has been made. It is therefore -partial, and confined solely to what is erroneously termed the regular -practice. In declaring all remedial agents a failure, does not the -author himself commit a greater failure in omitting to survey the whole -subject of treatment, and to trace out and to show from the application -of the pathology of the disease the probable cause of such failure? - -However formidable this disease may appear, on account of its rapidity -and its firm, unyielding grasp upon the vital powers, the forbidding -and almost hopeless prospect of relief, and the lamentable results -which have attended some modes of treatment, it seems particularly -unfortunate for the profession that there should have been a -disposition on the part of this learned author to abandon all remedial -agents as comparatively useless, without a more thorough investigation -into the cause of failure. On this point no effort or inquiry even is -made. This is the more remarkable and surprising after dwelling at -length on the pathology of the disease. It would seem as if all the -light and science derived from this source for nearly half a century -had been overlooked, or the pathology of the disease, from some cause -not satisfactorily explained, had been deemed unworthy at least in -this instance to dictate the course of treatment. This should govern -in cases of cholera as in all other forms of disease, or else all -our efforts and remedies will prove abortive. Now, had the doctor -carefully investigated the various modes of treatment and compared -the results of each, he might have come to a different conclusion. -But, being confined and limited in his investigations, he is unable -to discover anything reliable or worthy his commendation, except the -formulas above and the recommendation of Dr. Maclean. Among all the -remedies and expedients named, there is only one tending to fulfil, -the indications required, and that one, though prompt and magical in -its effects, has been unequivocally condemned, without looking beyond -the transient result for any light it might shed upon the subject. How -it should have escaped his notice and passed so long unobserved by the -numerous professional gentlemen who had often witnessed the effect, and -were anxiously searching for light and the means of affording relief -to the suffering patient, is a most singular circumstance which can -only be accounted for on the principle that they all were anticipating -some strange phenomenon, or development of cure as mysterious as the -disease itself, which led them to overlook the simple and effective -means of relief so clearly represented and shown in their numerous -experiments for something more heroic and powerful than as yet the -imagination ever conceived. - -If we trace the action of calomel, the use of opium, the effect of -cupping, bleeding, blistering, etc., etc., we shall obtain no very -desirable information; nothing valuable tending to indicate a correct -principle of practice. If we go still further, and examine the tendency -and effects of the various baths exhibited at Scutari, the use of the -flesh-brush, the bare hand, the heated sand, the embrocations, the -turpentine and other irritants, the boiling water, or the burning -alcohol, skinning and cooking the patient alive, we shall be shocked -at the enormous cruelty and barbarity that have been pursued, and turn -from the repulsive exhibition, without discovering one ray of light -to guide us in the right direction. Disappointed and baffled in our -inquiries, shall we here abandon our investigations and dismiss the -whole subject, because our course is involved in difficulties? Would -intelligence and reason justify the neglect to improve the means at -command? We think not; but rather induce us to advance in search of -truth if the elements of success are not quite exhausted. Let us be -encouraged and stimulated to untiring perseverance so long as there -remains any experiment untraced and uninvestigated in its bearing upon -the direct action of the disease. Had Dr. Aiken, or those other eminent -surgeons who took part in those numberless experiments, instituted -on the Continent and in England, especially those who initiated the -process of injecting into the veins a solution of soda raised to a -temperature from 105° to 120° Fahr., continued their investigations -patiently and assiduously, they might probably have discovered long ago -the correct theory of practice for the treatment and cure of cholera. - -But they failed to see, or, if they saw at all, rejected the feeble -ray of light struck out by the experiments in which they had themselves -participated, and like the celebrated Dr. Hunter, who refused to listen -to the discoveries made by his pupil, the indefatigable Jenner, who -traced the identity of the variola with the common disease affecting -the kine; and thence extracted the vaccine lymph and established a -principle by which that loathsome disease and often recurring epidemic -has been nearly banished from the earth. Though they have thus failed, -they have nevertheless left on record, in unmistakable language, -the result of their bold experiments, which we may investigate, and -appropriate the instruction drawn thence for our own and the advantage -of our fellow-men. - -What, then, are these results, regarded as shedding light on this -intricate subject? We refer only to one the most obvious which we have -already cited above. Let us repeat and analyze, and, if practicable, -show the principle evolved. There was, on various occasions, the -solution of soda injected into the veins at the temperature from 105° -to 120° Fahr.: a higher temperature could not be borne. This process -was performed slowly, thirty minutes being occupied in injecting the -ten pints. Now mark the result as the operation proceeds. Says Dr. -Aiken, "After the introduction of a few ounces, the pulse, which had -ceased to be felt at the wrist, became perceptible, and the heat -of the body returned." Mark the language: "only a few ounces" were -required to arrest for the time being, the progress of the disease -and restore warmth to the body; a very remarkable fact, replete with -instruction, as will appear as we proceed. Again says the Dr., "by -the time three or four pints had been injected the pulse was _good_, -the cramps had ceased, the body, that could not be heated, had become -warm, and instead of cold exudation on the surface, there was a general -moisture. The voice, before hoarse and almost extinct, was now natural; -the hollowness of the eye, the shrunken state of the features, the -leaden hue of the face and body had disappeared; the expression -had become animated, the mind cheerful, the restlessness and uneasy -feelings had vanished; the vertigo and noises of the ear, the sense of -oppression at the precordia, had given way to comfortable feelings; -the thirst, however urgent before the operation, was assuaged, and -the secretion of urine restored, though by no means constantly so." -Such is the astonishing result obtained by this experiment, and this, -too, when only three or four ounces had been injected--all the urgent -symptoms mitigated and relieved. What, we ask, could have been more -satisfactory, or better calculated to aid the discovery of an important -truth? Every distinctive and fatal symptom for the time is relieved, -and the normal condition and functions of the system restored; a result -which could only have been obtained by the evolution of a principle of -sufficient promptness and power and diffusibility to arrest and utterly -suspend for a time the force of this disease. - -What, then, was the principle evolved in this experiment, which gave -immediate relief? Did it consist in the half ounce of muriate of soda -alone, or in the four scruples of sesquicarbonate of soda alone, or -in the ten pints of water alone, or in the whole combined, or more -especially in the high temperature to which the solution was raised? It -is a well-established fact that, in order to raise the temperature of -cold water to blood heat and above, a large amount of free caloric must -necessarily be absorbed, and exist mechanically in the fluid; and, in -this condition, the solution was introduced into the veins, and there -evolved its vast amount of free caloric, which immediately permeated -every organ of the system, arresting disease, raising the temperature -of the body, and restoring its normal functions. Of this there can be -little doubt. For free caloric is one of the most prompt, effective and -diffusive stimulants known, and was evidently in this case the remedial -agent which produced the result. True, it may be said the effect was -transitory, and passed off as soon as the caloric became eliminated. -This, however, cannot alter the nature, character, or influence of -the principle on which it was produced. It is usually admitted that a -remedy that has power to control disease, will, by its continued action -and influence, restore the normal condition of the system permanently, -or at least aid Nature to repair her own work. By this we would -not be understood as advising a repetition of the experiment under -consideration, even under the most urgent circumstances; far otherwise -would be our advice. We are arguing for the purpose of evolving and -establishing a general principle of practice. - -The great question, then, is, Did the principle evolved fulfill the -indications required? and if so, is it available and consistent with -the pathology and the peculiar phenomena, or symptoms of the disease? -To settle this point, we need only turn to the law and the testimony, -the very highest authority on the subject. The doctrine now universally -accepted and prevailing regarding its pathology is, that a poison, -virulent, and subtle, and unknown, has been absorbed and infects the -blood, so that, after a longer or shorter time, a primary disease of -this vital fluid is produced, by which the vital energy is impaired, -and all other morbific changes induced. The term "Algide," first used -by the French Pathologists, very accurately describes one of the most -remarkable and constant symptoms, viz., the diminution of animal heat. -On this depend the altered condition of the blood, the depression of -the nervous power, the impaired functions of the respiratory and all -the vital organs which are essentially involved by the disease. The icy -coldness of the surface, the breath, the extremities and general loss -of temperature, all show the character of the disease and the wants of -the system. - -Did, then, the principle evolved accord with the pathology and -phenomena of disease? And did it fulfill the indications required? -If not, we ask by what means was the disease arrested, and all the -urgent symptoms mitigated and relieved, or by what were the good -effects produced, and the normal action for a time restored? Can the -result be reasonably accounted for on any other principle than the one -assigned--the stimulating power of the free caloric? We think not; for -it accords most perfectly with the pathology and the peculiar phenomena -of the disease. It assuaged the more urgent symptoms, answered the -imperious demand of the waning powers, revivified and reinvigorated -the vital energies, and restored for the time the normal tone of -the system. What more could be desired in any single agent than the -result here obtained? That it accomplished all this, there can be no -question, according to the statement of the learned professors who have -repeatedly witnessed and described the results. - -The question, however, will arise, Can this principle be rendered -available? Most certainly it can; and though it may not be convenient -to introduce free caloric into the stomach, we can, by combination, -introduce a stimulant of equal potency which shall be equally -as prompt, effective and diffusive in its action, similar in its -influence, and similar in its results. It is the principle--not the -precise element for which we contend. - -It is universally admitted that in many instances we may learn much -from observing the manner of death which, in a majority of these cases -of cholera, may be described by the term asthenia--a death similar to -that which occurs in congestive fevers, and in some cases of accidental -poisoning. Perhaps the most striking fact observed in these cases is -the perfect exhaustion attending the last moments of existence, and -the quiet, undisturbed manner in which life terminates. This very -clearly shows the exhausting nature and congestive character of the -disease, and gives us an idea of the course of treatment necessary to -be pursued. If, then, there is anything to be learned from this source -relative to its treatment, it does most certainly corroborate and -strengthen the position we have here taken. - -Another feature of the case in aid of our position consists in its -entire accordance with the modes of treatment which have been most -successful in the cure of cholera. The two formulas cited above, and -now most universally adopted in Europe and India, are based on a -similar principle. So in this country 1832,-33 and 34, the successful -modes of treatment consisted in the adoption of a principle essentially -similar. Hence we infer from the teachings of this experiment, and from -all the collateral facts on the subject, that the general principle to -be observed in the treatment of this disease is a prompt and diffusive -stimulant; and hence we deduce the doctrine already apparent, that -every form of treatment, to be successful, must be based on a prompt -and effective stimulant of sufficient power to meet as speedily the -indications required, as did the free caloric in the experiment to -which we have referred. - -Here we might pause for a moment and examine the suggestion and -doctrines advanced by the learned Drs. Bell, Johnson, and many -other eminent practitioners in India and Europe. We might further -investigate the principles and trace the practical philosophy of such -eminent surgeons, as Drs. Mackintosh, Thompson, Wallis Maxwell, Massy, -Hill and Brady, all of whom have had opportunity of investigating the -nature and character of the disease and extensive experience in its -treatment. - -We might also, in a further examination of the subject, embrace a host -of American authors whose works teem with every shade of doctrine, -and almost every variety and description of practice, some evincing a -degree of skepticism on the subject more wonderful and marvelous than -is becoming the great apostles of medicine. It would seem as if the -guiding light of science and experience had forsaken them in this, the -hour of their need; that facts and arguments had failed to illumine -their minds, or direct their inquiries in the proper course for the -discovery of "the truth." Their conclusions on this subject are, -therefore, marvelously inconsistent and conflicting. Over this mass -of specious and conflicting testimony we might long ponder, without -deriving any very valuable information worthy an elaborate effort, or -making any discovery to aid in the establishment of a general principle -of practice for the cure of cholera. But this investigation must be -deferred to another occasion, when time may permit a more thorough -and critical examination of their doctrines and practice than can be -presented in this brief essay. We would, however, remark in passing, -that in some instances their philosophy, doctrines, and results may -lead us to the same conclusion to which we have arrived from other -sources as above, and from our regard and belief in the progress of -science, feel compelled to advocate the same, as offering the best hope -of success in the treatment of this disease. - -In the employment of an anti-miasmatic principle and remedial agent, -we feel ourselves abundantly sustained, by the concurrent testimony, -of those English surgeons connected with the Medical Bureau in the -department of India, whose numerous experiments and carefully detailed -clinic cases occurring in the recent irruption and prevalence of -the disease in that section, exhibit its utility in such a striking -contrast with all former practice, as to leave no doubt as to its -direct and specific action in the cure of cholera. It is in allusion to -these experiments, and in answer to the question, what is deemed the -most successful mode of treatment, that the learned Professor Maclean -unhesitatingly observes, "Alkalies in the effervescing form, free -stimulation of the surface, and chloroform in small doses, offer the -best hope of relief." As this opinion comes from such high authority, -and is compatible with the pathology of the disease, we may, without -fear of controversy, add in conclusion, in any and every form of -medication for the cure of cholera, we must not forget that chloroform -is our sheet-anchor; and must be so combined and administered as to -meet promptly the indications required. - - -SECTION II.--PHYSIOLOGICAL CONDITION OF THE BLOOD. - -ITS NON-AERATION--NON-OXYDATION. - -In the preceding section we alluded to the suggestions and doctrines -advanced by the learned Dr. C. W. Bell, Physician to the Manchester -Infirmary, and late Physician to H. M. Embassy in Persia--and also -to Dr. George Johnson, of Kings College, whose views and doctrines, -relative to the Pathology, illustrative of the congestive character -and non-aeration of the blood, coincide with those of Dr. Bell. A -brief examination of their philosophy and doctrines will show very -conclusively the first direct impression of the poison--the gradually -altered condition of the blood, and the corresponding loss of nerve -power--the impeded arterial circulation and the general tendency to -congestion, as well as the altered condition and stagnation of the -blood, especially during the stage of collapse. - -The question is asked, "What is the pathological explanation of this -remarkable train of symptoms?" and the answer is given, "The one great -central fact is this, that during the stage of collapse, the passage of -blood through the lungs, from the right to the left side of the heart, -is in a greater or less degree impeded." Very conclusive evidence as to -the existence of impeded pulmonary circulation during life is afforded -by the appearances observed in the heart, blood-vessels, and lungs -after death. - -After adducing the evidence of this impediment from _post-mortem_ -examinations, and affirming that the blood does not flow freely -through the lungs and pulmonary arteries, which are often filled and -much distended with blood, it is observed--"The most interesting and -conclusive evidence that arrest of blood in the lungs is the true key -to the pathology of choleraic collapse, is to be found in the simple -yet complete explanation which it affords of all the most striking -chemical phenomena of the disease, the imperfect aeration of the -blood, and the suppression of bile and urine." - -And again, says the learned author, "It is obvious that the stream of -blood from the pulmonary capillaries to the left side of the heart -is the channel by which the supply of oxygen is introduced into the -system. One necessary consequence, then, of a great diminution in the -volume of blood transmitted to the left side of the heart must be, -that the supply of oxygen is lessened in a corresponding degree. This -position, probably, will not be disputed by any one who will give the -subject a moment's consideration. Nor, again, can it be denied or -doubted that certain results must of necessity follow this limited -supply of oxygen." * * * - -"The blood in cholera is black and thick only during the stage of -collapse; in other words, during the stage of pulmonary obstruction and -defective aeration." - -Again, in his explanation of the injection of the solution of soda -into the veins of the suffering patient, it is affirmed, "The benefit, -however, is of but short duration, for the primary cause of the -impeded circulation, namely, the poisoned condition of the blood, -being still in operation, * * * the stream of blood through the lungs -will soon again be obstructed, and the patient thus passes into a -state of collapse as profound as, and more hopeless than, before. It -appears, therefore, that the hot saline injection into the veins and -the operation of venesection, when it rapidly relieves, as it often has -done, the symptoms of collapse, have this effect in common, that they -facilitate the passage of the blood through the lungs, and thus lessen -that embarrassment of the pulmonary circulation which is the essential -cause of choleraic collapse. But whereas the _hot injections act_ by -removing the impediment which results from spasmodic contraction of the -arteries; _venesection acts_ by relieving over-distension of the right -cavities of the heart, and thus increasing the contractile power of -their walls." - -Such are, in brief, the views of the learned Drs. Johnson and Bell, -whose works are very highly commended by their American editor to -the notice of the profession. These views, coming as they do from -the highest authority, fully sustain the doctrine that the earliest -impression of the disease is made upon the blood, and hence it becomes -altered and changed in its most essential life-sustaining principle; -for its oxygen becomes diminished, its consistency augmented, and its -flow through the lungs impeded. Through this channel the effect of -the poison soon makes an impression on the ganglionic mechanism, and -the nerve-power becomes correspondingly diminished, and the action -of the ganglionic nerves essentially deranged. But this is not all: -they exhibit in the clearest manner the congestive character of the -disease, and show the necessity of prompt and decided means to arrest -this tendency. Hence, they urge, in the strongest terms, the importance -of observing carefully this essential feature, and endeavor to exhibit -fully the condition of this vital fluid at a particular stage of -the disease, when bleeding, as recommended in their practice, is -required, and may be performed to the best advantage for the relief -of the partially congested blood-vessels, and to stimulate and give -freedom to the circulation. The passage of the blood, they affirm, is -impeded, clogged, and partially suspended. To remove this obstruction, -relieve spasm, and secure the prompt aeration of the blood, in hope -of arresting the progress of this disease, is ostensibly the object. -However, they seem studiously to avoid the most logical conclusions of -their explanations, and justify a practice that can give no hope of -permanent relief, while every fact and symptom is ominously suggestive -of the wants of the system, which imperiously demands the aid of -electrified oxygen, ozone, or free caloric, for the oxydation of the -blood. - -Says Dr. Reid, "I believe the true explanation of the arrest of blood -in the lungs to be this: The blood contains a poison, whose irritant -action upon the muscular tissue is shown by the painful cramps which it -occasions. The blood thus poisoned excites contraction of the muscular -walls of the minute pulmonary arteries, the effect of which is to -diminish, and, in fatal cases, entirely to arrest the flow of blood -through the lungs." - -Says Dr. Wallis, "The phenomena which are exhibited when the -deleterious air has been drawn into the lungs are these: the great -gastro-pulmonary nerve is either wholly or partially paralyzed; the -consequences are the cessation of all its functions, either wholly or -partially. This great nerve is a nerve of function, and performs the -functions of digestion and respiration, and influences all secretions." - -Dr. Maxwell, of Calcutta, uses the following language: "The development -of the stages of fever entirely depends on the changes the _leaven -has effected_. If this change has been such that the blood has become -too thick to flow through the lungs, then, as a matter of course, -the collapse stage is developed in excess; in other words, _cholera -asphyxia_ is exhibited. The blood, unable to pass through the middle -passage into the arteries, collects and swells out the veins, giving -that deadly or blue color to the skin. When the vomiting and spasms -come on, this mass of blood in the veins is squeezed with great force, -and hence the clammy moisture that is forced from every part during -these fits. There is no pulse, because there is no blood in the -arteries." "There are also lethargy and languor, and oppression in -breathing, caused by the blood being collected in the veins. These make -up the principal links in the chain of mechanical symptoms." - -Dr. Bell, dwelling on this congestive character of the blood, and -endeavoring to point out the best mode of relief, observes, "When this -has reached to such a point as to oppress the action of the heart, -yawning first and then shivering, or a sense of suffocation and pain -in the precordia, are the indications of oppressed circulation, and -of the commencing effort of the heart to overcome the mass of blood -which is stifling it. If, by the application of tourniquets to the -limbs, or by _bleeding_, part of the blood which is rushing from the -extremities to increase this congestion is prevented from reaching the -great veins, the heart, excited to increased action, is enabled, by -this relief, more quickly to overcome the obstruction and restore the -balance of the circulation, and the paroxysm passes off. If not thus -mechanically aided, the heart, after a severe struggle to maintain the -circulation during the period of constriction, is at length relieved -by this nervous disturbance or spasm of the capillary circulation -passing off of itself, and then the heart and arteries, so long excited -by the struggle, maintain for a time their increased action after -the obstruction in the capillaries is removed, and produce apparent -febrile action. Presently this excitement subsides, the vessels become -relaxed, and sweat succeeds. The vessels continue in this state for -a longer or shorter period, according to circumstances, till they at -length recover their ordinary tone and action in the intermission. This -fever, however, is not fever properly so called, but reaction; and the -sweating not critical, or essential, but relaxation. The cold stage -is alone essential, and is the physiological cause of the subsequent -stages." - -From the passages we have cited, it is quite evident that Drs. Johnson, -Bell, Parkes, Reid, Wallis, Maxwell, Massy, and many others, admit this -congestive character and impeded circulation of the blood to be the -result, or consequent of a primary affection of the blood, as we have -already observed in a former paper. The _term_ "Algide" is peculiarly -expressive of the diminished animal heat, and, as Dr. Bell represents, -it is the cold stage which is alone essential, and is the physiological -cause of the subsequent stages. It is the specific disease-poison, so -often referred to, that has been inhaled, the leaven that has effected -such obvious changes in the blood. The poison, virulent, and subtle, -and unknown, so marvelously active in its operations, that is exhibited -so prominently in all the works we have perused as the one great, -mysterious, and efficient cause which produces the disease called -cholera, and all the phenomena of its development. To its direct and -specific action, therefore, must be attributed all the phenomena of -the disease as the resulting subsequent consequences. - -It is also further evident, from the pathological facts and arguments -adduced in support of this theory of congestion, that the abnormal -condition or state of the blood-vessels is the result and the product -of the activity of the primary or final cause, and must be regarded -in relation to it as cause and effect. On this principle alone, the -thickening of the blood, the contraction of the left ventricle of the -heart, and of the capillary and pulmonary arteries, assigned by some as -the cause of choleraic collapse, must be accounted for. These effects -are not and cannot be from a process independent and outside of the -primary disease action, but are the result of such primary action. - -Again, it is evident, from the views and doctrines cited above, that -the disease is decidedly congestive in its tendency and character from -its very commencement. The impeded flow of the blood--the comparative -emptiness of the left ventricle of the heart and arteries--and -the excessive loss of temperature, all indicate a rapid process of -congestion attending the progress of disease. This is one of the -peculiar and prominent features of cholera, and is strikingly exhibited -in the morbid appearances observed in all those instances where death -has occurred within a few minutes from the first indications of attack. - -When the attack is violent, the process is rapid; when mild, it is -slow; and even in the collapse stage progresses tardily. In either case -it is the direct resulting consequent of the primary cause. How else -can the violent attacks, suddenly terminating in death, be accounted -for? To what other principle can this altered condition and stagnation -of the blood be attributed? The evidence confirmatory of this position -is abundant and conclusive. Many instances of the apparently rapid -action of the cholera poison are related by Dr. Milroy, in a historical -sketch of the epidemic of 1817; and at Kurrachee in 1855 and 6, it is -said, that within little more than five minutes, hale and hearty men -are seized, cramped, collapsed, and dead!! - -When the disease broke out at Teheran, in May, 1846, Dr. Milroy states -that those who were attacked dropped suddenly down in a state of -lethargy, and at the end of two or three hours expired, without any -convulsions or vomitings, but from a complete stagnation of the blood. - -In the paper before us, it is stated, that "in a great majority of -cases in which death has occurred during the stage of collapse, the -right side of the heart and the pulmonary arteries are filled, and -sometimes distended with blood; the auricle being partially, and the -ventricle completely and firmly contracted. The tissue of the lungs is, -in most cases, of pale color, dense in texture, and contains less than -the usual amount of blood and air. There is something surprising in -the contrast between the almost constant occurrence of this extremely -anęmic condition of the lung, from which scarcely even a few drops -of blood flow when the tissue is cut, and the hyperęmia of most -of the other viscera." This impeded flow of the blood through the -lungs, resulting, as it must, in a very scanty supply of blood to the -arteries, in connection with the corresponding fact of the increased -expansion of the veins, filled with black, and thick, and stagnant -blood which, by the action of a powerful poison, or malignant disease, -has become disorganized and unfitted for circulation, furnishes -indubitable evidence of one prominent and characteristic feature of -cholera which we term congestion, and to which we alluded in our -remarks when the question under consideration was first introduced; -in this view we are happy to find ourselves, on a more thorough -examination of the subject, ably sustained by eminent pathologists -and authors, who have arisen during the half century last past, and -whose works are said to embrace all that is known and reliable on the -character and treatment of Epidemic Cholera. - -It is worthy of notice, before passing from this part of our subject, -that according to Dr. Bell's _views_, the blood is forcibly sent into -the great central veins, and there stopped in its course without any -attempt to account satisfactorily for its singular arrest, at that -point--Dr. Johnson comes to his relief, lifts the veil, and explains -why it is kept there and cannot get any further. If the road, he tells -us, had been clear and uninterrupted through the lungs, the blood would -easily have got round to the left ventricle, and have again gone its -round, but it is stopped by the spasmodic contraction of the minute -branches of the pulmonary artery, which will not even allow the blood -to enter the pulmonary capillaries, as shown by the remarkable anęmia -of the texture of the lungs. - -In this connection may be introduced an opinion as to the cause of -the disease and some of its phenomena, which has obtained at least -some celebrity, and attracted the attention, if not the careful -consideration of the profession. It will account, in part, if founded -in fact, for the physiological condition under consideration. - -It is said, some have observed a chemical change in the constitution -of the atmosphere, and have attributed the cause of the cholera to -the loss or diminution of its ozone--a principle which is understood -to represent what is very properly termed electrified oxygen. Ozone -is, therefore, the vital element of the air. It is said that oxygen -cannot be assimilated or combined with the blood except when it is -in an electrified state constituting the peculiar property or state -of ozone. In this state it produces vital electricity of the blood, -_which is the life_. The brain is considered and represented as the -reservoir of this vital electricity, and the nerves are the telegraphic -wires or conductors of it. As a necessary consequence, all acts of -material and intellectual life depend upon this double cause. The -absence, then, it is affirmed, of this principle, termed ozone--or -electrified oxygen--from the atmospheric air in certain localities -and the consequent non-aeration or non-oxydation of the blood, may be -considered as an efficient cause which will account for some of the -most striking phenomena of the cholera. - -Whether this electrified oxygen, or ozone, is identical with free -caloric, it is unnecessary for our purpose at present to determine. It -will be admitted that oxygen is the source of animal heat, and when -introduced into the system generates its free caloric, which is an -essential life-sustaining principle. - -Dr. Massy, after describing a severe and advanced stage of cholera, -observes, "The treatment of this case depends in the first instance -on bleeding, and largely, if the patient's pulse is good, giving at -the same time twenty grains of calomel with one of opium. This, he -thinks, will be found the best practice. After twenty minutes, he gives -ten grains more of calomel and half a grain of opium. He considers, -however, a reliance on opium in this form of cholera most faulty--but -observes, as you draw blood, stimulate, give punch, brandy, or wine -and water, or carbonate of ammonia. Apply friction, with stimulating -and hot liniments to the extremities, warm sand-bags to the feet, -sinapisms to the calves of the legs and pit of the stomach; for, if -you can once raise the pulse, the chances in favor of recovery will be -vastly increased." The practice of bleeding and stimulating at the same -time is deemed of vast importance. Dr. Bell coincides in this view, and -devotes much space to the necessary instruction as to the time when and -under what circumstances to bleed and to what extent, endeavoring to -show the advantages arising from a strict observance of certain rules -in carrying out this practice. - -We have thus traced, _in extenso_, the views and doctrines of eminent -surgeons and authors on the changes of the blood, and especially of -the impeded circulation, to show, if practicable, the inconsistency of -the more common and prevailing practice, and its utter inadaptation -to the pathology and phenomena of disease. On the latter there seems -to be little or no discrepancy--on the former there is a great -diversity--as there has been no general principle established and -laid down as the basis of treatment and cure of cholera. It has -often been observed there is no disease on which so many different -modes of practice have prevailed, some purely experimental, others -empirical--and all without discovering an antidote to the poison, or -any efficient mode of relief. The cause, or the poison producing the -disease, still remains undiscovered. The direct mode of suspending -and removing it, or counteracting its power and neutralizing its -effect, and subsequently eliminating _it_ from the system, remains -still in doubt. What course, then, should the epidemic cholera again -prevail in our midst, shall we pursue? Shall we rest satisfied with -the diversified modes of treatment now prevailing? Or guided by the -light of reason, science and experience, endeavor to adopt a general -principle of practice, and exhibit and establish an efficient and -judicious system, consistent with the pathology and the phenomena of -the disease? Does then the practice, the prominent features of which -are given above, accord with the indications required? In short, does -the exhibition of bleeding and calomel and opium, accompanied with -sinapisms, and hot, stimulating applications to the surface, meet -the pathological condition and the phenomena of the disease? We have -seen that the rapid changes in the blood, and the consequent direct -tendency to congestion, are the proper and distinguishing features of -the disease;--and hence the diminution of animal heat and general loss -of temperature and their consequent effect, impeding the circulation, -depressing and prostrating the nervous power--impairing and paralyzing -the respiratory organs--suspending the functions of the liver and -kidneys--enfeebling the action of the heart, and causing the capillary -vessels of the mucous surfaces to pour off the serous fluid from the -blood, and every muscle and tissue of the system with great rapidity, -essentially constitute the phenomena of the cholera;--and that the -constantly increasing augmentation of the poison and its intensified -effects, measure the malignity, the violence, and the rapidity of the -disease. Is there, then, any tendency in bleeding to arrest this rapid -process of disease so disorganizing, depreciating, and enfeebling to -the vital life-sustaining fluid, the blood? Can abstracting a portion -of it, however large, suspend the poison, or its activity, or even -check its progress in its rapid course and fatal termination? Can it -have, under its depressing and depleting process, any tendency or -power to relieve the congestion that is taking place, or change in any -good degree the poisonous principle which is now generally admitted -to exist in the blood, and to be the sole and efficient cause of its -altered character and condition? The poison, once introduced into the -blood, like the leaven hid in three measures of meal, will continue -its activity, increasing its energy, and multiplying its forces, till -the whole circulation becomes affected, and its life-sustaining power -is destroyed and utterly lost, unless, by the exhibition of some -remedial agent, it shall be promptly arrested in its progress, and -suspended and eliminated. Again we ask, Will calomel fulfill any of -the indications required? Has it any influence or power to arrest this -disease, to quiet the nervous system, relieve the cramps, or restore -warmth to the body? Its specific action, so far as known, can have no -tendency whatever to relieve the system in any essential particular, -or stay the progress of disease, or delay its inevitable result, if it -remain unsubdued by the action of other remedies. Its action upon the -liver, however prompt it may be, is only of a secondary importance. The -primary cause must be overcome, its activity and energy suspended and -the system generally relieved, or there is little hope in the case. - -Here we may ask, Will opium aid, or give the relief so urgently -demanded? However serviceable as an astringent and anodyne in the -premonitory stage of the disease, it cannot be exhibited in the second -stage to so good an advantage, as its direct influence is to aid and -promote congestion in those cases, where a tendency of this kind is -already in existence. Hence, its continuance in the true or collapse -stage of cholera is now generally considered faulty. - -Once more: The auxiliaries employed in aid of the leading remedies -already noticed may be summed up in the language of the celebrated -Dr. Massy, in his instructions and directions on the subject of the -treatment now under consideration. He observes, "But, as you draw -blood, stimulate, give punch, brandy, or wine and water, or carbonate -of ammonia. Apply friction, with stimulating and hot liniments to the -extremities; warm sand-bags to the feet, sinapisms to the calves of the -legs and pit of the stomach; for, if you can once raise the pulse, the -chances in favor of recovery will be vastly increased." - -To these directions there can be no special objections, except in the -first instance in which he, indirectly, commends the use of means -tending to deplete and depress the system, already brought by disease -to the very verge of utter exhaustion. Remedies of this tendency -are contra-indicated, and cannot, to say the least, be employed to -advantage. - -Depressing remedies generally, instead of checking, or counteracting -the disease, will inevitably aid and hasten its fatal termination. -Stimulants, such as are prompt and diffusive in their character, must -be regarded as essential, and may be employed to great advantage. It -will be found, however, exceedingly difficult in most cases, even -where there is no depletion from bleeding, to keep up the waning -powers, and carry the patient, through this formidable disease, to -a favorable termination. Of the utility of warm applications to the -surface generally, there can be no question; yet, our main reliance is -on internal remedies, as has been already shown: the lost temperature -of the body must be restored, the production and diffusion of heat, or -caloric, must be internal through the administration of remedies, that -will promptly and kindly produce this result. - -What are, then, the remedies? We have ventured in this discussion -to recommend the internal use of chloroform, and believe it will be -found in combination with other prompt and diffusive stimulants, -specially adapted to meet this condition. In this recommendation, we -feel ourselves fully sustained by the result of various experiments -heretofore made, and the recent trials of its use, as an internal -remedy in the various stages of the disease. - -The earliest record of the use of chloroform in cholera is probably -to be found in the London _Lancet_ for November, 1848, in which Dr. -Hill reports a case of its successful use by inhalation. He placed -the patient in bed, covered with warm blankets, and applied friction, -stimulant liniments, and heated bags of bran to the surface, and kept -the patient under the gentle influence of chloroform, till the more -urgent symptoms entirely subsided. At intervals brandy-and-water, and -thin arrow-root or milk was given. All other medicines were avoided. -Though the urgent symptoms returned at first, as the effects of the -chloroform passed off, they were easily controlled by the repetition -of the inhalation. By persevering in its use, reaction set in, and the -patient became convalescent. - -Other cases, afterwards, were treated in the same way, with a similar -result. Some, however, required the gentle use of chloroform by -inhalation, at intervals, for twenty-four hours; after which, none -seems to have been administered. For aught that appears these cases all -recovered. - -Another very interesting case is related by Mr. Brady, who observes -that an elderly lady was seized with slight diarrhoea, which, on -the following morning, had become very profuse: excessive vomiting -supervened, accompanied by spasms in the calves of the legs, fingers -and toes. Under these urgent symptoms, the usual remedy, brandy, was -administered without avail; the dejections became incessant, and the -spasms increased in intensity, presenting the features of a decided -case of malignant cholera. In this condition, the physician was called -in haste, as it was believed and affirmed the patient was dying. -In describing this case, the physician observes: "On my arrival, I -found the patient presenting all the symptoms of malignant Asiatic -cholera, in an advanced stage; the features collapsed and ghastly; -extremities and tongue cold; burning sensation in the stomach and -oesophagus; pulse rapid and scarcely perceptible; voice diminished -to a whisper; stomach exceedingly irritable, and the dejections from -the bowels presenting the characteristic rice-water appearance; and -all the voluntary muscles of the body were affected by spasm, so that -the patient actually writhed in agony." Ordered the following: Rx. -Chloroform dram j; Ol. Terebinth. ounce j; aq. Dist. dram iij. M. And -gave immediately a large tea-spoonful, in a wine-glass, of dilute -brandy; and applied sinapisms to the calves of the legs and abdominal -and thoracic surfaces. Thirst was relieved by drinking plentifully of -water nearly cold. Though the stomach was irritable, the chloroform was -retained, as well as the fluid drank after it, and was followed by no -dejection. Half an hour after, two pills were administered, composed -according to the following: Rx. Calomel gr. v; fellis. bov. inspis. -gr. x; Ft. Pil. ij. Half an hour after these were given, vomiting -ensued, but soon subsided; the diarrhoea had apparently ceased; the -cramps had diminished in frequency and severity. A second dose of -chloroform, now one hour after the first, was administered, and soon -after this two more of the pills, both of which were retained, and gave -decided relief. The pulse rose in power and became slower, the spasms -less frequent, and, in an hour after the second dose, the patient was -bathed from head to foot in a warm perspiration, and expressed herself -comparatively free from all uneasy sensations. The attack had been -completely subdued, leaving behind a good deal of pyrexia and debility, -from which she rapidly recovered. - -Here it is worthy of notice, that in this case, severe as it was, only -two doses of the chloroform mixture were administered, each containing -about six minims of chloroform and forty of turpentine; the pills -would naturally tend to perpetuate rather than relieve the nausea and -vomiting, and in one hour after the administration of the second dose, -all the urgent symptoms were assuaged. - -In another case, the attending physician reports that, after giving -calomel, combined with opium, which was immediately rejected, the -following mixture was ordered: Rx. Chloroform vj minims; brandy dram -iij; water ounce iijss, one-third of which was given immediately, -and was thrown up in half an hour; a second dose was then given, and -was retained. The vomiting and diarrhoea ceased; the spasms became -less severe. In two hours after, gave the remaining third part; and -during the next six hours, administered in two doses six minims more -of the chloroform, with the most decided benefit, and the patient soon -became convalescent. To the extreme tenderness over the region of the -epigastrium flannel soaked in spirits of turpentine was applied; and -as no urine was secreted, I am firmly of the opinion that the usual -remedies would not have met this case. "I candidly confess," says the -physician, "I had no hope of success from its severity; and, but for -a knowledge of Mr. Brady's case, I believe I should have lost my -patient." - -Dr. Davies reports a case in which he used chloroform fifteen hours -after the seizure with relief, but not with success, and observes that, -in a number of cases occurring in the hospital, there were 22 cases in -which, as severe symptoms came on, the chief remedy was chloroform, -administered internally, in doses of from seven to ten minims every -hour, half hour, or quarter of an hour, according to the severity of -the symptoms. Of these 22 cases, 8 terminated fatally, and 14 recovered. - -Again: "Out of 9 cases of cholera, and 13 of the worst cases of -diarrhoea occurring in my own practice, and treated with chloroform, -_one died_. All these were in the better ranks of life. In some of -them, the warm bath (salt water) was used as an auxiliary, and the -diet consisted of nothing but cold milk and water, with some carbonate -of soda, _ad libitum_. The fatal case was that of a drunkard, who, -probably, did not take the remedy. These cases varied in severity, -from sickness and diarrhoea, and mild collapse, to sickness, -diarrhoea, severe cramps, and great collapse, with almost clear watery -evacuations, passing away involuntarily * * * Of 14 cases of cholera -treated by Mr. Towers, Medical Resident of the Infirmary, many of -them under my own observation, _one died_. The fatal case was that -of a woman aged 63, who was previously suffering great depression, -consequent on extreme destitution." - -Again, says Dr. Davies, "It will probably be remembered that, in my -second report, I expressed a very favorable opinion of chloroform in -this deadly malady. I considered I had strong grounds for so doing, -after observing the large proportion of cases which recovered under -its administration. From the history of this last visitation in the -county prison, however, the fact turns out, that, under some uncertain -circumstances, the use of chloroform will not prevent the proportion of -deaths being considerable. I have reason to believe that it was, from -over-anxiety, given in too frequent doses in some cases, and that it -thus rather added to the coma, which is one of the characteristics of -the malady. - -At the commencement of the outbreak, the doses were repeated every -hour, or every two hours, and it is to be noted that the first seven -cases _recovered_. - -As the cases multiplied, the remedy was given every half hour, and, in -some instances, every quarter of an hour; the result was that the next -six cases died. Whether these cases had anything in them inherently -more fatal, it is difficult to tell. The symptoms at first were about -equal, and the differences did not show themselves until towards the -end. There was next a recovery of seven cases in succession; in these -the remedy was administered less frequently, but subsequently two -deaths occurred under the less frequent administration. - -The chloroform was administered also by inhalation, in some of the -more severe cases of cramps, with the effect of affording relief in -every instance. The inhalation was not carried so far as to produce -insensibility. Although I am still of the opinion that chloroform -properly regulated is the remedy of all others hitherto tried to be -depended on, yet it cannot be considered a specific for cholera." - -Mr. Steadman reports a very interesting case treated by chloroform. -He observes, "The spasms were universal and extremely violent, as if -knots were being tied in the bowels, countenance livid and cold, voice -feeble, and all medicines rejected. In this condition gave chloroform -combined with 'aquę vitę' and distilled water. The first dose had -a partial but most satisfactory effect. In two hours after, as the -symptoms manifested a disposition to return, gave a second dose, which -entirely controlled all spasms, vomiting and purging. The patient was -ordered cold rice and mucilaginous drinks, and had the chalk mixture -with nitric ether prescribed. A dose of oxgall (gr. x) was given in -course of the day, which produced the desired effect. In two days the -patient was declared convalescent." The daughter, who had nursed the -mother in this case, was seized soon after in a similar manner, except -the dejections were more abundant and frequent. The mother having some -of the chloroform mixture left, gave it to the daughter without advice -or hesitancy, and obtained the same magic results. The first dose was -only partial in its effect, but the second completely subdued the -disease. - -Such are the results of some of the experiments which have been made -by the administration of chloroform; and, so far as appears, the first -cases treated by inhalation were severe malignant cholera in the -advanced stage, all of which recovered. So, also, those treated by the -remedy used internally, combined with a prompt and decided stimulant -like the spirits of turpentine, or aquę vitę and brandy, recovered. -In all these cases the remedy appeared to meet the urgent demand, to -remove the impediment to the circulation, to relieve the nausea and -vomiting, and purging and cramps, and restore, in a very short time, -the general action and normal tone of the system. Still we must admit, -that some cases, treated by its internal administration, and also by -inhalation, proved, on some accounts not satisfactorily explained, -unsuccessful. Were these cases given in detail, it would be much easier -to detect the cause of failure, or its questionable use in such cases; -but we have only the bare fact that they were thus treated, without the -manner or character of the combination, if any were made, being given. - -Hence Dr. Davies, under whose direction these cases occurred, -remarks, in view of this result, "that _no reliance_ could be placed -on chloroform alone." The correctness of this opinion cannot be -questioned, for the experiments we have cited all show the necessity -of a prompt and diffusive stimulant in aid of its action, to render it -sufficiently prompt and powerful to meet and overcome the disease in -the more rapid and severe cases. Chloroform, properly combined, offers -the best hope of relief, and is, without doubt, the most perfectly -adapted of any remedy known to the pathology and phenomena of the -disease. There is no remedy, when properly combined, so capable of -meeting all the indications required as this, and none that can be -administered with more certainty of success. - -In conclusion, we may, with much propriety, refer again to the -pathology suggested by the authors cited above, and inquire whether -the action of chloroform as a remedy in these cases be consistent? and -whether as such it has that curative influence, or direct controlling -power, to arrest, suspend, and cure the disease, so imperiously -demanded? We have seen that, according to the opinion generally -prevailing, the first impression of the poison is made upon the -blood, and through it upon the nerves, especially those which, from -their anatomical position, bear the most intimate relation to the -blood-vessels. Through this channel the first invasion appears to be -made on the ganglionic, the nerves of circulation. These nerves are -distributed chiefly to the viscera and blood-vessels, and are at least -very early involved and essentially disturbed, for their healthful -action depends in no small degree on the aeration or oxydation of -the blood. Says an eminent author, "The action of every ganglionic -mechanism depends on the existence of certain physical conditions, -among which the most prominent and important is the due supply of -arterialized blood. If this be stopped but for a moment the nerve -mechanism loses its power, or, if diminished, the display of its -characteristic phenomena correspondingly declines." Hence the loss -of power in these nerves, and their deranged action, the contraction -of the capillary and pulmonary arteries, the impaired and impeded -circulation and all the phenomena arising therefrom. - -Again, the great pneumogastric nerve, which is composed of both motor -and sensitive filaments, has a very extensive distribution in the -upper part of the abdominal cavity. It supplies the organs of voice -and respiration with motor and sensitive fibres, and the pharynx, -oesophagus, stomach and heart with motor influence. This very important -nerve, through the primary action and deteriorating process of the -cholera poison, becomes early involved, and its functions greatly, and, -in fatal cases, permanently deranged. The evidence of this disturbance -and loss of nerve-power is too obvious to be overlooked or disregarded -in the treatment of this disease. - -In confirmation of this, we may, with great propriety, adduce the -testimony of Dr. Wallis on the loss of nerve-power, and the process -through which the result is produced, who observes, that "the phenomena -which are exhibited when the deleterious air has been drawn into the -lungs are these: the great gastro-pulmonary nerve is either wholly or -partially paralyzed, the consequences are the cessation of all its -functions either wholly or partially. This great nerve is a nerve of -function, and performs the functions of digestion and respiration, and -influences all secretions." - -Hence it appears the nervous power generally, as before observed, is -very early and essentially impaired, and to such an extent that there -can be no rational hope of relief, unless some remedial agent can be -found that will exercise such a controlling influence and power, as -shall be adequate to restore the tone of the nervous system. - -Hence, we are forced to the conclusion that the prominent, leading, -and most urgent symptoms requiring special attention, are "the Algide" -or loss of temperature, the loss of nerve-power in the ganglionic and -pneumogastric nerves and their branches, the altered or disorganized -condition of the blood, the impaired or obstructed circulation, and -the early and direct tendency to congestion. These are the prominent -and essential features to be observed in the treatment. They are too -intimate, dependent and inseparable, to warrant any attempt to mark the -precise order of their development. They are the essential phenomena, -proceeding equally and directly together from the primary cause and -disease action, and strictly constitute the complex character of the -cholera, and exhibit its main, distinguishing features, which must -necessarily govern and dictate the maxims of rational practice in -the treatment of this disease. The object, then, of first importance -is to restore the lost temperature, the caloric already eliminated, -and prevent its further depression; to restore, at the same time, -the lost nerve-power to the nerves again; to arrest the process of -disorganization of the blood, and equalize the circulation; to relieve -and suspend the congestion; and then, according to all the experiments -which have been made, the consequent and dependent phenomena of the -cramps and the vomiting and the purging will disappear. - - -SECTION III.--DIFFERENT MODES OF TREATMENT. - -After speaking of the various expedients resorted to for the cure of -cholera, says Dr. Watson: "I believe that each, in some cases, did -good, or _seemed_ to do so; but I cannot doubt that some of them did -sometimes do harm. I had not more than six severe cases under my -own charge, and I congratulated myself that the mortality among them -was not greater than the average mortality. Three died, and three, -I will not say were cured, but recovered, * * * under large and -repeated doses of calomel. Yet, as I said before, I do not venture -to affirm that the calomel cured them." It seems that Dr. Latham -commenced the treatment and Dr. Watson followed it up, repeating the -half-drachm doses of calomel many times, as the patients seemed to -rally after its administration. Again, he observes: "It was remarked -of those who recovered, that some got well rapidly and at once, while -others fell into a state of continued fever, which frequently proved -fatal, some time after the violent and peculiar symptoms ceased. -Some, after the vomiting and purging and cramps had departed, died -comatose--_over-drugged_--sometimes, it is to be feared, by opium. The -rude discipline to which they were subjected might account for some -of the cases of fever." * * * "Never, certainly, was the artillery -of medicine more vigorously plied, never were her troops, regular and -volunteer, more meritoriously active. To many patients, no doubt, this -busy interference made all the difference between life and death. But -if the balance could be fairly struck and the exact truth ascertained, -I question whether we should find that the aggregate mortality from -cholera in this country was any way disturbed by our craft." - -In a report by the acting physician to the Bellevue Hospital, made to -then "Special Medical Council," August 2d, 1832, while the Epidemic -Cholera was still prevailing there and in the city, the physician -says: "The treatment I have divided into two kinds--the pathological -and the mixed. The first having been determined on, after the careful -examination of twenty-three persons dead of cholera; since then, ten -more have been examined, which serve to confirm the conclusions first -formed. - -PATHOLOGICAL TREATMENT--_First Stage._--This consisted in the -administration of blue pill and opium with absolute diet. If pain was -present, leeches to the epigastrium and arms, and when these could not -be procured, cups to the epigastrium. This plan never failed to arrest -the disease in the hands of those who diligently pursued it, where -the mucous membrane of the gastrointestinal canal was not previously -diseased. - -_Second Stage._--First, Blood-letting; second, diligent frictions -with the ointment alluded to above, when persons could be procured to -perform the duty; third, ice to allay the thirst; fourth, small doses -of brandy and laudanum, if the vomiting continues; fifth, cups to the -epigastrium, if there was pain and the brandy omitted. - -_Third Stage._--First, ice to allay the thirst, which is now, indeed, -unquenchable; second, external heat; third, a continuation of the -frictions; fourth, no opium, and, frequently, no brandy, especially -among the children. - -MIXED TREATMENT--_First Stage._--Besides the above treatment, calomel -and Dover's powders was a very frequent prescription; also scruple -doses of calomel, and calomel and opium in small doses, and all with -success. Nevertheless, I believe they occasionally did harm. - -_Second Stage._--First, blood-letting less frequent than above; second, -calomel and Dover's powders continued; third, calomel and opium; -fourth, calomel, capsicum and opium; fifth, soda powders; sixth, -scruple doses of calomel every half hour; seventh, ice. - -_Third Stage._--Calomel and Dover's powder; calomel and opium; calomel, -capsicum and opium; carbonate of ammonia and capsicum; scruple doses -of calomel every half hour. External heat in various ways; ice, etc. -Severe shocks of electricity along the course of the muscles to allay -the cramps; also, the burning of alcohol on the skin. The first was the -practice of Dr. Devan, the second, that of Dr. Gardner, and both lay -claims to having been the first to use these means." - -The ointment alluded to above is composed of mercurial ointment, one -pound, camphor finely pulverized, seven ounces, and the same quantity -of capsicum. With this, the patient was rubbed briskly from head to -foot and repeated at short intervals. The result was, that mercury -generally showed its specific effects upon the gums in from five to ten -hours from the commencement of reaction. The success of this external -application of mercury, conjoined with its internal administration and -frequent blood-letting, may be learned from the cholera statistics of -this and other institutions. - -Dr. Pereira employed sixty-grain doses of calomel, it is said, with -success, and Dr. Barton of New Orleans, in 1849, gave in ten cases from -120 to 150 and even to 180 grains of calomel at a dose, and, in one -case, gave 220 grains, intending, it is said, to have weight sufficient -to keep it down. This brave and heroic practice did not afford relief -in a single instance; the cramps, and vomiting, and purging continued, -and a few hours closed the scene--all died. - -The treatment recommended in the American Practice of Medicine, by -Dr. W. Beach, which was fully tested by the author himself while in -discharge of his official duties as physician of the Tenth Ward, city -of New York, during the prevalence of cholera in 1832, is worthy of -consideration on account of its simplicity, its great efficiency and -wonderful success. "Among all the medicines," says the author, "ever -given or proposed in the incipient or premonitory stage, none will -be found so efficacious as our neutralizing mixture, made of genuine -materials and given very strong. Occasionally, it may be proper to add -fifteen or twenty drops of laudanum; this, however, is very seldom -necessary. A vast number of medicines are recommended in this stage -of cholera, but there are none, I am convinced, so efficacious as the -above." - -In the second, or confirmed stage, the same medicine was continued in -larger and more frequent doses, with hot fomentations to the abdomen, -stimulating lotions, sinapisms and injections. The cholera drops were -also administered, composed according to the following formula: - - Rx. Tincture of Capsicum, - Tincture of Opium, - Spirits of Camphor, - Essence of Peppermint. - Equal parts--mix. - -Give a tea-spoonful every hour or half hour, according to the severity -of the symptoms. - -In the third, or collapsed stage, he directed a tea-spoonful of -pulverized black pepper to be mixed and given in a tumblerful of hot -gin-sling; also, the same to be prepared and applied hot to the bowels -and extremities. Also, to two tea-spoonfuls of either pulverized red -or black pepper, pour on a sufficient quantity of hot water, let it -stand till nearly cold; strain and inject the whole up the bowel. This -would often arouse the patient in the collapsed stage when there was -little or no hope of recovery. Such are in brief the remedies which -were used so successfully in the Tenth Ward of this city, in 1832. Here -it will be noticed that the general principal evolved in this treatment -consists in its prompt and diffusive stimulant, its antispasmodic and -corrective power so combined as to act gently and kindly, yet promptly -and successfully, as the records show, to which we shall refer in the -sequel. - -Another mode worthy of a passing notice is one analogous to this, -adopted and recommended by the eminent Dr. G. S. Hawthorne, of -Liverpool, England, who observes: "Of the medicinal remedies, the chief -is opium. This, I have explained, should be given in combination with -medicines of a cordial, stimulating and antispasmodic character, of -which the most efficient are camphor, capsicum, ether and aromatic -spirits of ammonia. The following formulę present the combination of -the medicines which I would prefer:" - - Rx. Powdered Opium, gr. xij. - Camphor, gr. xxx. - Capsicum, gr. ix. - -Spirits of wine and conserve of roses Q. S.--mix--divide into twelve -pills. Each of these pills, it will be observed, contains one grain of -powdered opium. These are accompanied with the following: - - Rx. Chloric Ęther, - Aromatic Spirits Ammonia, - Camphorated Spirits, - Tincture of Capsicum. - Of each, one drachm. - Cinnamon water, two ounces--mix. - -"Cholera," observes Dr. H., "presents itself in four distinct degrees -of malignity. All the modifications of the disease require to be -treated on the same principles, the only difference being that, in the -detail, the milder forms require less powerful doses of the medicines. -The mode of treating the most malignant form of the disease, will -serve as a model on which all the others are to be treated. This most -malignant form has, by all writers on the subject hitherto, been -pronounced incurable. They say it never was cured in a single instance, -and never can be cured by the power of medicine. I shall, however, -point out a mode of treating it which will prove itself infallibly -successful where my directions are followed with sufficient promptness, -boldness and skill." In detailing the mode of procedure, the doctor -observes: "Place the patient immediately in the horizontal posture in -bed, and give him on the instant, as this is an extreme case, ten of -the antispasmodic pills, and two ounces of the antispasmodic mixture, -and wash the whole down with a glass of undiluted brandy or whisky, -flavored strongly with cloves, essence of ginger, or some such warm -aromatic spice. In the mean time, have him covered with an additional -blanket, and let the usual means of communicating heat, such as jars -or bottles of hot water, bags of hot salt or sand, hot bricks, or -whatever can be most readily procured, be applied without delay to the -feet and different parts of the body, so as to restore the temperature -and produce perspiration as quickly as possible. As soon as the -perspiration has begun to flow freely, superadded to the medicines and -cordials already administered, a glass of brandy-punch should be given, -the punch to be made strong and to be swallowed hot as possible. After -this, no drink should be given until the perspiration has flowed freely -for a few minutes. The stomach will then retain it, and the patient -should be indulged freely with copious draughts of rennet whey, warm -toast-water, flavored with some agreeable spice, mint, or balm-tea, -or any such mild beverage. The necessity of attending to this is most -important. When the discharges from the bowels cease, and when the -pulse becomes full and bounding, the body is covered with a copious, -warm perspiration, which will not fail to be the case under such -treatment; the danger is over. The perspiration, if the patient can -bear it, should be kept up for twelve hours, and may, with advantage, -be continued moderately even longer. Its duration, however, must be -regulated according to the strength of the patient and the state of the -pulse. After the first four or six hours, more heat need not be applied -than is perfectly agreeable to the feelings of the patient. It is -remarkable how suddenly the precordial oppression, etc., are relieved -on the breaking out of a free perspiration, and, what is of greater -importance still, the vomiting, where it exists, immediately ceases." -In short, all the urgent symptoms soon subside, and the patient becomes -convalescent. - -Such is Dr. Hawthorne's treatment, which is affirmed to have been -invariably successful. It is based on the same general principle as the -preceding--a prompt and diffusive stimulant. Here we might ask, What -constitutes the chief reliance in the formulę? Was it the opium that so -promptly met and arrested the disease? or the combination of the other -powerful stimulants with which it was united? Dr. H. places his main -reliance on this drug, and yet affirms that it produced no narcotism or -other sensible effect whatever, except as a diaphoretic, and even in -this its influence may be questioned. The prognosis becomes favorable -from the fact of a sudden rise in the temperature of the body, for -the icy-coldness disappeared, the heat of the surface returned, the -circulation was equalized and a profuse perspiration set in, and, -as these conditions appeared, the urgent symptoms subsided. Not the -excessive doses of opium, but the remedies in combination as a whole, -produced by its prompt stimulating power these results, and the patient -was thus relieved. - -Mr. Forward, while superintending some of the public works in the State -of Kentucky, in 1832, had in his employ more than two hundred laborers, -among whom the Cholera Epidemic of that year appeared about a week -before its irruption in Louisville. The first case was that of a young, -sober, industrious white laborer, who was at the time vigorous and -apparently healthy. It was a sudden and severe case and occurred about -eleven o'clock at night. The physicians who usually attended these men -were at a distance, and could not be obtained without considerable -delay. Under these circumstances, Mr. Forward, after visiting the -patient, becoming acquainted with the symptoms, and believing it a -genuine case of cholera, commenced treatment at once, fearing, as he -states, the patient could not live till a physician could be obtained. -It was, indeed, a desperate case; violent spasms, with constant -vomiting and severe purging, attended with that livid appearance and -peculiar coldness so characteristic of the disease. "Of the treatment," -says Mr. Forward, "I gave him first a quick, stimulating emetic -prepared from the lobelia seed, which checked the vomiting and purging, -but had little effect upon the spasms. I then applied the steam bath, -having his feet and legs at the same time immersed in water as warm as -he could bear, which was made strong with salt and wood ashes. I then -sweetened a tumbler of warm water and put into it a tea-spoonful of -"number six," and about the fourth part of a tea-spoonful of Cayenne -pepper, and gave him one-third of it when I commenced sweating him, and -the balance at intervals while he was sweating. By the time he had been -sweated ten minutes, he was free from spasms and pain, but I continued -the sweating ten or fifteen minutes longer, then wiped dry, after which -the patient laid down and went to sleep--being thus relieved and cured." - -Another case of a colored man who was strictly temperate and healthful -occurred an hour or two later the same night. His attack, too, was -sudden, and still more severe; cramps very violent, vomiting and -purging equally as severe, though he had not been awakened from his -slumbers more than fifteen minutes. This case was treated the same -as the former, with the emetic, sweating, and when the sweating had -subsided, administered a table-spoonful of spirits of turpentine, which -relieved him entirely, and he soon went to sleep. The next morning -both were comfortable, and went to work and remained well. During the -prevalence of cholera at that time, Mr. Forward had thirteen cases in -his own family, and, on one day when the epidemic was at its height, -seven cases among the laborers. All these and many others that occurred -were treated in the same manner, with the same undeviating success. -Not a single instance of death from cholera in his own family, or -among the hands on the road. When the epidemic cholera reappeared in -1835, the same course of treatment was pursued, with the same uniform -success. Such results, considering the malignant character of the -disease, are truly astonishing. Whatever may be said of the general -principle of practice in these cases, its success must be admitted -as equaling, if not surpassing, the treatment of any equal number of -cases on record. Though conducted by an unpretending and unprofessional -gentleman, yet, out of the whole number attacked during the continuance -of the epidemic, not a single case was lost. - -In a report of a case of cholera treated successfully by rectified oil -of turpentine, administered internally as a specific, by Richard Brown, -Esq., Surgeon, Cobham, Surrey, November, 1848, it is stated that the -patient, "aged fourteen, having suffered from severe bowel complaint, -presented all the symptoms of cholera in the stage of collapse. The -bowels acted incessantly, and anything taken into the stomach was -immediately rejected; the pain around the umbilicus was intense, -attended with severe cramps of the legs; the pulse exceedingly small, -and scarcely perceptible; tongue coated in the centre, and flabby; the -surface of the body much below the natural standard; the countenance -of a blue cast, and expressive of the greatest anxiety. So decided, -indeed, was the symptom that the case was considered almost without -hope." "But I had determined," says the physician "to treat the first -case of cholera that occurred in my practice with rectified oil of -turpentine, given internally, the active principle of which, camphogen, -possesses stimulating, diuretic, diaphoretic, sedative, antispasmodic, -antiputrescent properties. I administered immediately one drachm of it -combined with mucilage and aromatics, directing it to be repeated every -two hours, the patient to be kept warm and to take meal broth with -excess of salt." - -Now mark the result of this simple, uncombined remedy. In the evening -of the same day all the urgent symptoms were assuaged, the purging and -vomiting had ceased, the pulse was raised, the surface of the body had -become warm and moist with perspiration, the pain around the umbilicus -diminished, and the cramps less violent, but the countenance still bore -the appearance of great anxiety. Such were the immediate results of -the administration of this remedy, which appear, from the subsequent -history of the case, to have been permanent and unattended with any -constitutional derangement, or other serious and unpleasant effect. On -the morning of the next day the patient was steadily improving; much of -the anxiety of countenance had vanished, but the pain in the belly and -cramps of the legs still remained, though much relieved. On the second -morning after the attack the patient was very much better; no pain in -the belly, and does not feel sick from the turpentine. On the third -morning the patient was up, and, though exceedingly weak, there was no -trace of any alarming symptom remaining. The bowels had moved from -the effects of a previous dose of calomel (two grains) given the next -morning after the attack, and the evacuation was much more healthful. A -mild tonic and alterative plan of treatment was all that was necessary -to restore the patient to her usual health, and she is now well. The -remedy was given at first every two hours, then every four, and lastly -every six hours. This treatment commenced on the 26th and terminated -on the morning of the 29th. Its duration about sixty hours, when the -patient is declared convalescent and comparatively well. Here we might -ask, What experiment with any single remedy has been more important -and satisfactory in indicating and directly pointing out a general -principle of practice for the successful treatment and cure of this -formidable disease? We say single remedy, for it is doubtful whether -the two grains of calomel exercised any curative influence whatever, -or in any way varied the result. It is, therefore, to the use of the -rectified oil of turpentine that the favorable termination and cure of -the disease is to be attributed. - -There is another mode of practice which has been exhibited to some -extent in almost every part of the world, claiming to be more -efficacious and successful than any other in the cure of epidemic -cholera. It is the general principle which is the great and important -consideration with which we are concerned in presenting it among the -various modes adopted for the cure of this disease. This is found -clearly defined and ably presented by Dr. Joslin in his lecture on -cholera, in which, after exhibiting the views and doctrines governing -the practice, and contrasting its results with those of other modes, -he observes, in relation to the treatment of cholera in its early -stages, that "whatever may be the form of attack, give one drop of the -tincture of camphor dropped on a lump of sugar, and then dissolved in -a table-spoonful of cold water. Repeat this every five minutes until -there is a decided mitigation of the symptoms. This will usually be -after five or six doses. If the disease be taken in time, ten or -twelve doses are ordinarily sufficient. There is abundant testimony -of the efficacy of this camphor treatment from all parts of Europe." -Again, speaking of the first variety, in which the most prominent -symptom is diarrhoea, the Dr. observes, "If camphor does not soon give -relief, we are to resort to phosphorus, or to phosphoric acid. Dr. -Quinn has employed both with equal success. Phosphoric acid is to be -preferred when there is a gluey matter on the tongue. In some cases, -veratrum, chamomilla, mercurius, or secale may be indicated. However, -phosphorus and phosphoric acid rarely fail to cure; and some high -authorities are in favor of giving one of them at first, in preference -to the administration of camphor in this form of cholera." - -Again, in the second variety, cholera gastrica, Dr. Joslin observes, -that "the remedies are generally ipecacuanha or veratrum, sometimes nux -vomica. Camphor is to be given at the outset. Put two or three globules -of the third of ipecac. in a little sugar of milk and place them on -the tongue. This may be repeated, if necessary, in half an hour, an -hour, or an hour and a half. But if the disease is not checked, give -veratrum or other medicines according to the different indications." -Again, in the third variety, cholera spasmodica, "the remedies are -camphor, cuprum metallicum, and veratrum. If camphor has not relieved, -give cuprum, and repeat it many times, at intervals of half an hour or -an hour, if its salutary effect is not manifested. If necessary, then -give veratrum in repeated doses, or other medicines, according to the -different indications." In the fourth variety, cholera sicca, "there -is no diarrhoea or vomiting; there is sudden prostration of the vital -powers," etc. "The first remedy, as in other varieties, is camphor. -If the patient is cold, blue, pulseless, that is, collapsed, carbo -vegetabilis; some recommend hydrocyanic acid." In the fifth variety, -cholera acuta, veratrum is named as the main remedy. - -Such is, in brief, the treatment so highly extolled and recommended -by some in the cure of cholera. It is, in substance, the same as -was originally suggested when the disease first appeared in Europe, -nearly half a century ago, and will probably continue unchanged for -generations to come. Of its general principle and its adaptation to the -pathology of the disease we shall speak more at length in the sequel. - -After referring to the pathology of the epidemic cholera, showing its -strong analogy to congestive fever, from the fact that in both diseases -the blood recedes from the surface, and collects upon the internal -organs, inducing a state of congestion, and showing the necessity of -adopting prompt and efficient means to promote reaction, Dr. Massie -observes, "I am not so bigoted, or so wedded to any system of medicine, -as to be its champion to the exclusion of others. I consider I have a -perfect right to investigate all of the different systems, and avail -myself of any information which I may deem important and true, and I -will premise by saying that the treatment I now adopt for cholera -has been attended with more success than when I treated it under a -different system." - -"If I am called at an early period of the disease, even when there is -nausea, vomiting, and diarrhoea, I commence the treatment by giving -equal parts of rhubarb root pulverized, saleratus, and peppermint plant -powdered; one pint of boiling water being added to half an ounce of -this compound. After simmering it for half an hour, sweeten with loaf -sugar and strain, and, when nearly cold, two or three table-spoonsful -of good French brandy should be added. Give two table-spoonsful of -this, taken warm, in connection with the following preparation, viz.: -Rx. Pulverized cinnamon, cloves, and gum guaiacum, each one ounce, good -brandy one quart, given in two tea-spoonsful to a table-spoonful every -fifteen or twenty minutes to an adult." - -"The patient should be well covered with warm clothing, and bottles of -hot water, bricks and stones placed around his body. This course is -almost sure to be followed by a moderate moisture of the skin, which -should be kept up for eight or ten hours; to do which, I give ptisans -of catnip or spearmint, and apply hot tincture of Cayenne by flannel -cloths over the abdomen; if this fails to keep up the perspiration, -I administer the following: Rx. Camphor, grs. x.; Ipecac., grs. v.; -Opium, grs. ijss; Supercarbonate of soda, scruple ij. Mix, and divide -into two, three, or more powders; give one every hour, or oftener." - -"In very urgent cases, I have used tincture of camphor, ounce iv; -essence of peppermint, ounce iv; syrup of ginger, ounce ss; tincture of -Cayenne, dram j. A table-spoonful, from one to four in an hour. I have -given the saturated tincture of prickly ash, with the compound tincture -of guaiacum, with good effect, in doses from a tea-spoonful to a -table-spoonful every fifteen or twenty minutes. When there is excessive -irritability of the stomach, the following injection should be given -after every discharge: Rx. Saturated tincture of prickly ash, ounce -ss; water, ounce j; tincture opii, dram ss. Mix." Such are the views -of Dr. Massie, as presented in his Treatise on the Eclectic Southern -Practice of Medicine. They are confirmatory of the observations and -experience of many other eminent practitioners, and strictly accord -with his views of the pathology and essential phenomena of the disease. - -We find in a very valuable work, entitled the Eclectic Practice of -Medicine, published at Cincinnati by Professors Powel and Newton, a -full account of the mode of practice generally adopted and pursued by -the great body of physicians in the West, the substance of which we -are induced here to present, preserving, as far as practicable, the -language of the authors. For our inquiries are, What are the modes of -practice? and what modes, if any, are consistent with the pathology and -the essential phenomena of the disease? Each mode, however prominent or -however obscure, is entitled to a fair representation in our inquiries, -and should be held responsible for its deviations from the strict and -generally received principles of science, and the consequences arising -from any such deviations, or departure therefrom. - -"When called upon," say these eminent professors, "to treat a patient -in the early stage of the disease, he should at once be placed in a -recumbent position, and everything should be avoided which will have a -tendency to disturb the mind, as well as the stomach and bowels. In the -greater part of cases in this early stage, the administration of the -compound pills of camphor, made according to the following formula, is -sufficient to prevent a further development of the disease: - - Rx. Camphor, } - Opium, } [=a][=a]., gr. xxxv. - Kino, } - Capsicum, gr. v. - Conserve of roses, Q. S.--Mix. - -Divide into thirty pills, and give one after each discharge from -the bowels, or oftener, if the urgency of the case requires it. -Occasionally, however, there may be applied a large sinapism over the -whole abdomen with advantage. Greenhow's aromatized brandy,[II.] the -aromatic tincture of guaiacum,[III.] may sometimes be beneficially -alternated with this pill. Should there be an overloaded condition of -the alimentary canal, the fluid extract of rhubarb and potassa,[IV.] -three parts, with saturated tincture of prickly-ash berries, one -part, may be administered in table-spoonful doses every hour, and -continued until the bowels are properly evacuated, after which the -above astringents may be given; but where the diarrhoea is excessive, -it would be imprudent to wait for catharsis, as the discharge should be -checked as speedily as possible. - -In the second stage, when nausea, vomiting, and cramps are present, -more active means should be pursued. To overcome the nausea or -vomiting, the preparation of Dr. O. E. Newton, termed in the American -Dispensatory compound mixture of camphor,[V.] may be used with -excellent effect; it is prepared as follows: - - Rx. Camphor water, } - Peppermint water, } [=a][=a]., f ounce j. - Spearmint water, } - Paregoric, f dram ij. - Mix. - -From a tea-spoonful to a table-spoonful may be given every five or ten -minutes; and in cases where this does not act sufficiently prompt, the -following may be administered: - - Rx. Common salt, dram j. - Black pepper, dram j. - Vinegar, f dram v. - Hot water, f ounce iv. - Mix. - -Of this a table-spoonful may be given every ten or twenty minutes, and -continued until the nausea ceases. - -To remove the cramps, hot bricks, or bottles of hot water, etc., should -be kept applied to the feet, legs and arms, and cloths wet in water -as hot as can be borne, must be applied over the abdomen and changed -every few minutes; this should be perseveringly pursued until relief -is obtained. Sometimes advantage will ensue from stimulant applications -along the whole length of the spine. Cramps of the muscles of the limbs -may be overcome by bathing with the compound cajeput mixture,[VI.] -either alone or in combination with chloroform, and applying friction -at the same time. This course usually checks the further progress of -the disease, and the patient is saved; however, should it fail and -the stage of collapse come on, in addition to the above treatment -energetically pursued, the patient should be enveloped in blankets, wet -with water as hot as can be borne, which should be renewed every ten -or twenty minutes, and stimulants may likewise be given; the saturated -tincture of prickly-ash berries will here be found beneficial, both by -mouth and enema." - -Dr. Morrow observes, that "to fulfill the most prominent indication, -the production of an equilibrium in the circulation, and excitability, -the compound tincture of guaiac[VII.] may be given." This is prepared -by adding gum guaiacum, cinnamon and cloves--each, one ounce to a quart -of best brandy, and is administered in tea-spoonful doses in hot, -sweetened water and brandy, every fifteen or twenty minutes till relief -is obtained. As a general remedy, its exhibition is most salutary. -In some cases where excessive nausea is the most prominent symptom, -it may be advisable to administer an emetic to relieve the gastric -irritability, to equalize the circulation and check the spasms. For -this purpose, the acetous tincture of lobelia and sanguinaria,[VIII.] -with the addition of one-third spirituous tincture of aralia -spinosa,[IX.] is preferred. This is given in doses from a tea-spoonful -to a table-spoonful every ten minutes in warm catnip-tea, sweetened. -In very urgent cases, it may be given in larger doses and frequently -repeated. - -In most cases, the saturated tincture of xanthoxylum fraxinifolium -bac. may be used with great advantage. It is a reliable, excellent and -prompt remedy. When given in the early stages, it will frequently -relieve in from ten to twenty minutes. In combination with the fluid -extract of rhubarb and potassa,[X.] it has generally proved very prompt -and efficient. In cases of partial collapse, when the patient is -suffering from severe cramps, Hunn's Antispasmodic Mixture[XI.] is an -excellent remedy. In cases of violent spasms, it has been administered -every ten minutes in doses of from one to two tea-spoonsful in hot -brandy-and-water sweetened, with great advantage, and it is peculiarly -applicable in such cases where there is not too great irritability of -the stomach. In many cases, camphor is very beneficially prepared, by -adding one drachm of camphorated spirits to a half-pint of cold water -and the mixture given in tea-spoonful doses every three or four minutes. - -Dr. King states that in the early stage he has used very extensively -the following preparation: - - Rx. Ox Gall, ounce j. - Capsicum, } - Gum Guaiac, } [=a][=a]., scruple iv. - Leptandrin, dram iv.--Mix. - -This was given in doses of one grain, and repeated two or three times -a day. He had also succeeded in some cases with a mixture composed as -follows: - - Rx. Sulphur Sub., grs. iv. - Gum Guaiac, grs. ij. - Charcoal, grs. ij. - Camphor, gr. j. - Opium, grs. ss.--Mix. - -Dose, one to ten grains, repeated every ten minutes until relief is -obtained. In some cases, however, this compound did not appear to -exercise any beneficial influence. In cases of excessive irritability -of the stomach, oat-meal cake coffee was given, for the purpose of -allaying its irritability, with admirable effect. The saturated -tincture of prickly-ash berries,[XII.] combined with tincture of opium, -was used in some cases as an injection, with very good effect. - -Dr. R. S. Newton observes that he had also used a preparation composed -of equal parts tannin, capsicum, camphor and kino, with considerable -success, to be given in doses of four grains, and repeated at short -intervals until the discharges were checked. - -He considered the saturated tincture of xanthoxylum fraxinifolium -bac.[XIII.] the most valuable of all the remedies for the cholera which -he had tested. When the stomach would not retain it, he gave it as an -injection. It had a peculiar influence on the system, and having taken -the remedy, he could speak from experience of its effects. When given -as an injection, the effect produced was almost instantaneous; the -sensation was as if he had received an electric shock; its use was very -soon followed by a copious perspiration. He had more confidence in this -than any other one remedy with which he was acquainted. - -Dr. Wright observes that he had also used the neutralizing extract, -saturated tinc. xanthox. fraxi. bac., and the compound tincture of -guaiac.[XIV.] He had succeeded best with a mixture of equal parts -tincture of prickly-ash berries and neutralizing extract.[XV.] - -He had always found it necessary to attend strictly to the surface. The -best external application he found was equal parts of capsicum, salt -and mustard. - -Dr. Chase states that, "in the early period of the disease, he had -used the leptandrin, combined with neutralizing extract,[XVI.] very -successfully. He thinks opium can be dispensed with in the treatment of -cholera altogether. In typhoid cases, he pursued an entirely different -course, and remarked that many cholera cases presented symptoms similar -to those described in Wood's Practice, as belonging to pernicious -fever, which must be treated according to their peculiar character." - -Such, it is said, is the more general and successful practice in the -Mississippi Valley, where the disease has several times prevailed in -its most malignant form. For its curative efficiency much is claimed. -Its utility, however, must be measured, as in all other cases, by the -unerring rule, the actual results sustained by incontrovertible facts. -The nearer any mode of practice accords with the general principle -of pathology, the greater must necessarily be its success, for it is -not in this disease, or in any other, that the bold, energetic and -heroic practice, which is inconsistent and incompatible with this -principle, cures, however extensively adopted and rigidly pursued. For -this principle must direct and govern the practice, or else it becomes -necessarily experimental or empirical, and must be inevitably attended -with the most lamentable results. - - -SECTION IV.--STATISTICS--PERCENTAGE OF LOSS--VARIABLE RESULTS--THEIR -CAUSE. - -The results of the different modes of practice which we have briefly -noticed will aid materially our effort to discover and establish some -general principle for the successful treatment and cure of cholera. -For all modes, whatever be their merits or demerits, are supposed to -be founded on the pathology of the disease. To treat any disease -successfully, its pathology must be observed, and so applied in the -arrangement and adoption of a mode of practice as to secure not only -entire harmony, but a complete and perfect adaptation of the treatment -to its pathological character. The nearer any mode approaches to an -exact conformity to this principle the greater will be its success. -The neglect to conform, in the treatment of the epidemic cholera, to -this acknowledged and universal law, has, no doubt, been the prolific -cause of the sacrifice of thousands of valuable lives. For this -principle is the key to unlock the mystery of disease, unfold the -process of diseased action, and, as an unfailing and definite rule, -must govern all correct theories as well as all rational practice of -medicine, under whatever name it may be conducted. All practice, then, -deviating from, opposed, or contrary to, this principle must be purely -empirical, and unworthy the confidence of an intelligent community. -Hence we may refer to statistics rather than argument on the subject, -to ascertain how far and to what extent each of the different modes of -practice conform to the general principle; and on the other hand, to -show what modes may be at fault, being deficient in the application -of science, opposed to the established laws of practice, and contrary -to observation and experience, and therefore utterly and hopelessly -empirical. - -The statistics collected from the most reliable sources, and here -presented, may be regarded as a fair representation of the general -average of loss by the different modes of practice. In a report now -before us, it is stated, "The average proportion of deaths in Paris -from cholera, treated under the allopathic practice, was 49 per cent.; -while that under the homoeopathic was only 7-1/4 per cent." "In -Vienna, (Aus.,) under the former, the deaths are reported at 31 per -cent.; while under the latter it was only 8 per cent. In Bordeaux, -death occurred under allopathic treatment at the rate of 67 per cent., -and under homoeopathic, 17 per cent. only. The general average in -the places last mentioned will stand thus: Allopathic, 49 per cent.; -homoeopathic, 10-1/4 per cent." The record of mortality in twenty-one -hospitals in Europe shows the average deaths under allopathic treatment -to be 65-1/8 per cent., while in ten hospitals where the cholera -patients were under homoeopathic treatment, the average deaths from -that disease was 11-3/4 only. In a report "published by the authorities -of Pischnowitz (in Prussia), it will be seen that 680 cases were -treated as follows: 278 treated homoeopathically, of which 27 died; 381 -treated allopathically, of which 102 died." - -In St. Louis, during the prevalence of cholera in 1849, the number -treated by three homoeopathic doctors, to July 13th, was 1,567, of -which 51 died--a loss of 3-1/4 per cent. - -In Cincinnati, during the month of May, there were treated by the -eclectic physicians 330 cases of cholera and 198 cases of cholerine, of -which only five died. - -In the same city, during the same time, there were treated by the -allopathic physicians 432 cases of cholera, of which 116 died. - -Again, during the month of June there were treated by the eclectic -physicians, when the disease had reached its maximum intensity, and -many of the patients being reached by the physicians only in the -collapsed stage, 764 cases of cholera, with a large number of choleroid -diseases not fully reported. During this month, the mortality with all -physicians was necessarily greater than either in the preceding or -subsequent month. Including then the month of May, the aggregate to -July 1st is 1,094 cases, with a loss of only 36, which is considerably -less than four per cent. (being 3.28); while the mortality of the old -school cholera practice being 26 per cent. in May, must have risen to -at least 50 per cent. in June, when the ratio of mortality was more -than doubled with all physicians. The _Western Lancet_ for July, 1849, -issued while the cholera was still raging, and speaking in behalf -of the allopathic physicians, observes, "that of the cases of true -cholera, with rice-water discharges, at least one-half the cases in -this city, as everywhere else, proved fatal." This confession of the -_Lancet_, edited by a thoroughgoing allopathic physician, advocating -the interests of that school, must be regarded below rather than above -the actual allopathic loss. Now, admitting the _Lancet's_ correctness, -and taking into account the aggregate loss of only 36 by the eclectic -physicians in treating 1,094 cases of "true cholera," we ask what -must have been the loss by the allopathic school of practice to have -brought the average percentage of all schools up to 50 per cent., as -affirmed by the _Western Lancet_? If the cholera hospitals be included -in exhibiting the results of the different modes of practice, it will -appear from the reports that the total number of deaths, compared to -the admissions, was, under the eclectic treatment, 23-1/3 per cent.; -under the allopathic treatment, 60 per cent. This percentage is -confined exclusively to the three cholera hospitals reported. - -In the report of 1832, by Dr. Atkins, it appears "that the total number -of cases" of cholera in this city, New York, "including those in the -hospitals, as well as those reported to the Board of Health, had been -5,835 on the 1st of September. The total number of deaths by cholera to -September 1st was 2,996." More than one-half died. "Dr. Buell reports -the success," says Professor Clark, "of sixty-grain doses of calomel -in one of the New York hospitals, as 93 deaths in 100 cases;" very -remarkable success! the largest mortality in the city. - -As like causes produce like effects, we need not be surprised at -this high rate of mortality, for, says Professor Aikin, "taking -the whole number attacked, it is said that the number of deaths in -Astrakan were _as one to three_; in that of Nizhni Novgorod, _as one -to two_; in Moscow and Kazan, _as three to five_; and in Penza, in -the country of the Don Cossacks, _as two to three_. In the summer -of 1831 the mortality at Riga, St. Petersburg, Mittan, Limburg, and -Brody, according to the _Berlin Gazette_, was _about one-half_, -while at Dantzic, Elbing, and Posen it was _about two-thirds_ of the -whole number attacked. The period of the epidemic, however, greatly -influenced the mortality; for on the first onset, _nine-tenths_ of -all those attacked perished, then _seven-eighths_; and the proportion -of deaths forms a gradually decreasing series of _five-sixths_, -_three-fourths_, _one-half_, _one-third_, till, towards the close, a -large proportion of those attacked recovered. The uniformity of this -law in every country affected with cholera, whether Europe, America, -India, or China, is extremely remarkable." This high rate of mortality -is truly and peculiarly illustrative of the inadaptation of the general -mode of the so-called regular practice to the pathology of the disease. -This, no doubt, is the main cause of its failure, and justly exposes it -to the unenviable distinction of being empirical. - -The practice of Dr. Beach, the physician of the Tenth Ward of this -city, during the prevalence of the cholera in 1832, embraced about -one thousand cases, of which only a small percentage was lost. One of -his associates, Dr. Hopkins, reported 157 cases, of which only 6 died, -being less than 4 per cent., which probably is not much below the -general average of the other districts in that ward at that time. - -Mr. Forward, an unprofessional gentleman of Kentucky, treated a large -number of cases, during the prevalence of the disease among his -employees, numbering over two hundred, without the occurrence of a -single death. Another instance similar in principle is that of Dr. -Browne, who reports a case treated by rectified oil of turpentine, -with the most satisfactory and happy result. So, too, the late Dr. -Sharp, of Paris, Ky., adopted a similar principle of practice, and -became, thereby, eminently distinguished for the cure of cholera; his -percentage of loss being very small indeed. - -We might extend these statistics and references, and quote from the -reports of many other distinguished physicians who have been very -successful in the treatment of this disease; but these are sufficient -for the purpose of directing our inquiries as to the utility and -success of different modes of practice. It is immensely important to -ascertain, if practicable, the general principle which has been most -successful in the treatment of this disease, before it shall again make -its appearance among us as a prevailing and fatal epidemic; especially -when we realize and duly appreciate its vast mortality, as represented -in the report now before us, that prior to its recent irruption and -prevalence in India and Europe, nearly fifty millions of the earth's -inhabitants have been swept away by this terrible scourge alone. - -This estimate may, however, appear excessive and unworthy belief. -Yet the general average for the forty-three years included is only a -little over one million per annum, truly a vast number to be carried -off by the prevalence of one disease alone. But, if we reduce this -estimate within more reasonable limits, and take only two-fifths of -it, or twenty millions, as an approximation to the truth, it would -still be appalling, and imperatively demand, on account of the vast -interests involved, the most rigid and thorough investigation as to -both the direct and indirect cause of this vast sacrifice. It will -also furnish us a sufficient apology for attempting a brief review -and critical examination of the principles involved in the different -modes of practice noticed above, in order to ascertain any failures or -errors that may have, in some degree, operated as the indirect cause, -in procuring this immense loss of life. All must admit that there are, -in respect to the treatment of the cholera, great and palpable failures -and errors which, though they have continued for nearly half a century, -and have been sanctioned by high authority, as well as by long usage, -ought nevertheless to be fully shown and exposed, so that they may -henceforth be avoided. In our examination, there is but one rule to be -observed, and one criterion of ultimate appeal by which to try each -and every principle on which any mode of practice may be conducted. -This universal and acknowledged rule is Pathology, the science which -unfolds and exhibits the nature and character of disease, and "dictates -the maxims of rational practice." It is the foundation and only base of -rational medicine, which proceeds on the assumption that the nature and -character of disease is fully known and appreciated. This knowledge is -not only rational, but indispensable, in order to understand and apply -the principles which ought to govern in the medication and cure of -disease. - - - - -CHAPTER IV. - -SECTION I.--GENERAL PRINCIPLE OF RATIONAL PRACTICE--DICTATED BY THE -PATHOLOGY OF THE DISEASE--CONFIRMED BY OBSERVATION AND EXPERIENCE. - - -It has been observed that the essential characteristic, the leading -and most prominent indications requiring special attention and -permanent relief, are the "Algide," or loss of temperature; the loss -of nerve-power in the ganglionic and pneumogastric nerves and their -branches; the altered or disorganized condition of the blood; the -impaired or obstructed circulation, and the early and direct tendency -to congestion; and that these prominent and essential features are -correspondingly developed, and in their relation to each other are -too intimate and dependent to admit the idea of priority and regular -order of succession. The primary impression being on the blood, these -proceeding, _pari passu_, together constitute the complex character of -the disease, and suggest the general principle of rational practice. -If our pathology be correct, it must be regarded as the foundation -and only base for a successful mode of treatment, and must be allowed -to dictate the maxims of rational practice in the prevention and cure -of this singular disease. The neglect to apply to the treatment of -the cholera the science of its peculiar and established pathology -and phenomena, or to give heed to its teachings, has no doubt led to -the errors and failures in practice, which, from their too general -occurrence, induced the learned and celebrated Dr. Velpeau to declare, -before the Academy of Medicine in Paris, that "we know nothing more of -the treatment of cholera now, than on its first appearance in 1832. All -our remedies and modes of practice have failed." - -By observing the fundamental principles of the science of medicine, -and adopting a mode of practice suggested by the pathology and -phenomena of the cholera, these errors and failures, which have justly -brought odium upon the so-called regular profession, will probably -result in saving nine-tenths of those attacked, instead of losing that -appalling proportion, as has been the case in some instances in years -past. - -What, then, is the principle which, for nearly half a century, has -been strangely overlooked, and utterly disregarded by the so-called -regular profession, so far as the maxims of rational practice are -concerned in the treatment of this disease? We unhesitatingly affirm -the principle suggested by the pathology of the disease is, and -must be, one that will reproduce and resupply the lost caloric, or -restore warmth to the body; one that will restore promptly the lost -nerve-power to the ganglionic nerves especially; one that will arrest -and remove the tendency to congestion, equalize the circulation and -relieve the oppressed respiration, and thus mitigate the long train of -dependent symptoms. For this purpose, a prompt and diffusive stimulant -is required of sufficient power to meet these urgent demands, and -suspend promptly any further depressing influence or action of the -cholera poison. A stimulant, essentially different from alcohol in any -of its forms, is required. Alcohol, except so far as it necessarily -enters into the composition of medicines, is inadmissible. So, too, -are all those stimulants whose action is violent, or tends to induce -constitutional derangement, or impairs in any way the subsequent -health of the patient. It must be one prompt, kind and diffusive in -its nature, and peculiarly adapted to meet and relieve the essential -urgent symptoms on which the whole train of _non-essential symptoms_ -depend. In short, it must be one possessing the singular properties of -a stimulant, sedative and astringent, especially an arterial stimulant -and antispasmodic. - -In confirmation of this doctrine, we may refer to the general principle -exhibited in the most successful modes of practice. During the -prevalence of the cholera in 1832, the physician having charge of the -Tenth Ward in this city, in which more than a thousand cases occurred, -adopted as the principle of general practice in that ward a prompt and -diffusive stimulant, which was, at that early day, regarded by him as -based on the pathology of the disease. This principle was strictly -observed and fully carried out in practice by all his assistants. -The result, embracing the different stages of the disease, and some -of the most malignant cases, was the curing and saving of more than -nine-tenths of those attacked. - -Another instance directly in point is the course pursued by Mr. -Forward, an unprofessional gentleman, who had over two hundred laborers -in his employ, among whom the cholera prevailed in 1832 with its -accustomed severity. On its first appearance, Mr. Forward, unadvised, -and depending on ordinary domestic remedies, adopted as the base of -practice in the emergency a prompt and diffusive stimulant, which -proved perfectly successful. Being advised to continue the same -course, should any more cases occur, the result was, in treating a -large number of cases, including thirteen in his own family, that all -were cured. Again, on the reappearance of the cholera in 1835, the -same practice was pursued, with the same uniform success. Can anything -be more satisfactory or more conclusive as to the adaptation of a -principle of practice to the pathology of the disease, or furnish -better evidence of the correctness of the doctrine we have advanced? - -Richard Brown, Esq., surgeon, Cobham, Surrey, November, 1848, reports -a case treated successfully by rectified oil of turpentine, the -therapeutic character of which is unquestionable. - -Dr. Massie, of Texas, adopted a similar principle of practice, and -highly commended the same to his professional brethren, as the safest, -best, and most efficient in the treatment of the cholera. He affirms, -that of all the modes devised for the prevention and cure of this -disease, none is so simple and efficacious as the one exhibited in his -practice. - -The homoeopathic treatment, which claims to be a complete and perfect -system, arranged and adopted by its originator and all his disciples, -confirms the correctness of the doctrine we have advanced. Its -curative principle in the treatment of cholera is based on a prompt -and diffusive stimulant, peculiarly adapted, so far as it has any -power, to meet and relieve the essential symptoms of this disease. -Hence its success and favorable results, which show a saving of nearly -nine-tenths of all the cases treated. - -Again, the eclectic physicians, who now, including all of the reform -school, constitute a majority of the practitioners of medicine in -this country, adopted a principle essentially similar, which has -governed their practice in the treatment of this disease from its -first appearance in 1832. Their system seems to have been more -strictly conformed to the pathology of the cholera than that of any -other school. Hence, their unparalleled success furnishes the most -substantial and conclusive evidence, sustaining the correctness of -the doctrine we have adduced, and the general principle of rational -practice suggested and imperatively demanded by the pathology of -the disease. Their treatment, directed mainly to the relief of the -essential symptoms, has been based on a prompt and diffusive stimulant, -which, fulfilling to some extent the indications required, has enabled -them to meet the disease on each occasion of its reappearance with some -assurance of success, and more generally to arrest its progress or -subdue its power as exhibited in its several stages, and even in many -instances to restore the patient and save life in the last stage of the -almost hopeless collapse. This is clearly shown in the actual results -which fully exhibit the incomparable fact that in private practice -considerably more than nine-tenths of the cases of "true cholera" -are cured, and the constitution and health of their patients saved -unimpaired. - -Again, this doctrine is substantially confirmed by the results of -the experiments made by Drs. Hill and Davies, in the exhibition of -chloroform, either alone or combined with other stimulants. In the -carefully detailed account of its exhibition in the various stages of -the disease, it is clearly shown that its direct action tends to arrest -and suspend the depressing influence of the primary cause, and when -properly combined with other stimulants, affords very prompt relief. -The favorable results thus obtained encourage the hope that it may -prove a successful remedy and lead to the adoption of a more consistent -mode of practice in the treatment of epidemic cholera. In India, in -Europe, and in America, it is now regarded as a very important remedy, -and especially indicated in this disease. As an antidote to miasmatic -poison, and as a prompt and diffusive stimulant when properly combined, -it is admirably calculated to meet and suspend the most urgent -symptoms. In short, it may be considered, in relation to this disease, -an excellent therapeutic agent, and well calculated to form the base -of the principle for which we contend. - -But again, our doctrine is confirmed by the experiment usually -termed "venous transfusion." The solution of soda, when raised to -a temperature from 105° to 120° Fahr., and injected into the veins -of the suffering patient, gave _temporarily_ prompt and immediate -relief; but, when injected at a lower temperature, failed. In this -experiment, the sole and only agent contributing to the result was, -as before explained, the free caloric which immediately permeated -every tissue, supplied warmth to the body, relieved the depressed -nerve-power, equalized the circulation, and restored generally the -normal action of the system. Of this result, and of the diffusive and -prompt stimulating power of free caloric, there can be no question. -The principle here evolved, which answered so perfectly the imperious -demand and so immediately suspended the power of the disease, is the -very principle dictated by its pathology. Stronger and better evidence -of the utility of a prompt and diffusive stimulant, permanent in its -character and influence, cannot be furnished; one that will act kindly, -without violence and without any disturbance to any organ or tissue, to -injure or delay the return of immediate and perfect health after the -disease is subdued. Such we affirm to be the principle demanded in the -successful treatment of the epidemic cholera. - - -SECTION II.--REMEDIES, RECIPES, ETC. - -Considering the general principle of treatment, and the nature of the -remedy so clearly suggested by the pathology of the disease to be fully -established, it now remains for us to point out some of those curative -agents which may be employed to advantage. It may be here observed, -that among the few that can be confidently recommended, there is no -single remedy yet discovered which seems to possess all the properties -necessary to meet the complex condition presented in a malignant -case of cholera. Yet it is believed we have simple remedies, which, -when properly combined, will prove successful. Among the number that -seem best adapted to meet and fulfill the indications, may be named -chloroform, as the leading remedy on which we may reasonably hope for -success. This may be united with spirits of camphor, the tincture of -xanthoxyli fraxinifolii bacca, the compound fluid extract of rhubarb -and potassa,[XVII.] and the oil of monarda punctata, and a very -valuable and reliable remedy obtained. The following formula exhibits -the mode of combination, which may be varied and adapted to suit any -emergency: - - Rx. Chloroform, (sq.,) dram ij. - Spirits Camph., dram j. - Ol. Monarda, gtts. x. - M. et adde-- - Tinc. Xanthox. Frax. Bac., ounce ij. - Fluid Ext. Rhei et Potas., ounce iv. - -M.--S.--From dram j. to ounce ss. every half-hour, hour or two hours, -according to the urgency of the symptoms and the stage of the disease. -As soon as relief is obtained, it should be given in minimum doses and -less frequently. This is admirably adapted to the cold stage, and will -give prompt relief in a great majority of cases. - -In the premonitory stage, it can be administered to good advantage -in small and less frequent doses. In some instances, an additional -astringent may be necessary. The deceptive and painless diarrhoea -should receive prompt attention, and be regarded and treated as the -incipient form of the disease. According to the best authorities, the -diarrhoea commences with the first chemical change or alteration of -the blood, and proceeds gradually, in most cases, for some hours, and -even in some instances, though rarely, for days. It is not sufficient -to check the diarrhoea merely; the cause must be removed, which is -essentially of miasmatic origin. When the cholera is prevailing, and -the diarrhoea is essentially choleraic, or the result of a depressing -miasmatic influence, it should be treated with chloroform, aided, if -required, by appropriate astringents. - -In the fully developed stage, and even in the stage of collapse, -perhaps no combination is better adapted to meet promptly all the -necessities and wants of the system, and suspend the action of the -cholera-poison, than the one named above. It is a simple, prompt and -diffusive stimulant, approximating the principle indicated. This -peculiar remedy is essentially required, and should be continued -through all the stages of the disease till relief be obtained, varying -its administration according to the urgency of the symptoms. When the -stomach is too irritable to retain medicine, it should be given by -the bowel. Take of the above mixture, one-half ounce, of the tincture -of prickly-ash berries one-half ounce, of the tincture of opium ten -drops, of warm water one ounce and a half--mix and inject. This may -be repeated after every evacuation three or four times, unless relief -be obtained earlier. Thus, it should be administered perseveringly by -stomach and by bowel, aided by due employment of all necessary external -means for furnishing warmth and giving relief. Opium, however, should -be omitted after two or three injections. Its continued use to check -the movement of the bowels is decidedly injurious. - -The vomiting and irritability of the stomach may often be allayed by a -strong decoction of spearmint and horse-peppermint (monarda punctata), -equal parts, alternated with camphor water in small repeated doses -every five minutes. This will often succeed when all other means fail. - -The compound cajeput mixture[XVIII.] is a very excellent and prompt -stimulant, and may be alternated with other remedies with good effect. -It is particularly useful in allaying violent cramps, and restoring -warmth to the body, and may be given in doses of one tea-spoonful every -ten or twenty minutes in mucilage, simple syrup, or, better still, in -hot brandy-and-water sweetened. - -The aromatic tincture of guaiac[XIX.] will be found very useful in some -cases, and may be united with chloroform according to the following: - - Rx. Chloroform, (sq.) dram ij. - Spirits Camphor, dram j. - Ol. Monarda, gts. v. - M. et adde-- - Tinc. Guaiac. Arom., ounce iv. - M. - -S.--From one-half to one tea-spoonful every half hour, or, if -necessary, in violent cases every twenty minutes, in a little sweetened -water. This may be alternated with some other remedy to great advantage. - -Chloric ether has been with some a very favorite remedy, and, in -combination with other diffusive stimulants, may serve a good -purpose. So, too, the spirits of turpentine, and the rectified oil of -turpentine, have proved very beneficial, the former in combination, -the latter administered alone. These agents, however, can be rendered -more prompt and effective by combination. It is the promptness, the -instantaneous or electric action like that of oxygen, ozone, and -caloric that gives value to the combination, and renders it peculiarly -efficacious when it possesses the other peculiar properties required. - -In the early stage, sulphuric acid, in the form of elixir vitriol, has -given very prompt relief, and is very highly recommended as a curative -agent in the treatment of this disease. The following formula presents -the mode of its exhibition: - - Rx. Elixir Vitriol, ounce j. - Tinc. Xanthox. Frax. Bac. ounce ij. - Ess. Lemon, dram j. - -M.--S.--Tea-spoonful in a gill of sweetened cold water every two or -three hours. - -This recipe was used in the incipient stage quite extensively in the -epidemic of 1849, with decided advantage. It generally removed the -symptoms speedily, without any other treatment. In the more advanced -stage it was thought not so reliable as other means named above. - -Dr. Fuller, of this city, advocates the use of sulphuric acid as -a prompt and efficient remedy, and affirms that according to his -experience, a great majority of cases may be cured by this mode of -treatment. - -Dr. Cox, of England, has also spoken in its favor, and recommended -its use as an infallible remedy. The eclectic physicians are entitled -to the credit of its first introduction as a curative agent in the -treatment of the Asiatic cholera, combined with the tincture of -prickly-ash berries and the essence of lemon, as noticed above. In our -estimation it may be rendered more effective, combined according to the -following: - - Rx. Elixir Vitriol, } - Chloric Ether, } [=a][=a]., ounce j. - Tinc. Xanthox. Frax. Bac. ounce ij. - Ess. Lemon, dram j. - M. - -S.--A tea-spoonful in a gill of sweetened cold water every two or three -hours. Thus combined, it forms a very prompt and diffusive stimulant, -and is well adapted to meet the indications in the earlier stage of -the disease. In the last stage perhaps no remedy will be found so -prompt and decided in its action as the injection named above, with the -internal use of chloroform as combined in the recipe on page 189. - -In cases of excessive irritability of the stomach, the following -combination was administered with good effect, and was especially -beneficial in cases attended with stupor from the commencement of the -disease: - - Rx. Common Salt, dram j. - Black Pepper, dram j. - Vinegar, f. dram v. - Hot Water, f. ounce iv. - M. - -Of this, when settled, or strained, a table-spoonful may be given every -ten or twenty minutes. It seldom failed to quiet the stomach and check -the motion of the bowels. In this condition the injection should be -also administered, and repeated as occasion may require. - -Some advocate the use of the spirits of ammonia and tincture of -capsicum, properly combined with other diffusive stimulants, as a very -efficient and successful remedy. The following is, perhaps, the most -desirable formula: - - Rx. Chloroform, (sq.) } - Spts. Camph., } [=a][=a]., dram iij. - Spts. Ammonia Aromat., } - Tinc. Capsicum, } - Elix. Opii (McMunn's), dram ss. - Syr. Zingiberis, ounce ij. - -M.--S.--Tea-spoonful in water every thirty minutes till relieved. Then -less frequently, according to circumstances. This is said to give -very prompt relief in the earlier stage of the disease. With some -practitioners the following has been quite a favorite remedy: - - Rx. Ęther Chloric., ounce j. - Tinc. Cardamom., ounce ij. - Spts. Camph., ounce ss. - Elix. Opii (McMunn's), dram ss. - Syr. Zingib., ounce ij. - M. - -S.--Two tea-spoonsful in water every 10 or 30 minutes till relieved, -then continued less frequently and in less doses every one, two, three, -or four hours, according to circumstances. - -For the purpose of promoting reaction in cholera and diarrhoea, the -following formula has been extensively used and most universally -approved. It is, indeed, so highly valued in England and in India, that -it is ordered to be always in store and in readiness in the Medical -Field Companion of the army when on the march: - - Rx. Ol. Anisi, } - Ol. Cajeput, } [=a][=a]., dram ss. - Ol. Juniper, } - Ęther Chloric, ounce ss. - Liquor Acid. Haleri,[XX.] dram ss. - Tinc. Cinnamon, ounce ij. - M. - -S.--Ten drops every fifteen minutes, in a table-spoonful of water. An -opiate may be given with the first and second dose, but should not be -continued. - -Another recipe which has been used with some success in private -practice, illustrative of the use of chloroform as a diffusive -stimulant and sedative, is the following: - - Rx. Chloroform (sq.) } - Spts. Camph., } - Tinc. Capsicum, } [=a][=a]., dram ij. - Tinc. Zingib., } - Tinc. Cardamom., } - Syr. Simplex, ounce ij. - M. - -S.--Tea-spoonful in a little water every half hour, hour, or two hours, -according to circumstances. An opiate may be given with the first and -second dose, but should not be continued. Should the first dose be -ejected, give another immediately after the vomiting. - -In collapse, which is simply a more advanced stage of the disease, -indicating the gradual failing of all the powers of life, our main -reliance is on enemata, as noticed above, often repeated, and continued -as occasion may require. - -Rev. Dr. Hamlin, of Constantinople, observes, "It is difficult to say -when a cure has become hopeless. The blue color, the cold extremities, -the deeply sunken eye, the vanishing pulse, are no signs that the -case is hopeless. Scores of such cases in the recent epidemic have -recovered." - -Here it may be proper to add, that a cure, even with the most efficient -remedies, cannot be easily effected without placing the patient at -the commencement in a recumbent position. This appears indispensable. -The patient should be placed in bed and kept there in the horizontal -position, comfortably covered with blankets, and with warm applications -to the feet. Every necessary convenience should be at once provided to -prevent, if possible, the patient from rising to, or standing upon, -his feet, for the erect posture, before relief is fully obtained, -will inevitably hasten the unfavorable termination of the disease. On -this direction, therefore, the physician must insist if he would save -his patient. Says an eminent physician, perfectly familiar with the -disease, "This direction faithfully observed, and good nursing, will -save very many patients even without medicine." - -Of the auxiliary aids, consisting of various external applications, we -cannot speak in very flattering terms. To the mind of the practitioner -the more important are readily suggested, and are promptly employed by -nurses in the earlier stages of the disease. It is impossible for any -person to attend on a case of true cholera without being instinctively -moved to apply heat friction, and warm stimulants to the surface for -the relief of the suffering patient. Any attempt to prevent these kind -offices and apparently beneficial appliances would be unwise, and most -certainly, in private practice, unavailing. It becomes, therefore, -necessary to direct the use of those which are most agreeable to the -patient and tend to preserve and sustain the recuperative power; those -which tend to weaken and depress the system are the most objectionable. -Among the number that seem to do good, we may mention bottles of hot -water to the feet and calves of the legs, hot bricks dipped in water -and wrapped in flannel and applied to different parts of the body; -blankets wet in water as hot as can be borne, and wrung out so as -not to drip, and applied to the whole surface, and changed at short -intervals, so as to keep up a steady and permanent temperature of -the surface; flannels moistened with spirits of turpentine, or other -stimulant embrocation, and laid over the stomach and bowels, may be -employed, as these all, in some instances, seemed to be beneficial. -Their necessity and use, however, must be governed by circumstances. -As we have before said, our main reliance is on a prompt and diffusive -stimulant internally; other means, at best, are very uncertain. - -Such are some of the remedies evidently suggested by the pathology -and phenomena of the disease, and adapted to meet and remove the more -urgent, essential symptoms. They are not entirely new. They have been -employed to some extent in former epidemics of cholera, and have -sustained a good reputation as useful and curative agents in the -treatment of this disease. The combinations here suggested are the -result of observation and experience, and are intended to present the -form in which these remedies can be exhibited to the best advantage. -They are simple, prompt, and reliable, such as will leave the system, -when the disease is subdued, in its ordinary condition, without any -injury whatever to prevent its immediate return to its normal state -of health. Let them be employed, and their utility thoroughly tested. -They will bear the strictest scrutiny, and sustain their reputation -untarnished under the most trying circumstances. Should the cholera -appear again in our midst in its epidemic form, and these remedies be -generally employed and properly administered, we venture to predict -their efficacy will be abundantly proved in the successful result of -saving more than nine-tenths of those attacked. - - -SECTION III.--PROPHYLAXIS--OR MEANS OF PREVENTION. - -In presenting a course of preventive treatment consistent with the -origin and general character of the disease, we are necessarily limited -to the means of sustaining the _normal_ action of the system, and -suppressing the operation of those causes which, by reducing the -general health, tend to generate, foster, and develop the cholera. Of -the former so much has been written and published, inculcating the -general principles of hygiene, that it seems quite unnecessary to dwell -on a subject so familiar to the great mass of community; yet, there -are occasions when the most familiar truths have to be impressed upon -the mind, by constant repetition, to prevent threatened dangers, and -obviate the most serious consequences. In no instance is this more -important than in time of prevailing epidemics; for it is an undeniable -fact, that multitudes _will_ neglect the most obvious principles of -hygiene, and tolerate, with utter indifference, the most offensive -nuisance, in and around their dwellings, and if attacked by disease, -will often wonder why _they_, more than _others_, should be visited by -a malignant disease, or become the victims of a prevailing epidemic. -Hence the necessity of urging the observance of some of the most -obvious principles of hygiene, in the preventive treatment of Asiatic -cholera. - -Pure air, pure water, and a frugal nutritious diet are Nature's -great preventives for the thousand ills of life. These are the great -essentials in sustaining the healthful and normal condition of the -system, always of primary importance in preserving its tone and energy, -and rendering it impervious to any miasmatic or epidemic influences. -Therefore, the tone of the system should, more especially when -epidemics are prevailing, be kept fully up to its normal standard. -This cannot be accomplished without pure air,--whether our dwellings -be located in the city or in the country; free ventilation of all -apartments is of the first importance. Kitchens, sitting-rooms, -dressing-rooms, and especially sleeping-rooms, should be kept -constantly and thoroughly ventilated; cellars and vaults, too, should -receive attention, and be kept free from a deteriorated or foul -atmosphere. Everything within and without our dwellings, tending to -impregnate the atmosphere with noxious effluvia, should be removed, and -the foul air promptly purified by the use of appropriate disinfectants. - -Pure water for drinking and culinary purposes is another preventive -remedy, whose employment cannot be safely omitted. It is a well-known -fact that, in various localities, wells only a few feet deep, which are -mainly supplied by drainage or surface water, have proved a fruitful -source, and in some instances a direct and efficient cause of epidemic -cholera. - -The water from rivers flowing past large cities and villages is often -so impure as to render its use decidedly deleterious, if not an actual -source of disease. In some cases they have been literally so filled -with portions of fish, and other animal matter, that all city supplies -were made endurable only by long-continued filtration. The waters of -many of our Southern and Western rivers are rendered impure from the -lime and surface drainage with which they are so highly impregnated -that they often become a direct source of diarrhoea and cholera. Pure -water, free from the impregnation of vegetable, animal and mineral -substances, should be sought and obtained for domestic use. - -A good nutritious diet is an indispensable requisite in the prevention -of disease. The system in comparative health requires, and should -regularly receive, its proper aliment. Its daily recurring demands -should be judiciously met with pure and wholesome food, in such -quantity as can be readily digested, assimilated and duly appropriated -for the supply of its wants. Due regard, however, must be had to the -existing and peculiar condition of the digestive organs, on which -mainly depends the process of supporting and perpetuating the general -health. - -It is not the profuse variety and the incongruous mass composed of -baked, roasted, boiled and fried meats, fish and fowl, oyster, lobster, -frog and turtle, with puddings, tarts, jellies, cakes and creams from -the pastry room--fruits and salads, native and foreign, rich and -rare--alcoholic stimulants, and cooling ices, but the simple, plain -and frugal diet, properly cooked and particularly nutritious, that -conduces to the most vigorous health. - -Regular, temperate habits in all things, are especially commended; -excesses of all kinds are reprehensible. Great and sudden changes in -the habits of living are always deleterious, and must be particularly -so, when an appalling and fatal epidemic is prevailing. Temperance, -sobriety and cheerfulness, regular hours for meals, for rest and for -business, repeated ablutions and perfect cleanliness, moderate exercise -and avoidance of irregularities, persevering self-government and duly -subjected passions, all contribute to health, to happiness, and the -prevention of disease. - -Exposure to the extremes of heat and cold should be avoided, and -the clothing properly adapted to the climate--to the season and its -variable temperature. Constant vigilance is necessary to guard against -the numberless causes tending to produce an abnormal condition, -resulting in the derangement of the stomach and bowels, or in -depressing the nervous power, thus enfeebling and prostrating the -general health. The neglect of these hygienic principles and essential -preventives of cholera may induce the condition which temptingly -invites the disease. Some are vastly more susceptible than others, and -may not be able, with all their watchfulness and care, to avoid an -attack, should the disease extensively prevail among us. - -The premonitory symptoms requiring special attention, when the epidemic -cholera is prevailing, are definitely presented in Chap. II., Sec. -2, page 56, to which special reference is made. Whenever any of -these do occur, though generally supposed to present no particular -characteristic of the cholera, they should, however, receive prompt -attention. The loss of animation, the depression of nerve-power, the -pain in the forehead and slight vertigo, the nervous agitation and -oppression at the chest, with slight nausea, may in most instances be -promptly removed. They should be at once patiently and perseveringly -treated by the use of camphor water, prepared as follows: Take spirits -of camphor, one tea-spoonful, and put it into a half-pint of cold -water, and give of the mixture two tea-spoonfuls every half-hour, hour, -or two hours, according to the severity of the symptoms. A strong -decoction, or tea of horsemint (monarda punctata), is an excellent -remedy even in this early stage. The essence of monarda, or horsemint, -in doses of eight or ten drops in a little water, and repeated every -hour or two, will often give prompt relief. Where the horsemint -cannot be obtained, the spearmint, and the peppermint also, may prove -serviceable. - -Keith's concentrated Tincture of Veratrum Viride is also an excellent -remedy in these premonitory symptoms. Put three or four drops into a -tumblerful of cold water, and give of the mixture a tea-spoonful every -hour or two hours, as occasion may require. This may be alternated with -the essence, or tea of horsemint. - -But another more general symptom, which may be properly termed the -incipient stage of the disease, is the slight diarrhoea, usually -termed painless, though it is by no means always so, but frequently -the very reverse, severe and painful. This at first may be slight, but -gradually increasing, soon becomes obstinate, painful, and exceedingly -difficult to control. It therefore should receive attention at its -very commencement, for it is in reality the stealthy invasion of -the citadel--it is the cholera. The loss of life becomes imminent; -treatment becomes indispensable; send at once for your physician. And, -in the meantime, continue the camphor mixture, the horsemint tea, and -give of the fluid extract of rhubarb and potassa, prepared according -to the formula in the American Dispensatory, one or two tea-spoonfuls -every hour, and, if necessary, add four or five drops of laudanum, or -its equivalent in paregoric, to each dose, till relieved. In this early -stage, opium in small doses may be given four or five times, but should -not be continued. These remedies, properly administered, will control -the great majority of cases. - -If, however, the diarrhoea be uncontrolled and vomiting ensue, the -recipe on page 189 will be found very efficient, and should be -perseveringly administered till relief is obtained. It is prepared -as follows: Chloroform, two drachms; spirits of camphor, one -drachm; essence of monarda (or horsemint), three drachms; tincture -of prickly-ash berries, two ounces; fluid extract of rhubarb and -potassa, four ounces--mix. Give from one-half to one table-spoonful -every half-hour, hour, or two hours, according to the urgency of the -symptoms and the stage of the disease. This remedy is well adapted to -every stage, and may be used in collapse as an injection, combined as -follows: Take of the above mixture _two table-spoonfuls_, and add to -it tincture of prickly-ash berries, _two table-spoonfuls_; laudanum -_ten drops_; warm water, _six table-spoonfuls_--mix, _and inject up the -bowel_. This injection should be repeated as often as required. In some -desperate cases it has been repeated many times and the patients saved. - -Wherever the disease prevails, all discharges from cholera patients -should be promptly disinfected and disposed of. Bedding, linen, -water-closets, cesspools, etc., should be thoroughly disinfected and -renovated, so that no germ may remain to propagate the disease. - - - - -FORMULĘ - -FOR SOME OF THE PREPARATIONS USED IN THE ABOVE RECIPES. - - - GREENHOW'S AROMATIC TINCTURE OF GUAIACUM.--Take of guaiacum, cloves - and cinnamon, each, in powder, _one ounce_; best brandy, _two pints_. - Macerate for fourteen days and filter. - - Dose.--From a tea-spoonful to a table-spoonful, in sweetened water, - every fifteen or twenty minutes.--_Am. Dis._ - - - COMPOUND CAJEPUT MIXTURE--HUNN'S DROPS.--Take of oils of cajeput, - cloves, peppermint, and anise, each, _one fluid ounce_; rectified - alcohol, _four ounces_. Dissolve the oils in the alcohol. - - The ordinary dose is from ten drops to half a tea-spoonful; to be - given in simple syrup, mucilage of slippery-elm, or in hot brandy and - water _sweetened_.--_Am. Dis._ - - - FLUID EXTRACT OF RHUBARB AND POTASSA.--Take of the root of the best - India rhubarb, in powder, and bicarbonate of potassa, of each, _one - ounce_; cassia or cinnamon, and golden seal, in powder, of each, - _half an ounce_; boiling water, one-half pint. Macerate the roots and - seeds for an hour; strain and dissolve the potassa in the strained - liquor when nearly cold, and add one gill best brandy; essence of - peppermint, one tea-spoonful, and refined sugar, _two ounces_. - - Dose.--From one to two tea-spoonfuls as often as necessary.--_Am. - Dis_. - - - TINC. XANTHOXYLI, or Tincture of Prickly-ash Berries.--Take of - prickly-ash berries _eight ounces_; diluted alcohol, _two pints_. - Form into a tincture by maceration, or displacement, and make two - pints of tincture. - - The ordinary dose is twenty or thirty drops. In cholera, from - a tea-spoonful to one or two table-spoonfuls, according to - circumstances.--_Am. Dis._ - - - TINCTURE OF OIL OF MONARDA--Essence of Monarda, or Horsemint.--Take - of oil of horsemint _one fluid ounce_; alcohol, _nine fluid ounces_, - Imp. Meas. Mix with agitation. - - Dose.--From ten to twenty drops on sugar, or in sweetened - water.--_Am. Dis._ - - - ELIXIR OF OPIUM, prepared on the base of Dupuy's formula is less - objectionable as an ingredient in recipes for an advanced stage of - cholera than other preparations of that drug. - - - - -FOOTNOTES: - - -[I.] Sulphuric acid, one part; Rectified Spirit, three parts. - -[II.] See American Dispensatory. - -[III.] See American Dispensatory. - -[IV.] See American Dispensatory. - -[V.] See American Dispensatory. - -[VI.] See American Dispensatory. - -[VII.] See American Dispensatory. - -[VIII.] See American Dispensatory. - -[IX.] See American Dispensatory. - -[X.] See American Dispensatory. - -[XI.] See American Dispensatory. - -[XII.] See American Dispensatory. - -[XIII.] See American Dispensatory. - -[XIV.] See American Dispensatory. - -[XV.] See American Dispensatory. - -[XVI.] See American Dispensatory. - -[XVII.] See American Dispensatory. - -[XVIII.] See American Dispensatory. - -[XIX.] See American Dispensatory. - -[XX.] Sulphuric acid, one part; rectified spirit, three parts. - - - - -Transcriber's Notes: - - -Passages in italics are indicated by _underscore_. - -The tables have been equalized as good as possible. - -Rx. is used for Prescription. - -There are diacritical marks in the text, they are marked as [=a] which -represents a marcron (straight line) above the a. - -Fractions are displayed as follows: 1/4 correlates with one-fourth, 1/2 -correlates with on-half, 1-1/2 correlates with one and a half.... - -The following words have been retained in both versions: - - formula (pages 73, 136, 157, 189, 194, 196, 198, 211 and 214), - formulas (pages 76 and 87) and formulę (pages 8, 138, 142 and 213) - - ether (pages 123, 138, 193 and 195) and ęther (pages 73, 139, 197 and - 199) - - spoonful and spoonsful (various occurrences in the text) - -Other than the corrections listed below, printer's inconsistencies -in spelling, punctuation, hyphenation, and ligature usage have been -retained. - -The following misprints have been corrected: - - changed "December, 805; making a total in" - into "December, 805"; making a total in" - (page 9) - - changed "principle of a specific disease--poison." - into "principle of a specific disease-poison." - (page 13) - - changed "violent and fatal whereever it appeared." - into "violent and fatal wherever it appeared." - (page 27) - - changed "cholera in 1832, at Cataria; in Palermo, 40,000." - into "cholera in 1832, at Catania; in Palermo, 40,000." - (page 32) - - changed "In Bassorah and Bagdad, situate in low, unhealthy" - into "In Bassorah and Bagdad, situated in low, unhealthy" - (page 32) - - changed "In the Province of Caucassus, out of" - into "In the Province of Caucassus, out of" - (page 32) - - changed "phenomena, for numorous cases of" - into "phenomena, for numerous cases of" - (page 47) - - changed "The slight, painless diarrhoeea, depression of" - into "The slight, painless diarrhoea, depression of" - (page 57) - - changed "be withheld. This pecnliar icy coldness" - into "be withheld. This peculiar icy coldness" - (page 59) - - changed "urinary secretion and micturation entirely" - into "urinary secretion and micturition entirely" - (page 60) - - changed "the second or febrile stage. The former is" - into "the second or febrile stage." The former is" - (page 61) - - changed "spent in the gradual introducion of the" - into "spent in the gradual introduction of the" - (page 69) - - changed "Other methods of restoring warmth were had" - into ""Other methods of restoring warmth were had" - (page 71) - - changed "when on the march:"" - into "when on the march:" - (page 73) - - changed "philosophy of such eminent surgeon, as" - into "philosophy of such eminent surgeons, as" - (page 88) - - changed "Medical Bureau in the departmnet of India, whose" - into "Medical Bureau in the department of India, whose" - (page 89) - - changed "opium, accompanied with sinipisms, and hot, stimulating" - into "opium, accompanied with sinapisms, and hot, stimulating" - (page 110) - - changed "if it remainun subdued by" - into "if it remain unsubdued by" - (page 112) - - changed "PATHOLOGICAL TREATMENT--_First Stage_: This consisted" - into "PATHOLOGICAL TREATMENT--_First Stage._--This consisted" - (page 132) - - changed "the medicines which I would prefer:" - into "the medicines which I would prefer:"" - (page 138) - - changed "Aromatic Spirits Amomnia," - into "Aromatic Spirits Ammonia," - (page 139) - - changed "It was a sudden and severe, case and" - into "It was a sudden and severe case and" - (page 143) - - changed "are camphor, cuprum metalicum, and veratrum." - into "are camphor, cuprum metallicum, and veratrum." - (page 152) - - changed "may be given. This is prepared" - into "may be given." This is prepared" - (page 161) - - changed "administered in tea-spoonful does in hot, sweetened" - into "administered in tea-spoonful doses in hot, sweetened" - (page 161) - - changed "unfold the process of d seased action, and, as" - into "unfold the process of diseased action, and, as" - (page 167) - - changed "in that of Mishni Novogorod," - into "in that of Nizhni Novgorod," - (page 172) - - changed "in Moscow and Kasan," - into "in Moscow and Kazan," - (page 172) - - changed "During the prevalence of the cholora in 1832, the physician" - into "During the prevalence of the cholera in 1832, the physician" - (page 182) - - changed "Rx Chloroform, (sq.,)" - into "Rx. Chloroform, (sq.,)" - (page 189) - - changed "M. S.--From dram j. to ounce ss. every half-hour," - into "M.--S.--From dram j. to ounce ss. every half-hour," - (page 189) - - - - - -End of the Project Gutenberg EBook of Asiatic Cholera, by -Elijah Whitney and A. B. 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