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 formulæ 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 Æther,
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 formulæ? 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.