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. Æther 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, }
Æther 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.
FORMULÆ
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 formulæ (pages 8, 138, 142 and 213)
ether (pages 123, 138, 193 and 195) and æther (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)