CHOLERA, ASIATIC. 



167 



more undertake their functions of eliminating 

 their secretion from the blood. The fifth indi- 

 cation is to moderate and control the reaction 

 which now sets in, in such a way as to avoid 

 congestion, local determination, or inflammation 

 of the vital organs. 



If the disease has passed beyond this stage 

 before any attempts are made to grapple with 

 it, the indications for treatment are somewhat 

 changed. The tendency to spasm, which is clos- 

 ing with violence the superficial blood-vessels, 

 and hurling the non-oxygenated blood, dark, 

 thick, and viscid, upon the already overburdened 

 vital organs, must be controlled and subdued, the 

 surface circulation restored, and the secretions 

 reestablished, a work of great difficulty, but one 

 which in most cases of considerable vital power 

 can be accomplished. 



Even when the symptoms of oppression of the 

 lungs and heart have grown still more distress- 

 ing, and the poor victim already cold and death- 

 ly, except where the fierce fire of the disease 

 burns and tortures stomach and heart, tosses 

 in piteous distress from side to side, and finds 

 no relief, his case may yet not be past all hope. 

 If, even then, the blood can be impelled to the 

 surface and the extremities, before it becomes 

 too viscid for movement ; if secretion can be 

 reestablished and a free glowing perspiration 

 made to take the place of the clammy and fetid 

 exudation which now bedews the skin, the 

 limbs resume their vitality, and the misery at 

 the heart be relieved, the patient may yet be 

 saved; and to these objects all the resources of 

 medical skill must be directed. 



Let us, then, glance at the different methods 

 of treatment which have been recommended, 

 having in view the fulfilling of these indications. 

 The thousand remedies which have been pre- 

 scribed empirically, and without reference to 

 the nature of the disease, merit no further no- 

 tice than this, that their prescribers have some- 

 times ignorantly blundered upon remedies which 

 did accomplish the objects desired, though with- 

 out any intention on their part. 



In the preliminary stage the authorities are 

 very generally agreed on the propriety of using 

 alteratives rather than astringents and stimu- 

 lants solely. Perhaps nothing better for this 

 purpose has been or can be prescribed than the 

 aromatic syrup of rhubarb of the shops, with 

 the addition of two grains of carbonate of soda 

 to the ounce. Of this a tablespoonful may be 

 given as a dose to an adult, to be repeated if 

 necessary twice or thrice, and if the diarrho3a is 

 obstinate, with the addition of twenty or twenty- 

 five drops of laudanum. Absolute rest in this 

 stage of the disease is indispensable. The patient 

 must take to his bed and keep it, and be warmly 

 covered. If the disease is obstinate, apply a flan- 

 nel roller around the abdomen, and repeating 

 the dose of laudanum and rhubarb, give an enema 

 of two to four ounces of starch emulsion with 

 a teaspoonful of laudanum, and surround the 

 patient with bags of hot sand, bottles of hot 

 water, stockings filled with hot boiled potatoes, 



mashed, or something of the kind which wiL 

 promote free perspiration and bring the blood to 

 the surface. A mustard poultice to the abdomen, 

 and others to the calves of the legs, will prove 

 advantageous, if there is fulness and pain in the 

 abdominal region, or any tendency to cramps. 



The treatment of this stage by the mission- 

 aries in Constantinople, in 1848, in 1855, and 

 in the recent epidemic, which proved wonder- 

 fully successful, varied but little from this ; it 

 was as follows, as stated by the Rev. Cyrus 

 Hamlin, D. D., who had been most active in 

 the treatment of cholera among all classes: 



" The mixture which I used in 1848, 1855, 

 and 1865 has saved thousands. It consists of 

 equal parts by measure of 1. Laudanum and 

 Spirits of Camphor ; 2. Tincture of Rhubarb, 

 thirty drops for an adult, on a lump of sugar, 

 will often check the diarrhoea. But to prevent 

 its return, care should always be taken to con- 

 tinue the medicine every four hours in diminish- 

 ing doses, twenty-five, twenty, fifteen, ten, nine, 

 when careful diet is all that will be needed. 



" In case the first dose does not stay the 

 diarrhoea, continue to give in increasing doses 

 thirty-five, forty, forty-five and sixty drops 

 at every movement of the bowels. Large 

 doses will produce no injury while the diar- 

 rhoea lasts. When that is checked, then is the 

 time for caution. I have never seen a case 

 of diarrhoea taken in season which was not thus 

 controlled, but some cases of advanced diar- 

 rhoea, and especially of relapse, paid no heed to 

 it whatever. As soon as this becomes apparent, 

 I have always resorted to this course : Prepare 

 a teacup of starch, boiled as for use in starching- 

 linen, and stir into it a full teaspoonful of lau- 

 danum for an injection. Give one-third at each 

 movement of the bowels. 



" In one desperate case, abandoned as hopeless 

 by a physician, I could not stop the diarrhoea 

 until the seventh injection, which contained 

 near a teaspoonful of laudanum. The patient 

 recovered, and is in perfect health. At the 

 same time I use prepared chalk in ten grain 

 doses, with a few drops of laudanum and cam- 

 phor to each." The missionaries also applied 

 mustard poultices to the pit of the stomach, and 

 enjoined perfect rest. The " Potter's Powder " 

 of the shops (prepared chalk, pulverized cam- 

 phor, and carb. ammonia) will be found, in 

 many cases, a preferable mode of administering 

 the chalk and camphor, to that suggested by 

 Dr. Hamlin. 



In more advanced cases the missionaries say: 

 " When there is vomiting and purging, perhaps 

 also cramps and colic pains, the following mix- 

 ture should always be resorted to: Equal parts 

 of laudanum, tincture of capsicum, tincture of 

 ginger, and tincture of cardamom seeds. Dose, 

 thirty to forty drops, or half a teaspoonful in a 

 little water, and to be increased according to 

 the urgency of the case. In case the first dose 

 should be rejected, the second, which should 

 stand ready, should be given immediately after 

 the spasm of vomiting has ceased. Use large 



