168 



CHOLERA, ASIATIC. 



mustard poultices of strong pure mustard on 

 the stomach, bowels, calves of the legs, feet, 

 &c., as the case seems to require." 



Some of the more eminent of the English 

 and French physicians oppose the use of opium 

 in any form, and advocate the use of diffusible 

 stimulants, compound spirits of ammonia, 

 champagne, and brandy, with inhalations of 

 chloroform, and the internal use of that remedy, 

 with spirits of turpentine and brandy, six drops 

 of chloroform, forty of turpentine, and a wine- 

 glass of diluted brandy, and follow this by cal- 

 omel (five grains) and beef's gall (ten grains), 

 alternating the calomel and chloroform at inter- 

 vals of an hour or oftener, till reaction comes 

 on. Others use chloroform and brandy with- 

 out the spirits of turpentine. The object which 

 these physicians desire to attain by the use of 

 the chloroform, by inhalation and internally, is 

 the subduing of the cramps and spasms, there- 

 by enabling the superficial circulation to be re- 

 stored. The success which has followed this 

 mode of treatment is said to have been marked ; 

 but it is not so well adapted as that which has 

 been already described for administration by 

 those who have had no medical knowledge or 

 experience, and the success which has resulted 

 from it would seem to be no greater. 



The first stage of the disease, prior to the 

 establishment of the tetanic spasms, and at all 

 events before the stage of exhaustion or collapse, 

 is the favorable one for successful treatment. 

 Taken at this stage, cholera is not often a fatal 

 disease. Ninety-five, and in some countries 

 ninety-nine out of every hundred patients at- 

 tacked, recover if properly treated. 



But when the cramps and spasms have tor- 

 tured the patient, when the blood has retreated 

 upon the centres of life, and the poor fellow, al- 

 ready apparently more than half dead, whispers 

 in those painful tones for " water, water, water," 

 while his wild, despairing gaze seeks vainly for 

 help, and his poor, withered, sodden hands are 

 laid piteously on his breast, the case is, though 

 not hopeless, yet one demanding the highest 

 courage, perseverance, and skill. We have 

 shown what are the indications for treatment 

 at this stage, in which the struggle is emphati- 

 cally one for life. By Avhat medicines shall 

 these indications be best fulfilled ? 



The appliances for maintaining and rousing 

 the heat of the surface already mentioned, bags 

 of sand, bottles of hot water, or flannel cloths 

 wrung out in very hot water and covered with 

 blankets, must be continued and increased ; the 

 mustard poultices should be often renewed, and 

 the abdomen, thighs, and legs covered with 

 them; frictions with hot cloths kept up with 

 vigor and zeal, the patient kept on his back, and 

 carefully covered. An eminent physician who 

 has had large experience in the treatment of 

 the disease in India, in Europe, and in this 

 country, urges that in addition to these external 

 means of endeavoring to restore vital action, the 

 following treatment should be adopted : A large 

 '.njection of from three to four pints of as hot 



water as the hand can bear, with six ounces of 

 brandy (whiskey would probably be equally 

 effective), and two drachms (teaspoonsful) of 

 laudanum, should be thrown up the rectum, 

 and at the expiration of an hour may be drawn 

 off by a tube, when it will be found quite cold, 

 and another enema of hot water without the 

 laudanum and brandy immediately thrown up. 

 At the same time administer by the mouth, every 

 half hour, a teaspoonful of a mixture of equal 

 parts of laudanum and spirits of camphor in a 

 half ounce of brandy. At the expiration of an 

 hour from the administration of the second in- 

 jection throw up a third, adding this time again 

 the brandy and laudanum. At intervals of 

 half an hour, midway between the doses of 

 laudanum and camphor, give five grains of 

 quinine, either in the form of solution, or bet- 

 ter, if attainable, in the sugar-coated pills. If 

 this is rejected repeat it immediately, and if the 

 laudanum and camphor are thrown up, give a 

 grain and a half of dry opium every hour till 

 the patient ceases to vomit. Apply, if possible, 

 mustard poultices to the spine, and rub the 

 limbs vigorously with dry warm flannel sprink- 

 led with powdered mustard, and check the 

 tendency to vomiting by linen cloths wrung out 

 in hot water and laid on the pit of the stomach. 

 Appease the thirst by giving the patient bits of 

 ice of the size of a hickory-nut, to suck or swal- 

 low whole, and if the cramps are distressing 

 control and relieve them by the firm applica- 

 tion of roller bandages. This treatment may 

 well be called heroic, but the eminent practi- 

 tioner who commends it, asserts that it had very 

 rarely failed, and that it is to be maintained till 

 the withered, puckered, sodden fingers begin to 

 become plump and warm with the heat of the 

 returning circulation, and then when the signs 

 of reaction are becoming marked, stop the in- 

 jections, double the interval between the doses 

 of quinine and between those of laudanum and 

 camphor, and immediately give twenty grains 

 of calomel. If at the expiration of two hours 

 the evacuations have not become bilious and 

 natural, repeat the dose. If they have, stop the 

 quinine and the laudanum and camphor, and 

 give ten grains of calomel, which should be fol- 

 lowed up, at the expiration of two or three 

 hours more, with a full dose of castor oil (two 

 ounces or more). If by this time, as will prob- 

 ably be the case, the patient has passed urine 

 and dropped into a restful slumber, he is saved, 

 and requires henceforth only good nursing and 

 simple farinaceous food, with mild tonics, to be 

 restored to complete health. 



There is, IrTsome cases, apparently irrespec- 

 tive of the treatment, a tendency to a severe 

 fever in the period of reaction. The fever is 

 analogous to typhus, though with perhaps an 

 unusual tendency to congestion of the brain. 

 This tendency is to be corrected by leeches be- 

 hind the ears or on the neck, blisters on the 

 back of the neck, and ice to the head. In other 

 respects the treatment does not differ materially 

 from that of ordinary mild cases of typhus. 



