214 



CHOLERA. 



tog, and cramps ; yet hardly have they been bled 

 and swallowed their medicine, when all these symp- 

 toms vanished, sleep came on, and the patients liuve 

 awakened after some hours, weak but well. In most 

 instances, however, the medicines require to be re- 

 peated. Sometimes the symptoms will continue in a 

 nuch diminished form ; at others, the disease will 

 make efforts to reappear, after the stimulus has been 

 exhausted. In both cases, the repetition of the medi- 

 cine will produce the desired results. 



" In some very weak, aged, or broken down per- 

 sons, the system has rallied for a moment, and then 

 sunk ; in this last case, medicine ceases to be of use 

 nature is exhausted the leverage of life is broken. 

 \V e must never, however, presume this to be the case, 

 beforehand, but continue our efforts, till death itself' 

 bid us cease. Some constitutions appear so irritable, 

 that the vomiting will continue for days with inter- 

 missions, causing much annoyance to the poor patient. 

 In these cases, I find mustard sinapisms or blisters, 

 applied to the stomach, and occasionally warm baths, 

 opium in some form, and a little wine negus at inter- 

 vals, with some soup or tea, having bread sopped in 

 it. sufficient for its suppression. Some patients com- 

 plain much of a difficulty in making water. These 

 will require, in many cases, the use of the catheter, 

 abdominal frictions, stupes and warm baths: mild 

 opiates will generally be necessary in addition. With 

 these remedies, this troublesome affection commonly 

 ceases in a few days. Sometimes the mercury will 

 affect the mouth. In this case, port-wine gargles, 

 the warm bath, careful nourishment, and opiates, will 

 soon cause this symptom to disappear. Every patient 

 has invariably recovered, whose mouth has been af- 

 fected ; and although I never try to produce this re- 

 sult of mercury, as some practitioners recommend, I 

 do not find the recovery in the least retarded, by it. 

 Such a trifling and occasional inconvenience in the 

 employment of so admirable a remedy, when the re- 

 sult is the salvation of human life, and a complete 

 victory over a formidable and malignant disease, is 

 not to be regarded for a moment. The patients will 

 sometimes be troubled with griping pains in the 

 stomach and intestines, during their convalescence ; 

 but wine and opium, and now and then a warm bath, 

 quickly disperse them. If the bowels should prove 

 costive, from ten to thirty grains of the compound 

 powder of jalap may be given, or from half an ounce 

 to an ounce of castor oil, with an ounce of pepper- 

 mint-water and twenty drops of laudanum. Some- 

 times I make the attendants administer a simple 

 enema or injection of gruel with or without castor oil ; 

 for I have more than once seen the use of purgatives 

 bring back the serous purging of the complaint, to 

 the great danger and prejudice of the patient. In- 

 deed, during the prevalence of cholera, purgatives 

 should be very carefully dealt with, when it is neces- 

 sary to use them. They are almost always improper, 

 when purging actually exists as for common salts 

 and other saline purgatives, they should not be 

 touched. In two fetal cases, which occurred in pri- 

 vate practice, castor oil in the one case, and castor 

 oil and salts in the other, were most improperly taken 

 by the patients, when they felt the disease coming 

 on them. And I may here be permitted to remark, 

 that very many lives indeed, might be saved, by peo- 

 ple calling in instant advice, wfien affected with un- 

 usual purging, whether during night or day. 



" I never found it of any use to bleed the patients 

 in collapse, even so far as it is practicable to do so. 

 The patient in most instances is cold, and requires to 

 be heated with the warm-air bath, a simple contriv- 

 ance, consisting of a few half hoops, the end ones of 

 iron, stayed" together by longitudinal braces. A solid 

 piece of wood is adapted to one end., pierced with a 



hole, through which a curved tin tube, four inches In 

 diameter, proceeds, and which serves to transmit the 

 heated current of air, impelled upwards by the flame 

 of some spirits of wine, held in a tin cup, supported 

 by a rod on which it slides. By the use of this ap- 

 paratus, the patient may be well heated in from ten 

 to twenty minutes. The same object, however, is 

 readily effected by bladders or bottles filled with 

 warm water pillow-cases, containing each a few 

 pounds of hot salt or hot bricks wrapped up in flan- 

 nel or other cloths. The heat of the bottles may be 

 tempered in the same manner. As soon as the pro- 

 cess for heating is put in operation, the patient must 

 receive a scruple of calomel, two grains of opium,and 

 a drachm of laudanum^ mixed with spirits and hot 

 water ; an injection, composed of half a pint of starch 

 or gruel at blood heat, and containing a drachm of 

 laudanum, is to be given at the same time. Men and 

 women may commonly receive these doses ; but they 

 must be lessened for weak persons and children, as 

 already stated. When the patient's body is well 

 heated, let it be carefully rubbed, using, if at hand 

 the following liniment, wliich is also proper during 

 the cramps, viz. : 



Common spirits, a pint ; 



Tincture ot Spanish flies, two drachms ; 



Camphor, two drachms ; 



Strong vinegar, or water of ammonia, an ounce 



Spirits of turpentine, two ounces. Mix. 

 I do not, however, place very much confidence in 

 hand-rubbing, and still less in the liniment in ques- 

 tion : the other medicines are matters of much more 

 importance ; but, if there be plenty of help, it is as 

 well not to omit either. Let mouthfuls of mulled 

 wine negus, white-wine whey, or good punch, be 

 given at intervals, during the collapse. If, after four 

 hours, the pulse and heat have not returned, let ten 

 or twenty grains of calomel, and a proportionate 

 quantity of opium, and the opiate injection, be repeat- 

 ed ; and every four hours afterwards, five grains of 

 calomel and a grain of opium, so long as life remains 

 or till the patient recover. If, however, the extremi- 

 ties continue cold and blue, and the nose, tongue 

 and chin keep cold likewise if the patient try to 

 keep his hands constantly out of the clothes, and fall 

 into a dull, nearly insensible state, from which it is 

 difficult to rouse him, little hope can be entertained 

 of his recovery. But, as I have said before, we 

 should never relax using all our efforts while life re- 

 mains. In fatal collapse, the system continues insen- 

 sible to the action of the strongest stimuli, in what 

 ever quantities it seems, indeed, to make no differ- 

 ence whether they are given or not. The young and 

 comparatively vigorous, are, in general, most apt to 

 recover from collapse. Collapse will sometimes set 

 in before the pulse is extinguished ; and, with the 

 better classes, the pulse will often continue to the 

 last, in a very subdued state, however. We must l:e 

 as careful not to overdose as to underdose ; but the 

 preceding directions are, I think, sufficiently explicit 

 on this point : they contain the substance of my own 

 practice ; and in no instance have I had reason to 

 suppose that I had exceeded in this respect, although 

 the contrary was at first the case. If the patient re- 

 cover from collapse, the pulse will begin to beat 

 freely a natural heat will return to the surface 

 the eye will grow bright the patient will become 

 cheerful, and talk the natural dejections will be re- 

 sumed a warm perspiration will flow over the sur 

 face, and there will be a craving for food. The con- 

 stitution, however, will sometimes rally for a moment 

 the pulse will return ; but in a short time, the 

 j awakened powers die away, in spite of every effort, 

 I and the prostration becomes complete. Even when 

 | the hopes of a perfect recovery maybe safely indulg- 

 | ed in, constant caution must never cease for a ra<>- 



