587

Five hours after the commencement of the

Battack I saw him, and immediately resortedtn the same mode of treatment which I pur-sued in the two former cases, but the mer-cury did not take effect, and he died infourteen hours.At my first visit the symptoms were not

of tbat violent character which would haveled any one to think he would die, but assoon as his wife acquainted me with thebrandly which he had taken, I immediatelypronounced the case to he fatal.

iCASE 8.-On the 14th of July last, Mary

Shipley, residing at 12, Henry Street,Hampstead Road, was suddenly seizedwith the usual symptoms of cholera, andhad taken a small quantity of brand v, a

small dose of calomel and opium, and themixture recommended by Dr. Stevens, atthe desire of a medical gentleman before 1saw her. On my arrival, three hours after.wards, I immediately gave her ss of calo-mel, and ordered iss of ung. hydr. fort. tobe rubbed in. Next day all the symptoms,except the purging, were considerably re-lieved, and with very gentle treatment shewas in nine days pronounced convalescent.N.B. Three other cases have been under

my care since the last mentioned, whichhave undergone the same mode of treat-ment, and are now convalescent. I havealso recommended several medical friendsto pursue the same plan in the treatmentof this disease.

Remaps.

BOn perusing the above cases of spas-modic or malignant cholera, it will be per-ceived that the first fatal case was treated

according to the stimulating plan, and diedin eight hours afterwards ; and that thesecond took a large quantity of brandy be-fore I saw him, and died in sixteen hours.In the treatment of this disease I have,

except in the two first cases, pam no atten- Ition to symptoms, because they are not thecause, but merely the effects of the malady,and a favourable issue has invariably beenthe result. In di,ease a certain action al-

ways exists, which, if not superseded byanother action, will soon pervert the harmony of the animal economy. In cholerasuch a state of things invariably exists, andwhat agent do we possess that can producea specific effect on the vital system so

speedily and so beneficially as mercury ?In the treatment of syphilis do we attendto symptoms when we salivate 1 The samequestion is applicable to iritis, peritonitis, Itnd every other acute inflammatory diseasewhich has its seat in a vital part, and whyshould not cholera come under the samerule 1

,

That salivation of cholera patients isattended with the happiest effects will soon

appear evident to every one who mayadopt it. From experieuce I find that ssdoses of calomel act in nine cases in ten

like

a charm. They allav the vomiting

and purging, cause a return of heat to theskin, then a profuse warm perspiration,and, subsequently, a gentle and refreshingsleep. In very violent cases I have given120 grains of calomel in three hours, aswell as had ij of the ung. hydr. fortius,rubbed in without any ill eifects appearing ata subsequent period, such as violent ptva-lisin. 1 state this, in order that the nume-rous readers of TnE LANCET may not bealarmed in pushing’ the mercurial plan to aconsiderable extent in the treatment of

cholera, for unless they put a speedy stopto its action, the svstem will be soon wornout, and death be the result.

Sols Row, Hampstead Road,Aug. 1, 1832.

TREATMENT OF

MALIGNANT CHOLERA.

Stimulants injurious.—Efficacy of Calomeland Counter Irritants.—Danger of Bleed-ing ; &c.

To the Editor of THE LANCET.

SIR,—Having seen a good deal of cl1o-lera, and attended to the post-mortem ap-pearances presented in about twenty cases,I am induced to make the following remarks,which you may perhaps deem worthy of aplace in your journal. I would particularlycaution against the use of stimulants, thosewho may not have seen their effects in thisdreadful malady. The great prostration ofstrength, the small, frequent, feeble pulse,the short breathing, and the paralised stateof the vital powers, indicate the use of sti-mulants, but their extensive exiaihition hasonly shown their total inefficiency ; nay, Iwould even say their injurious efi’ects, forI have seen brandy and carb. ammonite

given in very large doses, and after eachdose there was a decided depression of thevital powers. However much this may be

opposed to generally-received opinions, Ihave no hesitation in stating it as a fact,calculated to nrevent a mode of treatment

plausible enough in theory, but practically

bad. On the commencement of an attack ofcholera, while the pulse is pretty strong,

plausible enough in theory, but practicallybad. On the commencement of an attack ofcholera, while the pulse is pretty strong,the cramps not severe, and oppression notgreat, a few doses of calomel and ext. hy-osciami, followed bv a little rhubarb, or asmall bleeding, will very much mitigate orcut short the disease; but when collagse hasexisted for six or eight hours, and thepulse cannot be felt at the wrist, when the

588

breath and tip of the tongue are cold, and- when the surface of the body has a coldinanimate feel, and the eyes are muchsunken and have a glassy appearance, medi-cal treatment becomes useless, for the pa-tient’s fate is sealed in a very few hours.Cases neither so slight as the former, norso hopeless as the latter, very frequentlyoccur ; in such cases, the treatment I shouldrecommend is the following, and if activelyand assiduously enforced, it will be produc-tive of the happiest results :-The bodyshould be enveloped in warm blankets,heated air applied to the surface of the

body, and if the dejections be frequent, anenema containing tinct. opii and tinct. ca-tachu, each a drachm, should be given,while the irritable state of the stomach isbest allayed by effervescing draughts, con-taining an excess of alkali; but these areonly auxiliaries to counter irritation, andcalomel and ext. hyosciami, given in analmost unlimited quantity ; 8 grs. of calo-mel, with the same quantity of ext. hyos-ciami, should be given every two hours,gradually diminishing the dose, or extend-ing the period between each dose ; at thesame time extensive irritation must be pro-duced on the surface of the body : this maybe difficult to obtain, but no means shouldbe untried, for the patient’s safety verymuch depends upon it. Common blistersare not sufficiently active. Sinapisms,heated almost to scalding, may fail ; evenhot spirit of turpentine may not produce thedesired effect, but a compound, containingequal parts of spt. cornu. cervi, and ol. tere.binthinæ, with a sufficient quantity ofpulv.cantharidis to form a semi fluid, will

scarcely fail to produce redness, heat, andvesication, if the parts be well rubhedwith a piece ofnannel dipped in it; the irri-tation should be kept up by occasional rub.bing. until the constitution begins to rally.The legs are the most convenient seat forirritation, and may be the most useful, fromtheir distance from the seat of oppression.Other parts of the body should be rubbedoccasionally, with spt. camphoræ, contain-ing a drachm of camphor to an ounce of’

spirit ; so soon as reaction commences,calomel and antimony must be given insmall doses every four or five hours, andbleeding to a considerable extent will bealmost always necessary. If local determi-nations take place, leeches mu.t be appliedin large numbers, with blisters and coldlotions.

Cholera appears to me a congestive dis-ease, and in the early stage as much subjectto proper remedies as any other severe com-

plaint. Whether the diarrhoea, which, withscarcely an exception, precedes the symp-toms of collapse, be considered the first

stage of cholera, or as a distinct affection

producing this disease by the excessivedraining of fluids from the body, I am fullyconvinced that no bad symptoms followwhen it is treated in the manner noticedabove. The symptoms during collapse,and appearances on dissection, prove theunequal distribution of the blood, and con.gested state of internal organs; the qualityof the blood is also depraved, but it seemsto me that no change in its properties canmaterially benefit the patient, until the ba-lance of the circulation be restored. This,then, should be the great object of our re-medial means, but it cannot be accomplish-ed by the means usually had recourse to.When a vein is opened, or a stimulant given,in common congestive fever, or the cold

stage of intermittent fever, determinationtakes place to the surface, and the action ofthe heart is increased ; but in the collapsedstage of cholera, even a small bleeding cutsshort the thread of life. From a bleeding tothe extent of four ounces, I have known thesmall feeble pulse become imperceptible,the features shrink fearfully, the patientgradually sink under the use of powerful

stimulants, and death follow a few hoursafter the bleeding.

I

1

t

The severity of the stage of excitement isproportionate to that of the stage of col.lapse, and is much more fatal in youug thanin elderly subjects, probably from the

greater activity in the vascular system ofthe former. Sedative means must be veryfreely had recourse to as soon as reactionappears. Tart. antimonii will then befound a valuable remedy, but not sufficientof it-elf, for I have never seen a case with-out determination either to the head, chest,or abdomen. The head is the most frequentseat of increased action, which can be re-duced only by bleeding almost to death’sdoor, cold lotions, and counter irritants;these last should never be applied to the

head, but to the neck, chest, or extremities.Two or three dozen leeches will be foundmost useful in removing abdominal conges-tion. Although the successful result andappearances on dissection fully justify theabove treatment, the pulse will seldom in.dicate bleeding, for it is generally small andweak ; indeed a moderately strong pulseshould be considered a favourable symptom.In conclusion I may state, that the treat.

ment recommended above is founded on ob.servations made in an ample field, and onthe post-mortem appearances presented in agreat many cases. I am, Sir,

Your obedient servant,AN AsSISTANT-SuKGEON, R. N.*

Woolwich, 24th July, 1832.

* Our correspondent has forwarded us his nameand that of his ship.—ED. L.