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)