OBSERVATIONS ON MERCURIAL FRICTIONS IN MALIGNANT CHOLERA.

562 five minutes. I considered the case hope- spasmodic, narcotic, stimulant, cathartic, less, and ordered him a teaspoonful of the or diluent. In what point of view, then, mixture in brandy-and-water every are they to be considered, and on what minutes until the sickness ceased, and theoretical principle are we to employ to take, in addition to one of the pills asi them? To me there appears but one such prinabove, one containing two grains of P. Opii every half hour, until the violence of the ciple ; though it is, I believe, the fashion symptoms was abated. I saw him in the of the present day, to neglect and to dec’y morning, and never did I see so great a it ; I mean Hunter’s theory of the incomchange produced in so short a time ; patibility of morbid actions. It is to be insickness had ceased in half an hour, and quired, whether mercurial irritation is not also incomp.atible with cholera, so that, the purging about four o’clock ; the had entirely subsided ; the feet and h’.mds I if the one be artificially excitPd, the other were quite warm and natural, pulse very must 13pontaneously cease. Were we fortufull, 120, and hard; the tongue from white nate enough to be able to establish this as had become of a vivid red, and the diffi- truth, the treatment of cholera would be simple and satisfactory; and would culty of breathingwas gone; but his head became exceedingly light. I bled him consist only in exciting salivation by the ad 3Xx, ordered to continue the mixture shortest and least irritatingmeans; after every hour, and drink lemonade. In the which, we might hope that the cure would ensured. evening every unpleasant symptom had subsided ; he had passed water freely, and The advantage of mercurial frictions over administration of that medicine by the been in a violent perspiration all day ; his mouth rather sore, and complained of weak. mouth, are great and many. Bv ness. Ordered the quinine mixture, a re- in, all irritation to the stomach is avoiderl, In the second place, it appears to me, that petition of which completed his cure. in chulera there exists a spasm ofthe absorbing vessels of the intestinal canal, which prevents their conveying into the system OBSERVATIONS even such of the calomel as may be ietttined. Accordingly, it may be observed, that ON is extremely difficult, if not impossible, to salivate persons under such circumMERCURIAL FRICTIONS stances, by any quantity of calomel whatIN ever ; while, as I trust to be able to show, no such spasm exists in the vessels of the MALIGNANT CHOLERA. slcin, and the system is affected through very readily. I shall proceed to the By J. TYTLER, Esq., Surgeon, Bengal them detail of those cases which have led me to Service. i above opinions. the Tratasactions the the " of (Abstracted from Medical and Physical Society of Calcutta," : CASE 1.—T. R. B., a country-born lad, of vol. 5, 1831.) sickly constitution, subject to attacks of fever, and suspected to have disease of the OF the innumerable remedies proposed spleen. He had eaten a very heavy dinner for this terrible epidemic, scarcely one is in of fat broth the day before, and at four the least to be depended on. Antiphlogis- o’clock in the of the 17th Februties, antispasmodics, narcotics, stimulants, ary, was attached by cholera morbus.** ’* cathartics, diluents, have been tried in Fixing my attention on that very remarkevery possible combination, and every one able feature of the disease, the total abtried in vain. sence of bile, either in the matter vomited, In the midst, however, of these innumer- or in the alvine discharge, it suddenly ocable trials, it appears to me that one remedy curred to me, that mercurial frictions has been constantly and unaccountably have a tendency to retard this suppressed overlooked ; although I trust, before con- secretion. I therefore directed a quantity cluding, to be able to demonstrate that its of mercurial ointment to be rubbed into the efficacy is great and unquestionable, and thighs every two hours, and 12 grs. of calothat it may be used with wonderful success mel, and 40 drops tinct. opii, tobe given at in cases where everything else is either the same intervals. I visited him twice This remedy is! more in the course of the day, and found useless or mercurial friction on the skin. that he vomited every dose of calomel as Mercurial frictions do not accord veryfast as he took it, aiid that the purging clearly in character with any of the classeswent on uninterruptedly ; in short, there of medicine above enumerated ; they canwas little appearance of amendment, and on scarcely be said to be antiphlogistic, anti. leaving him, I felt fully persuaded that

i

fiveC

then

I

the

cramps I

most

bethe

rubbing

it

morning

might

impracticable.

563 next

morning would give

me

notice of his

The

dettb. To my great surprise I was informed

continued ;the only thing he had been able to keep in his stomach was 3ii of Madeira

next morning, that he was considerably wine, which he had taken by sips in the better, and on going to him, found almost course of the day. In this situation I left him, after he had been rubbed in for the every symptom of cholera removed. vomiting had ceased, but he had had one or last time, about eight p. m., fully expecting

pulse to hear next morning that he was either take a dead or dying; for I can truly say that I salivated. ’had never known a patient recover from to do more than give a such desperate circumstances. My surprise It unnecessary ’Or two of purging medicine till his and gratification were, therefore, extreme, dosewas when on visiting the hospital next morning, mouth got well. Remarks.—If it be here said that calomel I found him almost quite well. His skin and opium, and not the frictions, cured the.moderately warm and moist; pulse 105 ; i mouth was very sore, and he was spitdisease, let it be remembered, that each dose was vomited almost as fast as it was copiously. He had a few minutes taken : the cu: e evidently depended on the before vomited a little, in consequence of some cold water, but otherwise his salivation, and the salivation surely was not produced by the rejected calomel. We may stomach was free from disturbance. He had observe, too, that the cure was not effected taken another allowance of wine, and was well, that I was induced to order a dose by a restoration of the secretion of bile, as I had expected; for the watery stools conti- of infusion of senna. This he rejected,bu nued next morning, when all other symp-found no other inconvenience from it, an& toms were relieved. It seems to have been three natural stools in the course of the simply the irritation producing ptyalismLdav. No other symptoms of disease rethat removed the cholera. mained, except a violent salivation, from which he gradually recovered, and was disCASE 2.—About a year ago, a country-- charged cured on the 22nd. Remark.—If it be again urged, that the born lad at Monghyr, of almost the same age and constitution, was taken ill early in the3calomel and laudanum cured this man, I morning, in consequence of having eatena must answer, as in the last case, that these some bazaar sweetmeats the night before.. medicines were rejected as fast as they I saw him about eight am. Calomel,, were swallowed, and that I never saw any laudanum, and stimulants, were adminis-- one restored by these medicines from such tered the whole day, with the most scru- a situation before. without producing the smallest change in the disease, and he CASE 4.-Serjeant Benjamin Church, a died at four p.m. These two cases were as sober man, of the Europeaninvalids, on the nearly parallel as can be imagined, and to 13th of March, after eating his hreakfast. what can the difference of event be reason- was seized with cold shivering and great ably ascribed, but to the difference of treat- thirst. On drinkingalittle water, he was ment? immediately attacked by watery vomiting and purging. What he vomited tasted inCASE 3.—William Holman, private of tensely bitter ; but the vomiting soon H. C. 2nd European regiment, was left stopped, and was succeeded by a sense of here sick by a detachment proceeding up violent heat in the stomach, and a feeling the country. On the evening of March 7th of cutting across the navel. The purging he was attacked by cholera, and continued continued, and he was brought to hospital vomiting and purging all night. He was about noon, and had there, immediately, brought to hospital next morning, and I two watery stools. When I saw him, hia there found him in a very advanced stage of skin was warm ; pulse 120, strong and full. the disease. I directeda quantity of mer- Very thirs’v, but the moment he tastes curi.tl ointment to be rubbed into his thighs water, i3 obliged to run to stool; no actual directly, and 13 grs. of calomel given inter- vomiting, but very squeamish. Venesection nally. This was done, but the calomel was ad 3 Bvi. After this he became faint; immediately vomited. Shortly after, the thirst continued, and other symptoms much frictions were renewed, and the calomel and the same. Almost immediately after the stool. Caopium again given, but again rejected.’ bleeding, had a copious This treatment was continued every twolomel gr. xii. At next visit, lialf-past one hours during the whole day. In the mean1). m. complaining of extreme pain of the time the sickness and purging continued ;stomach, tss if cutting. Skin very warm ; the cramps were frequent and severe, and 120 ; says his fingers and toes are to use his own expression, when they came e cramped, and feels quite cold. Is very on, his legs became as stiff as deal board.. desirous of sleeping, but as soon as he The cold perspiration and smallness of -pulses begins to dose, is roused bv the cramps)

two

watery stools.

The skin and

natural, and he was able little light food. He was gently were

to

his

ting drinking

so

had

pulous punctuality, but

watery

pulse

564 and

a

shooting pain

in the stomach.

No

Serjeant John Mackenzie was left here in

same party, and on the same account, last visit. Repet. inurxetio mercur. Tinct. as Holman. He is a man of sober habits, opii gtt. 1. spt. ather. gtt. xl. Aq.fontan. but of much-debilitated constitution. He ss. Soon after getting these medicines he had suffered much at Cheduba from fever, fell asleep, and continued so for a long terminating in enlargement of the spleen. time. On awaking, appeared greatly better. On this account he had been a consideratle 14th, Dilucul. seen by the garrison assist- time in hospital here, and was but lately ant-surgeon, Dr. Smith, who reports that discharged. On the 18th of March, after he appears tolerably easy. Pulse qute re- breakfast, he was suddenly attacked by eq. gular ; tongue moist; complains of pain in cruciating pain of the stomach coming on the abdomen. He ordered ol. ric’in. 3i, and in fits, attended with severe sickness, and this operated three or four times. 15th. attempts to vomit. The substance Le voPretty well, but very weak. Thinking all mited was, by his own account, lumps of danger over, and wishing to give rather a coagulated blood about half the size of his placebo than an active medicine, I incau. fist. On being brought to hospital about tiously ordered mist. camphor. giss ; this he noon, I found him rolling in agony in Lis took about nine o’clock, and had scarcely cot; pulse 120 ; excessive and unquench. done so, when he was obliged to run to stool, able thirst. Skin hot and clammy. In mv and there was attacked by cold shivering presence he retched violently, and brought and vomiting, as before. Vomited all his up a good deal of mucus tinged with a breakfast, and the retchingcontinued verylittle blood. Feitesect. ad 3xx statim. While What he brought up was yellow blood was flowing he complained ex. severe. and bitter. I saw him at noon, after he had cessivelv of sickness and thirst : dranl- fre. had three or four watery stools : pulse quently small quantities of water, and made quick ; skin hot ; a burning sensation at several attempts to vomit. At last, when. the stomach, and wishes much to have a the bleeding was nearly finished, he sud. fomentation to it. Tinct. opii gtt. 1, spt. denly became more than formerly sick, and ether. nitr. gtt. xl. Calomel. gr. xii stat. vomited a large quantity of the watery Inunctio mercural. femorib. fomentat. eacu- secretion peculiar to cholera. The pain, min. papaver. abdornin. The mercury was sickness, and unquenchable thirst, con. rubbed in at twelve and two o’clock; at tinued perfectly unabated. Calomel gr. xx. four p.m. he complained of very severe 7’tKCt. opii gtt. xl. Spt. œther. nitr. gtt. xl pain in the abdomen, with coldness in the statim, et inunctio mercurialis femoribus dilihands and feet; pulse soft and slow; he genter. In an hour afterwards no alteration. begins to have a clammy perspiration. Has Vomiting, purging, and pain, as before, and eaten nothing, and has had several watery so restless, it is difficult for the coolies to stools. The mercury was again rubbed in hold and rub him. Repeat friction, et l,abent at five and six p. m. Seen by Dr. Smith, opii gr. ii. Six p.m. has been rubbed in who reports pulse small and quick ; the three or four times as his agitation would pain at the stomach continues. He directed permit. Pulse 120, and small; skin cold tinct. opiigtt. xl, peroat. e.frictione. Eight and burning. The very acute pain of the p. m., sleeping gently. l6th, a good deal stomach has ceased, but he now complaini salivated; vomiting and all bad symptoms of pain in the region of the hver. Repet. ceased. Had one black stool in the night; frictio interval. 6 hor. Eight p.m. much pulse 99 ; skin natural. He took some better; skin warm and comfortable; has breakfast, and immediately after vomited not vomited since mv last visit, but he has up some black stuff, which gave him im- had several stools; has drunk and retained mediate relief. He has been well ever some tea: gums a little inflamed. Nine p.m. since, and was discharged on the 18th, at In all respects better; vomitingquite his request ceased, but still purging a little ; pulse 84, Remarks.—In this case it is demonstra- and regular ; skin warm and natural; inble that neither the bleeding, nor calomel clined to eat. Next morning all disease given the first day, eft’ected anything to- gone, except pain in the enlarged spleen. wards a cure. The disease returned in all Magnes. sulplt. 3i. This was retained and its violence two days after they were given.operated well, and he was discharged cured It is impossible to ascribe it to anything but on thf* 21st. Remarks.—In this very violent case the the mercurial frictions too sparingly employed the first day, but used abundantly bleeding, though apparently indicated in the strongest manner, the sympafterwards. CASE 5.—The two next cases will, I toms and the constitution of the patient, think, show the advantages of mercurial was so far from being ad vantageous, that it frictions over every other practice, even seemed to accelerate the progress of the yet more strongly than the preceding. malady. Only ’one dose of calomel was given, and that was immediately rejected, They both occurred on the same day.

vomiting,

but

one

watery stool since my the

the

own

both by

565

deal of vomiting succeeded.. ’Calomel g opium does not deserve considers- good tion. gr. xii, et rept. frictio. Nine p.m. Asleep ; i better, and he has ever since conCASE 6.-While in hospital, attending much 1 to improve, with the exception of Mackenzie, my attention was suddenly tinued ( fit of vomiting, which lie had two days called to William Bowers, a man of Hercu- one lean strength and constitution; invalidedsafterwards. This case has been the most for the loss of one of his arms ; of exces- tedious of all, owing no doubt to his previous excessive intemperance ; and he is sively drunken and disorderly had been brought to hospital on the evening st;ll in hospital with pain in right side, all of the 18th in a state of great nervous irri- symptoms of ch,lera having disappeared. Remark.—On this case the same obsertation from recent intoxication. No very are to be made as before. 1 he first urgent symptoms appeared till near the morning of the 18th, when, after attempingcalomel and laudanum could have had no to eat some breakfast, he was attacked share in curing the disease ; since, from severe sickness, vomiting, and purging, some unknown, though probably trifling and all the symptoms of well-defined cho- cause, it returned in all its violence the lera. I found him with pulse small and next morning. The mercurial frictions at quick; skin hot, and covered with perspi- first employed were sufficient to check, bat ration. Venesectio statim. After about 3xii not subdue it. On the second day they were taken away, he became excessively were more freely and successfully employfaint, and begged that the bleeding might ed. The bad effects following the exhi· be stopped, which wasdone, and his arm bition of the salts strengthen what was bebound up. Directed immediately calom. fore noticed of the impropriety of employgr. xx. Tinct. opii gtt. xl. Spt. ather. nitr. ingmedicines of doubtful efficacy. gtt. xl, et frictio mercurial. femorib. At six -General Remarks.—No time- should be p. m. has been rubbed in twice, and is lost in having recourse to mercurial fricrather easier. Pulse 120, quick, and small. tions ; and they may be begun, in a severe skin warm ; has had ten watery stools, and case, by two drachms of the strong ointment repeated vomitings since my last visit. on each thigh, for the space of an hour. Longs much for a little sago and wine ; After the interval of an hour, this may be this was ordered for him, and the frictions repeated; then after an interval of two directed to be continued. Eight p.m. A hours, and then of two hours more. good deal better ; the bandage accidentally After will loosened from his arm, and the blood burst begin to yield, and be effected ; and the pracout a second time, and he says he lost more the mouth 19th. Seven a.m. Much titioners must then be guided by circum now than before. the propriety of continuing, better; skin cool ; no more vomiting, but stances several watery stools. Eleven a.m. From diminishing, orleavingoff the frictions. Bome unknown cause the symptoms of cho. In the mean time, to support the strength, wine may be given, from time to lera re-appeared with even greater violence a than before. Skin hot and covered with time. When the irritation of the stomach perspiration; pulse excessively quick; vo- has subsided, and the vomiting has ceased, miting copiously, but no stools; complains whether salivation has actually commenced of intolerable uneasiness about the abdo- or not, if the constitution appear to have men, which is hard and tumid; says he suffered severely, and the debility be great, be to leave off mercury, and feels cold, and yet is sensible he is hot; it excessively restless and agitated. Enemato exhibit tonics. Of these, the most consodce mui-iat. 3i. 01. ricin. 3ii. Aq. tepid.venient will probably be found to be tincq. s. habeat calomel. gr. xii, et repet. frictioture, or extract, of bark, and when promercurial. One p.m. The injection pro-curable, sulphate of quinine. duced these scanty stools ; vomited the P. S.-Since writing the above, three calomel almost immediately; is much de. other cases of cholera have come under my jected in mind, and persuaded he is dying ; observation. One in a bearer, the second nausea remains, but is unable to vomit in an Ayah, and the third in a European now; longs much for beer. Repeat fric- ’ invalid. All of them were treated on the The bearer was tions, and give him a bottle of beer, with a foregoing principles. caution to drink but a little at a time. brought to me about twenty-four hours Three p.m. Much better in all respects ; after the accession of the disease, and ap. sickness less; drank a mouthful of the peared almost in its last stage. He was beer, and then was disgusted with it; rubbed in three or four times, after which feels his gums a little sore. Repeat fric- his friends carried him away, but I have tions at the end of an hour. Six p.m. heard that he is since well. The case of £ Still uneasy about the abdomen, but less the Ayah was particularly severe. She sick; no stools. Magnes. sulph. 3i. This was taken ill in the middle of the night, was vomited almost as soon as taken, anda in my own house; and next morning,

The

habits. He

Iby Bvations

ease theseprobably four inunctions, the disto

as to

little

may proper

566 saw her, had all the most aggra-same time to the various privations necessymptoms of the disease, and in ad-sarily attached to a life of laborious exerdition, appeared in a state of delirium. Her ition, and to the frequent consequences at.

when I vated

After four tending incautious habits. was scarcely perceptible. repetitions of the frictions, she also was Feeling, therefore, most acutely the into which the interests of the growers carried to her house by her friends. Next morning the symptoms of cholera had ceased.are exposed, as well as those of their la. She appeared, however, so wealt, that II bourers and venders, they venture to subjudged it improper to continue the frictions, mit to you the following statement of the and in the course of the day gave her ninr number of persons employed, who both a’e grains of solution of sulphate of quinine, and have been entirely free from the pre-

pulse

jury

themselves,

.

with three drachms of tincture of bark, and vailing disease, and beg leave to subscribe Gentlemen, yours most retwenty grains of blue pill. This restored her very much, and in the course of next , spectfully, S. HUTCHINS, Chairman. day her mouth became sore. She required nothing else but a dose of infus. sennæ. 24th July, 1832. She is now nearly well, with the exception rersons of violent rheumatic pains in her limbs. The Names of Cultivators. employed, Hutchins...... Earl’s Court .. 90 European invalid had been drinking the day before, and was brought to hospital, sufler.- J. Wilmot........ Isleworth .... 60 ing from the effects of intemperance. He H. Fitch ........ Fulham...... 70 Stoneham was attacked with exquisite symptoms of Crayford, Kent 755 cholera about an hour afterwards. He was R. Attwood...... Kew........ 36 Isleworth.... 65 rubbed in three times in the course of the H. Knevett day, and in the afternoon was much better. C. Knevett ...... Acton........ 55 Isleworth .... 200 He then got twelve grains of calomel. Next Chiswick.... 40 J. and is conhe was now salivated, Jefferys........ morning, valescent. In all of these cases opium and Chapman ...... Islewort’i .... 85 calomel were given in the first instance, J. Poupart........ Fulham . , ... , 30 but in all they were immediately vomited. S.I’oupart........ Battersea.... 23 H. Iliyers 21 Ealing C. Allen...... Old Brentfurd. 18

(Signed)

B

-

......

J. Norris ........ ......

J.

........

W. Attwood......

A. Dancer........

IMPUNITY WITH WHICH

-

VEGETABLES AND FRUIT

-

-

MAY BE EATEN DURING OF

THE PREVALENCE

CHOLERA.*

......

Mortlake .... 20 Fulham...... 40

Gain,fcrd Foster........

Acton........ 20

Humphrey ....

Hounslow.... 10 Charhon .... 30

......

W. Wright — Barnard

......

......

Kensington .. —

14

8

21 Growers. Total .. 1,010 To the Central Board of Health. i GENTLEMEN, - An impression having’ I All in health but one individual at Crayexisted in the public mind that the eating ford, who was unwell when the paper was of fruit and vegetables has tended to promote, signed. the disease now unhappily prevalent in this It may be added, in confirmation of the country, the persons whose names are un-i above, that in the extensive pari-h of Fuldersigned, growers and producers of these ham in particular, which is principally

I’

I

leave most respectfully occupied in gardening cultivation, not one for your information, and that of!iiistance of the cholera has appeared. the public in general, thatamong one thousand and ten persons, employed by twentyone individuals, being a very small tion of the number of those connected with LONDON HOSPITAL. horticultural pursuits in the vicinity of this Election for an Assistant Pbvsician metropolis, the average expenditure of many Tnr the London Hospital, vacant by the reof the femah, part of whom does not exceed of Dr. Macbraire, terminated on Is. 6d. or 2s. per week, and who Are enin the cultivation and gathering’ ofWednesday afternoon in favour of Dr. A. gaged fruit and vegetables, no case of cholera has Frampton, who was elected by a large mapresented itself, although a great number of; jority. The Candidates were, Dr.A. Frampand Dr. C. J. Fox. those so employed subsist almost entirely on a fruit and vegetable diet; exposed at the

commodities, beg

to state

propor-B

BitoB

signation

ton,

Cf,mmunicated by the Central Board of Health.