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Practical Deductions from Experiments on the Nature of Epi-demics; with Suggestions of Remedial Means for Treating Cholera.
477 1
"The foregoing train of symptoms may be readily divided into three sets, each of which forms a distinct stage of the disease, and indicates a peculiar mode of treatment. The first stage is that in which the contents of the stomach and intestines are discharged, mixed with bile. The second, or that of collapse, commences with rice-water evacuations, cramps, &c., and the third begins with partial cessation of these sympand the restoration of circulation, animal heat, &c. toms, " In the treatment of the first stage, if called in early, a dose of castor oil with twenty drops of laudanum, and ten or fifteen grains of powdered rhubarb, should be forthwith administered, to clear the bowels of any irritating matter they
affection of any organ remains, it must be subdued by appropriate remedies. It must never be forgotten, that in this stage, owing to the previous pulmonary congestion, patients are extremely liable to pneumonia. The chest must be examined daily, until convalescence is fully established; and should pneumonia be discovered, the application of a few leeches, dry-cupping, or a blister, in conjunction with the internal exhibition of a grain of calomel and ipecacuanha, with half a grain of opium, three times a day, will be sufficient to remove this complication. " The foregoing remarks being chiefly of a practical nature, I have purposely avoided giving any opinion on the causes of might contain. The epigastrium should be covered with a the disease. I shall here, however, venture to add, that I sinapism; the abdomen constantly fomented with warm water believe the remote causes to be, impure air, improper and incontaining mustard or with warm turpentine, and the extre- sufficient food, want of clothing, and personal cleanlinessmities kept warm by means of bottles of hot water, or bags of the former generating unhealthy blood, the latter impairing hot salt or oats. After the action of the castor-oil, a stimu- the function of the skin,* by which the lining membrane of lating cordial may be administered, such as ten grains of I the intestines becomes vicarious in its action, and predisposed aromatic confection, ten drops of the sedative solution of to increased secretion. The exciting causes may be referred opium, and a drachm or two of the compound tincture of car- to a meteorological state of the atmosphere-that condition damoms in ten drachms of cinnamon, or mint-water. This being either electric or hygrometrical. The remote causes draught may be repeated, or not, according to circumstances. require a certain length of time to render the predisposing If the sickness and diarrhoea continue, and the second stage sufficiently susceptible of the exciting, which will account for set in, we must pursue another mode of treatment. We may the periodical nature of the disease. " The comparatively few cases of cholera that occur among here observe, that at this period of the disease there is a great the between a cholera and one from rich, the well fed, and warmly clothed, may be attributed similarity patient suffering loss of blood-in fact, the analogy is so great, that we cannot to idiosyncrasy, emotion, or intemperance. Fear will produce easily avoid the conclusion, that death, in the collapse stage, is diarrhoea, and intemperance will lead to a congested state of the mucous membrane of the intestinal canal." as certainly the result of loss of the serum of the blood, as syncope and the extinction of life are the effects of a fatal haemorrhage. If the preceding view of this stage be correct, Practical Deductions from Experiments on the Nature of Epithen the great object to be obtained is stoppage of the vomitdemics; with Suggestions of Remedial Means for Treating ing and purging, and for that purpose an astringent has proved to Cholera. be the most successful mode of treatment. The most efficacious BY SIR JAMES MURRAY, M.D., T.C.D. & Edinb. styptic is the acetate of lead in combination with opium; half SIR JAMES MURRAY forwarded to us, last week, the following agrainof the acetate with a tenth or twelfth of a grain of opium, made into a pill, with crumb of bread, should be administered paper, requesting that it might be added as a postscript to his communication, for which, however, it was received every half hour until there is some mitigation of the symptoms, previous when they need not be given oftener than every hour, or hour too late. " 1st.—It has been shown (THE LANCET, ante, p. 261) that and a half, or two hours, according to the progress of the case. wet be the of this the should floors, damp beds, filthy clothing, close rooms, moist During management stage, patient kept as much as possible in the horizontal position, with the cellars, and soiled integuments, convey away natural electrihead and shoulders on a plane with the lower extremities. city from the human body as readily as it is carried along bell-wires in our rooms. Hence Boards of Health may Every means must be used to keep up the warmth of the body. the Frictions, with warm flannels, should be incessantly applied infer that there is no chance for prevention or cure unless the and the persons are kept perfectly clean and perfectly dryto the extremities, the rubbing being so directed as to favour places " 2nd.-The results of experiments set forth in THE LANCET the circulation of the blood to the heart. The sinapisms and fomentations to the chest, epigastrium, and abdomen must be (p. 343) demonstrate that sewers, drains, and cesspools are all continued. If the patient have an ardent desire for cold acting generators of galvanic emanations. The odious grates drinks, they ought by no means to be denied him, for although and gutters of our streets and areas are emitting these filthy they be immediately ejected, they are grateful and refresh- electric disturbances under our noses. It is therefore absoing, and if any of the liquid be retained in the stomach, it will lutely necessary to reform this state of things altogether, and havea chance of being absorbed, and will then make up for to dissipate these lethal vapours far above our roofs, rather the loss of the watery part of the blood. The liquids may be than allow such noxious miasms to be constantly discharged soda water, effervescing lemonade, toast-water, or plain cold into our apartments. " 3rd.—That as chimney flues are requisite to carry up water. A few drops of laudanum and a little brandy may be added to each draught, the quantities to be regulated by the smoke above our roofs, and as ventilators are necessary to tunnels, so it is much more needful to tap pent-up frequency of administration and the urgency of the symptoms. mines and A few grains of common salt to each would be a good addition. sewers, balance unequal galvanism, and waft away disgusting Should no amendment take place in from four to twelve hours, gases, rather than to discharge them into our halls, kitchens, or should the patient give signs of sinking at any period of and bed-rooms. (See THE LANCET, p. 343.) " 4th.—With respect to personal cleanliness, it is essential, this stage, the injection of salines into the veins, as practised by the late Dr. Mackintosh,* may be tried as a last resource. both for prevention and treatment. Energetic friction of the If, however, the vomiting and purging become less frequent; skin, not with a hair brush, but with warm, dry flannel, will if the pulse becomes perceptible, and the surface of the body go very far to keep the body well charged with good vital equivalents of electricity. regains its usual temperature, and the secretions be partially atomic " Vigorous rubbing during an hour, night and morning, conrestored, such as the bile appearing in the evacuations, the tributes largely to the above electrical improvement, as the case will have assumed a more favourable aspect, and the third electrometer readily demonstrates. of to be said have The treatment commenced. stage might " 5th.-The same instrument also shows that considerable this stage must be conducted on general principles, but we must bear in mind that the thinning of the blood demands advantages in the distribution of due equivalents are derivable The use of diffusible stimulants only means. special attention, and as this cannot be well accomplished in from internal any other way but through the medium of the stomach, the creates a short excitation, followed by very depressing galvanic patient should be allowed a sufficiency of any of the liquids abstraction. Perhaps I may be excused for mentioning that, break of balance between the atmospheric formerly mentioned. Stimulants are now inadmissible, unless during the awful’ the case assumes a typhoid character, which is not an unfre- electricity and terrestrial magnetism, in 1832,’ I found no in creating and quent result. If reaction runs high, it must be moderated by remedy equal to an abundant use of camphor, first and second gentle aperients, (such as castor oil,) diluents, and diaphoretics. maintaining healthy voltaic action during the If typhus sets in, a stimulating form of practice must be pur- stages of cholera. " This fact also agrees with the extensive experience of , sued. The diet should be bland and nutritious. If a chronic Professor Hart, of Dublin. " * The formula used for injection by Dr. Mackintosh, in the DrummondWhilst acting as a member of the Central Board, I had street Hospital, at Edinburgh, consisted in half an ounce of muriate of ‘ in of of ten at t of " * Inflammation and ulceration of the duodenum are frequent results of four soda, and pints water, scruples sesquicarbonate soda, He took half an hourr extensive destruction of the skin by burns, which shows that there is a a temperature ranging between 1100 and 120° Fahr. to inject this quantity. sympathetic action between it and the lining membrane of the bowels.
I
.
478 of the value of camphor, but I found it too slow of digestion in such a rapid disorder as cholera. It is now beforfi the profession in a fluid form. " Fluid camphor, being charged with carbonic acid, in vast quantities, is grateful to the digestive organs, and suits the purposes so ably explained by Dr. Parkin and others, in THE LANCET for some time past. "Although it is reasonable to evince a parental fondness for this preparation, I must insist upon its powers of sustaining the equilibrium of animal electricity, as advanced in my treatise on " Temperature," in 1828. When used to aid in the prevention of cholera, adults require a wineglassful of the fluid three or four times daily, for its efficacy to be evinced by the electrometer ; but, during the treatment of actual cholera, the above quantity should be given every ten or twenty minutes, till heat and circulation are restored, and a few drops of laudanum, or any other suitable tincture, may be given with it. The minute proportion of bicarbonated magnesia, combined with the fluid camphor, abates gastric irritation, and prevents acid fermentations in the stomach, which are so productive of disturbances in the primse vias. "From the theory of cholera published in the London --Medical and Surgical Journal, July, 1832, and since amply confirmed in many parts of the world, it is to be concluded that the judicious restoration of respiratory powers, by longcontinued galvanic passes through the respiratory nerves, is one of the most essential adjuvants that can be employed during collapse, or in that passive state of galvanic abstraction, which ought to be treated like suspended animation. With respect to preventives, in the meantime, as additional means, the deductions from galvanic trials show that the dress of persons ought to consist, as far as possible, of dry shoes and woollen stockings, flannel or silk next the skin, warm woollen and cotton clothing and bedding, with thick, dry carpets, and cushions of wool, hair, or cotton. Beds may be well insulated by placing the posts on blocks of wood baked in an oven, or boiled in linseed oil, on cakes of wax, -rosin, or asphalte, or in cups or dishes of thick glass, or on earthenware."
ample proofs
____
On the Internal Administration
of Turpentine in Cholera. BY JOHN MOORE, ESQ., M.R.C.S., &c., Bourton-on-the-Water, Mr. Moore
in which
remedy.
reports
Gloucestershire. the following cases of spasmodic
turpentine was beneficially employed as an
cholera., internal
" CASE 1.-During the prevalence of fever, which raged extensively in the parish of Great Rissington, in October, 1846, was summoned, at eight P.M., to Harriet H-, aged 40, who, with her husband and three children, were then convalescent from typhus. She was stated to be suffering from purging and vomiting, with violent crampy spasms. As I could not immediately leave, I sent a mixture containing a drachm each of laudanum and sulphuric ether, directing half to be taken directly. I saw the patient in half an hour; the first dose had been vomited; the second was retained. She was suffering excruciating pain; in the intervals which sometimes occurred, she appeared quite exhausted; countenance contracted, and of a leaden hue; skin cold and clammy; the
surface, generally, covered copiously with large drops of sweat; the knees drawn up; the abdominal muscles strongly contracted ; the hands clenched; alvine discharges, of the appearance of rice-water, with here and there large albuminous flakes. No urine had passed since commencement of attack. "I prescribed friction of the extremities, flannels wrung out of hot turpentine to be applied over the abdomen, and an injection containing half an ounce of rectified oil of turpentine, half a drachm of laudanum, and a pint of starch; brandyand-water to be repeatedly given. The symptoms rapidly declined in intensity; small doses of laudanum and ammonia were given at intervals, and a speedy convalescence took
place. " CASE 2.- At eight o’clock, A.M, on September 23rd, 1847, I was sent for, hurriedly, to Mary G-, of Great Rissington, aged forty, who had experienced an attack of fever twelve months before, and had been in a very .
asthenic condition
ever
since.
About the middle of the
night she was seized with vomiting, purging, and suppression of urine. The symptoms now were-countenance of a pale-bluish cast, and expressive of dread; skin cold and clammy; tongue moist, and slightly furred in the centre; pulse thread-like and irregular; abdominal muscles much
contracted; stools like rice-water. The vomited matter
contained albuminous flakes, and was tinged with
bile.
Pre-
pill containing four grains of calomel and one of directly; an enema containing half an ounce of turpentine, and half a drachm of laudanum with starch; turpentine cloths to be applied over the bowels; brandy-and-water as required. In the evening she was much relieved, the purging was lessened, and a small quantity of urine had been passed. The surface had become warmer, and the pulse improved. Spasmodic pains, however, still scribed,
opium,
a
to be taken
occurred at intervals.
Ordered to take of rectified oil of tur-
pentine, two drachms; tincture of opium, half a drachm; oil of cassia, twelve drops; mucilage, two ounces; water, to six ounces. Mix. Two tablespoonfuls to be taken every four
hours. Meat broths to be plentifully administered. " This treatment was persevered in for a week, during which the cramps continued at intervals, and the secretion of urine was scanty. An occasional dose of castor oil was also given. A low, nervous fever supervened, which was combated with bark, laudanum, and ammonia. On the 24th of October, recovery was fully established." Mr. Moore remarks:" In these cases the urgency and character of the symptoms were such as, if Asiatic cholera had been prevalent, would have fully justified me in calling them by that name; and it is but a fair inference that a like remedy will prove equally influential over like symptoms of diseases, which, though differing in one material point-the property of diffuso many analogous characteristics. sion-present " The most formidable symptom of cholera-that which most rapidly tends to produce fatal prostration-is -the escape of the serum and saline particles of the bloodfrom the internal surface of the intestines. Over this symptom turpentine exercises a manifestly powerful influence. Like another correspondent of THE LANCET, (Aug. 26th last,) I was led to administer turpentine internally in cholera by witnessing the salutary effects resulting from its external application, which by far exceeded what could be fairly attributed to counterirritation; but though I have as yet prescribed it empirically, reason and analogy are not wanting to account for its efficacy. " Without speculating upon their nature and position, (which would be foreign to my purpose,) I apprehend that there can be no doubt that orifices naturally exist upon the internal surface of the intestines, through which serous exudation takes place. Internal haemorrhage may occur where no suspicion of organic lesion exists. In cholera, the albuminous and saline particles of the blood pass away copiously by the bowels, and no abrasion of their surface has been discovered upon post-mortem examination. It is a fair assumption, therefore, that by the same orifices which in their normal state instil serum into the intestinal canal, for the purpose of its lubrication, grosser particles of the blood may pass when the said orifices are relaxed by the depressing agency of the choleraic or other poisons. Then, as turpentine exercises over passive haemorrhages an influence almost specific, analo. gical reasoning might lead us to anticipate its tending to mitigate or arrest that exhausting effusion by the bowels of the nutrient portions of the blood which occurs in cholera." in Cholera, and the treatment of by Transfusion. By CHARLES EDWARDS, M.D., M.R.C.S. &c., Cheltenham. " We find in cholera the component parts of the blood evacuated from stomach and bowels; the alvine discharges containing much albumen,* and the salts of the sernm. The residue of blood is thick, black, unfit to stimulate the heart, viscid, and seemingly oily. This will explain, by its detention in the capillary system, its seeming abundance, so that blood could be drawn from the surface almost as easily after as before death; also the apparent venous congestions and ecchymoses throughout the body.
On the
Pathology of the Collapse that stage
" This altered state of blood will of itself arrest the process of its own decarbonization by its effect on the brain and nerves, although, perhaps, partly a re-action; the nervous system being most likely affected primarily by the choleraic poison-the consecutive diarrhoea, by draining away albumen and serum, leaving a viscid residue, unfit to circulate, and still further poisoning the brain and nerves. The processes of secretion and elimination of bile and urine now cease, and the arteries contain venous blood. Further, by thisserous haemorrhage’ the blood in quantity is absolutely and suddenly diminished, (See Craigie, Edinburgh Journal, 1832,) and a state is produced akin to vascular inanition, or haemorrhagic
*
On this
head,
see a
succeeding article in this analysis.—ED. L.
"The foregoing train of symptoms may be readily divided into three sets, each of which forms a distinct stage of the disease, and indicates a peculiar mode of treatment. The first stage is that in which the contents of the stomach and intestines are discharged, mixed with bile. The second, or that of collapse, commences with rice-water evacuations, cramps, &c., and the third begins with partial cessation of these sympand the restoration of circulation, animal heat, &c. toms, " In the treatment of the first stage, if called in early, a dose of castor oil with twenty drops of laudanum, and ten or fifteen grains of powdered rhubarb, should be forthwith administered, to clear the bowels of any irritating matter they
affection of any organ remains, it must be subdued by appropriate remedies. It must never be forgotten, that in this stage, owing to the previous pulmonary congestion, patients are extremely liable to pneumonia. The chest must be examined daily, until convalescence is fully established; and should pneumonia be discovered, the application of a few leeches, dry-cupping, or a blister, in conjunction with the internal exhibition of a grain of calomel and ipecacuanha, with half a grain of opium, three times a day, will be sufficient to remove this complication. " The foregoing remarks being chiefly of a practical nature, I have purposely avoided giving any opinion on the causes of might contain. The epigastrium should be covered with a the disease. I shall here, however, venture to add, that I sinapism; the abdomen constantly fomented with warm water believe the remote causes to be, impure air, improper and incontaining mustard or with warm turpentine, and the extre- sufficient food, want of clothing, and personal cleanlinessmities kept warm by means of bottles of hot water, or bags of the former generating unhealthy blood, the latter impairing hot salt or oats. After the action of the castor-oil, a stimu- the function of the skin,* by which the lining membrane of lating cordial may be administered, such as ten grains of I the intestines becomes vicarious in its action, and predisposed aromatic confection, ten drops of the sedative solution of to increased secretion. The exciting causes may be referred opium, and a drachm or two of the compound tincture of car- to a meteorological state of the atmosphere-that condition damoms in ten drachms of cinnamon, or mint-water. This being either electric or hygrometrical. The remote causes draught may be repeated, or not, according to circumstances. require a certain length of time to render the predisposing If the sickness and diarrhoea continue, and the second stage sufficiently susceptible of the exciting, which will account for set in, we must pursue another mode of treatment. We may the periodical nature of the disease. " The comparatively few cases of cholera that occur among here observe, that at this period of the disease there is a great the between a cholera and one from rich, the well fed, and warmly clothed, may be attributed similarity patient suffering loss of blood-in fact, the analogy is so great, that we cannot to idiosyncrasy, emotion, or intemperance. Fear will produce easily avoid the conclusion, that death, in the collapse stage, is diarrhoea, and intemperance will lead to a congested state of the mucous membrane of the intestinal canal." as certainly the result of loss of the serum of the blood, as syncope and the extinction of life are the effects of a fatal haemorrhage. If the preceding view of this stage be correct, Practical Deductions from Experiments on the Nature of Epithen the great object to be obtained is stoppage of the vomitdemics; with Suggestions of Remedial Means for Treating ing and purging, and for that purpose an astringent has proved to Cholera. be the most successful mode of treatment. The most efficacious BY SIR JAMES MURRAY, M.D., T.C.D. & Edinb. styptic is the acetate of lead in combination with opium; half SIR JAMES MURRAY forwarded to us, last week, the following agrainof the acetate with a tenth or twelfth of a grain of opium, made into a pill, with crumb of bread, should be administered paper, requesting that it might be added as a postscript to his communication, for which, however, it was received every half hour until there is some mitigation of the symptoms, previous when they need not be given oftener than every hour, or hour too late. " 1st.—It has been shown (THE LANCET, ante, p. 261) that and a half, or two hours, according to the progress of the case. wet be the of this the should floors, damp beds, filthy clothing, close rooms, moist During management stage, patient kept as much as possible in the horizontal position, with the cellars, and soiled integuments, convey away natural electrihead and shoulders on a plane with the lower extremities. city from the human body as readily as it is carried along bell-wires in our rooms. Hence Boards of Health may Every means must be used to keep up the warmth of the body. the Frictions, with warm flannels, should be incessantly applied infer that there is no chance for prevention or cure unless the and the persons are kept perfectly clean and perfectly dryto the extremities, the rubbing being so directed as to favour places " 2nd.-The results of experiments set forth in THE LANCET the circulation of the blood to the heart. The sinapisms and fomentations to the chest, epigastrium, and abdomen must be (p. 343) demonstrate that sewers, drains, and cesspools are all continued. If the patient have an ardent desire for cold acting generators of galvanic emanations. The odious grates drinks, they ought by no means to be denied him, for although and gutters of our streets and areas are emitting these filthy they be immediately ejected, they are grateful and refresh- electric disturbances under our noses. It is therefore absoing, and if any of the liquid be retained in the stomach, it will lutely necessary to reform this state of things altogether, and havea chance of being absorbed, and will then make up for to dissipate these lethal vapours far above our roofs, rather the loss of the watery part of the blood. The liquids may be than allow such noxious miasms to be constantly discharged soda water, effervescing lemonade, toast-water, or plain cold into our apartments. " 3rd.—That as chimney flues are requisite to carry up water. A few drops of laudanum and a little brandy may be added to each draught, the quantities to be regulated by the smoke above our roofs, and as ventilators are necessary to tunnels, so it is much more needful to tap pent-up frequency of administration and the urgency of the symptoms. mines and A few grains of common salt to each would be a good addition. sewers, balance unequal galvanism, and waft away disgusting Should no amendment take place in from four to twelve hours, gases, rather than to discharge them into our halls, kitchens, or should the patient give signs of sinking at any period of and bed-rooms. (See THE LANCET, p. 343.) " 4th.—With respect to personal cleanliness, it is essential, this stage, the injection of salines into the veins, as practised by the late Dr. Mackintosh,* may be tried as a last resource. both for prevention and treatment. Energetic friction of the If, however, the vomiting and purging become less frequent; skin, not with a hair brush, but with warm, dry flannel, will if the pulse becomes perceptible, and the surface of the body go very far to keep the body well charged with good vital equivalents of electricity. regains its usual temperature, and the secretions be partially atomic " Vigorous rubbing during an hour, night and morning, conrestored, such as the bile appearing in the evacuations, the tributes largely to the above electrical improvement, as the case will have assumed a more favourable aspect, and the third electrometer readily demonstrates. of to be said have The treatment commenced. stage might " 5th.-The same instrument also shows that considerable this stage must be conducted on general principles, but we must bear in mind that the thinning of the blood demands advantages in the distribution of due equivalents are derivable The use of diffusible stimulants only means. special attention, and as this cannot be well accomplished in from internal any other way but through the medium of the stomach, the creates a short excitation, followed by very depressing galvanic patient should be allowed a sufficiency of any of the liquids abstraction. Perhaps I may be excused for mentioning that, break of balance between the atmospheric formerly mentioned. Stimulants are now inadmissible, unless during the awful’ the case assumes a typhoid character, which is not an unfre- electricity and terrestrial magnetism, in 1832,’ I found no in creating and quent result. If reaction runs high, it must be moderated by remedy equal to an abundant use of camphor, first and second gentle aperients, (such as castor oil,) diluents, and diaphoretics. maintaining healthy voltaic action during the If typhus sets in, a stimulating form of practice must be pur- stages of cholera. " This fact also agrees with the extensive experience of , sued. The diet should be bland and nutritious. If a chronic Professor Hart, of Dublin. " * The formula used for injection by Dr. Mackintosh, in the DrummondWhilst acting as a member of the Central Board, I had street Hospital, at Edinburgh, consisted in half an ounce of muriate of ‘ in of of ten at t of " * Inflammation and ulceration of the duodenum are frequent results of four soda, and pints water, scruples sesquicarbonate soda, He took half an hourr extensive destruction of the skin by burns, which shows that there is a a temperature ranging between 1100 and 120° Fahr. to inject this quantity. sympathetic action between it and the lining membrane of the bowels.
I
.
478 of the value of camphor, but I found it too slow of digestion in such a rapid disorder as cholera. It is now beforfi the profession in a fluid form. " Fluid camphor, being charged with carbonic acid, in vast quantities, is grateful to the digestive organs, and suits the purposes so ably explained by Dr. Parkin and others, in THE LANCET for some time past. "Although it is reasonable to evince a parental fondness for this preparation, I must insist upon its powers of sustaining the equilibrium of animal electricity, as advanced in my treatise on " Temperature," in 1828. When used to aid in the prevention of cholera, adults require a wineglassful of the fluid three or four times daily, for its efficacy to be evinced by the electrometer ; but, during the treatment of actual cholera, the above quantity should be given every ten or twenty minutes, till heat and circulation are restored, and a few drops of laudanum, or any other suitable tincture, may be given with it. The minute proportion of bicarbonated magnesia, combined with the fluid camphor, abates gastric irritation, and prevents acid fermentations in the stomach, which are so productive of disturbances in the primse vias. "From the theory of cholera published in the London --Medical and Surgical Journal, July, 1832, and since amply confirmed in many parts of the world, it is to be concluded that the judicious restoration of respiratory powers, by longcontinued galvanic passes through the respiratory nerves, is one of the most essential adjuvants that can be employed during collapse, or in that passive state of galvanic abstraction, which ought to be treated like suspended animation. With respect to preventives, in the meantime, as additional means, the deductions from galvanic trials show that the dress of persons ought to consist, as far as possible, of dry shoes and woollen stockings, flannel or silk next the skin, warm woollen and cotton clothing and bedding, with thick, dry carpets, and cushions of wool, hair, or cotton. Beds may be well insulated by placing the posts on blocks of wood baked in an oven, or boiled in linseed oil, on cakes of wax, -rosin, or asphalte, or in cups or dishes of thick glass, or on earthenware."
ample proofs
____
On the Internal Administration
of Turpentine in Cholera. BY JOHN MOORE, ESQ., M.R.C.S., &c., Bourton-on-the-Water, Mr. Moore
in which
remedy.
reports
Gloucestershire. the following cases of spasmodic
turpentine was beneficially employed as an
cholera., internal
" CASE 1.-During the prevalence of fever, which raged extensively in the parish of Great Rissington, in October, 1846, was summoned, at eight P.M., to Harriet H-, aged 40, who, with her husband and three children, were then convalescent from typhus. She was stated to be suffering from purging and vomiting, with violent crampy spasms. As I could not immediately leave, I sent a mixture containing a drachm each of laudanum and sulphuric ether, directing half to be taken directly. I saw the patient in half an hour; the first dose had been vomited; the second was retained. She was suffering excruciating pain; in the intervals which sometimes occurred, she appeared quite exhausted; countenance contracted, and of a leaden hue; skin cold and clammy; the
surface, generally, covered copiously with large drops of sweat; the knees drawn up; the abdominal muscles strongly contracted ; the hands clenched; alvine discharges, of the appearance of rice-water, with here and there large albuminous flakes. No urine had passed since commencement of attack. "I prescribed friction of the extremities, flannels wrung out of hot turpentine to be applied over the abdomen, and an injection containing half an ounce of rectified oil of turpentine, half a drachm of laudanum, and a pint of starch; brandyand-water to be repeatedly given. The symptoms rapidly declined in intensity; small doses of laudanum and ammonia were given at intervals, and a speedy convalescence took
place. " CASE 2.- At eight o’clock, A.M, on September 23rd, 1847, I was sent for, hurriedly, to Mary G-, of Great Rissington, aged forty, who had experienced an attack of fever twelve months before, and had been in a very .
asthenic condition
ever
since.
About the middle of the
night she was seized with vomiting, purging, and suppression of urine. The symptoms now were-countenance of a pale-bluish cast, and expressive of dread; skin cold and clammy; tongue moist, and slightly furred in the centre; pulse thread-like and irregular; abdominal muscles much
contracted; stools like rice-water. The vomited matter
contained albuminous flakes, and was tinged with
bile.
Pre-
pill containing four grains of calomel and one of directly; an enema containing half an ounce of turpentine, and half a drachm of laudanum with starch; turpentine cloths to be applied over the bowels; brandy-and-water as required. In the evening she was much relieved, the purging was lessened, and a small quantity of urine had been passed. The surface had become warmer, and the pulse improved. Spasmodic pains, however, still scribed,
opium,
a
to be taken
occurred at intervals.
Ordered to take of rectified oil of tur-
pentine, two drachms; tincture of opium, half a drachm; oil of cassia, twelve drops; mucilage, two ounces; water, to six ounces. Mix. Two tablespoonfuls to be taken every four
hours. Meat broths to be plentifully administered. " This treatment was persevered in for a week, during which the cramps continued at intervals, and the secretion of urine was scanty. An occasional dose of castor oil was also given. A low, nervous fever supervened, which was combated with bark, laudanum, and ammonia. On the 24th of October, recovery was fully established." Mr. Moore remarks:" In these cases the urgency and character of the symptoms were such as, if Asiatic cholera had been prevalent, would have fully justified me in calling them by that name; and it is but a fair inference that a like remedy will prove equally influential over like symptoms of diseases, which, though differing in one material point-the property of diffuso many analogous characteristics. sion-present " The most formidable symptom of cholera-that which most rapidly tends to produce fatal prostration-is -the escape of the serum and saline particles of the bloodfrom the internal surface of the intestines. Over this symptom turpentine exercises a manifestly powerful influence. Like another correspondent of THE LANCET, (Aug. 26th last,) I was led to administer turpentine internally in cholera by witnessing the salutary effects resulting from its external application, which by far exceeded what could be fairly attributed to counterirritation; but though I have as yet prescribed it empirically, reason and analogy are not wanting to account for its efficacy. " Without speculating upon their nature and position, (which would be foreign to my purpose,) I apprehend that there can be no doubt that orifices naturally exist upon the internal surface of the intestines, through which serous exudation takes place. Internal haemorrhage may occur where no suspicion of organic lesion exists. In cholera, the albuminous and saline particles of the blood pass away copiously by the bowels, and no abrasion of their surface has been discovered upon post-mortem examination. It is a fair assumption, therefore, that by the same orifices which in their normal state instil serum into the intestinal canal, for the purpose of its lubrication, grosser particles of the blood may pass when the said orifices are relaxed by the depressing agency of the choleraic or other poisons. Then, as turpentine exercises over passive haemorrhages an influence almost specific, analo. gical reasoning might lead us to anticipate its tending to mitigate or arrest that exhausting effusion by the bowels of the nutrient portions of the blood which occurs in cholera." in Cholera, and the treatment of by Transfusion. By CHARLES EDWARDS, M.D., M.R.C.S. &c., Cheltenham. " We find in cholera the component parts of the blood evacuated from stomach and bowels; the alvine discharges containing much albumen,* and the salts of the sernm. The residue of blood is thick, black, unfit to stimulate the heart, viscid, and seemingly oily. This will explain, by its detention in the capillary system, its seeming abundance, so that blood could be drawn from the surface almost as easily after as before death; also the apparent venous congestions and ecchymoses throughout the body.
On the
Pathology of the Collapse that stage
" This altered state of blood will of itself arrest the process of its own decarbonization by its effect on the brain and nerves, although, perhaps, partly a re-action; the nervous system being most likely affected primarily by the choleraic poison-the consecutive diarrhoea, by draining away albumen and serum, leaving a viscid residue, unfit to circulate, and still further poisoning the brain and nerves. The processes of secretion and elimination of bile and urine now cease, and the arteries contain venous blood. Further, by thisserous haemorrhage’ the blood in quantity is absolutely and suddenly diminished, (See Craigie, Edinburgh Journal, 1832,) and a state is produced akin to vascular inanition, or haemorrhagic
*
On this
head,
see a
succeeding article in this analysis.—ED. L.