- Email: [email protected]
REPORT OF A CASE OF CHOLERA SUCCESSFULLY TREATED.
425 29th.-Much the
refreshing pillow for the head, in acute rheumatism as a cool support for the inflamed limb, as also in certain uterine affections, inflamed piles, &c.; and when containing hot water it furnishes a most convenient means of imparting warmth to the spine. It is, however, in cases of ulceration of the back that its advantages are most strikingly developed; and in I compliance with the suggestions of many medical friends who have adopted these cushions in their practice, I am induced to invite the attention of the profession to the subject.
as a
same.
The bilious diarrhoea continues.
Ordered, tincture of catechu, half an ounce; compound tincture of camphor, half an ounce; water, five ounces. Mix. A fourth part to be taken every four hours. Urine much the
I
same.
30th.-Much better; pulse 80, fuller and steady; skin warm and moist; bowels not moved since yesterday evening; eructations much less, though singultus comes on occasionally. Has passed eight ounces of urine, possessing the same characters as before. Menstruation commenced to-day. Oct. 2nd.-Menstruation continues. Pulse 80. She takes nourishment, and is progressing favourably.
Chester-street, Belgrave-square, Oct. 1849.
REPORT OF A CASE OF CHOLERA SUCCESS-
The history of this case clearly shows that the diarrhoea and vomiting are not the most alarming symptoms, further than as they are evidence of great constitutional disturbance. The
FULLY TREATED. BY JOHN
GROVE, ESQ., Surgeon, Wandsworth. essence of the disease is something hidden from us for the preSEPT. 25, 1849. Mrs. B-, aged thirty-five. Attacked at sent. The theory which confines the fungous germs to. the two A.31., with diarrhoea, but without pain. This continued alimentary canal seems to be quite untenable, if the main
till seven A.M., when vomiting and severe spasms came on. At this time, application was made at my surgery, and my assistant sent a sulphur mixture, to be taken every half-hour,
until it should be retained on the stomach. At ten A.M., messenger was sent to me, stating that the patient was much worse, and required my immediate attendance. Her condition was as follows:—Countenance livid; eyes sunken; tongue and breath cold; hands blue, and sodden with a peculiar perspiration which pervades the surface in the collapse; pulse feeble; vomiting and diarrhoea incessant; spasms every now and then so severe in the extremities as to rouse her from the state of torpor in which she appeared to lie, and caused the voice to be elevated to a shrill scream, instead of the low whisper to which it was reduced; no spasm of bowels; thirst urgent. As the sulphur mixture* did not remain on the stomach, I administered a dose of ether and opium; this was retained, and some mitigation of suffering’ followed. The skin was rubbed all over with dry sulphur, and the patient laid between blankets. Bottles of hot water were applied to the body and extremities. Continued the sulphur mixture every hour.-At two P.M., much the same.At four P.M., the surface was becoming warm, and the perspiration gone, except on the hands, which still felt sodden, and retained their blue colour; breath warmer; countenance much the same; vomiting and spasms abated; pulse scarcely perceptible. Continued the sulphur mixture every half-hour. - Seven P.M.: The body warm, and every appearance of improvement, except that the hands remained cold and clammy; the skin and nails blue; no sickness. 26th.-Nine A.M. : She has had three hours’ sleep this morning; the sickness and cramps have entirely ceased; the surface of the body is warm, its livid appearance, as well as that of the nails, is changed to the hue of health; the tongue and breath quite warm; the pulse is soft and regular; the evacuations continue every half-hour; she complains of extreme exhaustion, and general soreness over the whole body. Continued the sulphur mixture every two or three hours. Arrowroot-water and brandy’and-water ordered as beverages. -Six P.M.: Pulse rapid and small; feet and body warm; hands cold; tongue warm; no thirst; bowels relaxed; evacuations still colourless; says she feels better. Continued the mixture. 27th.-Ten A.M.: Vomiting returned; the purging incessant; surface of body warm; no pulse at the wrist; constant pain in the epigastrium ; skin of its natural colour. Ordered carbonate of ammonia, five grains every hour.-Six P.M.: Face little flushed; surface of body warm; pulse 100, soft; two evacuations only since morning, of a bilious character; no vomiting; thirst urgent; no pain in epigastrium; she expressesI herself as being much better; her voice is firm; complains merely of a feeling of faintness and nausea; the urine has ’i appeared for the first time since the attack. Continued the ammonia, and occasionally a dose of sulphur, with opium, on relaxation of the bowels. a
facts of this case are considered in reference to it, for here the diarrhosa continued most urgent up to the third day, when thesickness returned, and yet the algide symptoms were gradually disappearing, though the pulse had become imperceptible at the wrist. Now, I conceive, according to the above theory, that the patient should have continued to exhibit the algide symptoms, or have sunk under the disease. This was not so, however ; and when the secretion of urine was restored, I placed some of it under the microscope, and detected the same appearances as are depicted in plate No. 1 of Dr. Brittan’s article in the Medical Gazette of a recent date. I will not pretend at present to say that these bodies are similar to those described by Dr. Brittan, though I strongly suspect them to be so. The urine was examined by another professional man, and he pronounced a positiveopinion as to the identity of the
~
objects. Supposing, however, the views of Dr. Brittan to be correct, the remedy used by me would be equally applicable, for whether the disease be in the blood or in the intestine, the sulphur is capable of coming in contact with the materies morbi, of neutralizing its effects, and of destroying its power over the body. Time, however, it is hoped, will throw additional light on this deeply interesting subject, but at the present our main object and paramount duty is, to occupy our time in alleviating suffering and combating the enemy; ourbest weapon is of more value than our eloquence or our arguments. Action, not speculation, should be now our watchword.
ON DR. AYRE’S TREATMENT OF MALIGNANT CHOLERA. BY JOSEPH
BULLAR, M.D., Southampton.
HAVING had an opportunity of closely watching the effects of small and repeated doses of calomel in malignant cholera, as recommended by Dr. Ayre, of Hull, I beg briefly to state the results, reserving the details for another occasion. There was a certain class of cases, in which calomel had no effect either way; it neither shortened life, nor prolonged it; the system was insensible to its presence. These were persons about or above forty years of age, whose previous health had been feeble or impaired by indisposition, or who had been exhausted by bodily fatigue, and in whom the collapse was sudden. When first visited, shortly after the seizure, they were pulseless, cold, covered with cold sweats, vomiting and purging by stool the rice-water evacuations, and painfully cramped. Such persons died in eight, ten, or twelve hours. In patients of the same class, where the collapse was not so sudden, the calomel was more effective; and several of these recovered who would have died otherwise. In younger persons and in children, even when the treatment was not commenced until they were in a state of decided collapse, with all the characteristic symptoms of the malignant type of the disease, the calomel, thus given, was strikingly beneficial. Not one of such patients died, although they were in the same state, in the same locality, and some in the same houses, in which others had sunk rapidly under different treatment. The dose given was one, and sometimes two, grains of 28th.-Improving. Diarrhoea and slight vomiting of bilious calomel, mixed with two grains of powdered white sugar, matter; singultus occasionally very distressing, as it causes every ten minutes, until the diarrhoea had ceased, the pulse eructations of bile; tongue slightly furred; no fever; pulse 90, had become perceptible, and there was some warmth of sursoft and steady. Continue sulphur-and-opium. face. When the stomach was so irritable as to reject everyx For an account of the thing, four or five drops of laudanum, or two or three drops this we refer the of mixture, composition of hydrocyanic acid, (L. P.,) in a teaspoonful of water, were to our review of a treatise by Mr. Grove, in the present number, pp. 430.
I
reader
refreshing pillow for the head, in acute rheumatism as a cool support for the inflamed limb, as also in certain uterine affections, inflamed piles, &c.; and when containing hot water it furnishes a most convenient means of imparting warmth to the spine. It is, however, in cases of ulceration of the back that its advantages are most strikingly developed; and in I compliance with the suggestions of many medical friends who have adopted these cushions in their practice, I am induced to invite the attention of the profession to the subject.
as a
same.
The bilious diarrhoea continues.
Ordered, tincture of catechu, half an ounce; compound tincture of camphor, half an ounce; water, five ounces. Mix. A fourth part to be taken every four hours. Urine much the
I
same.
30th.-Much better; pulse 80, fuller and steady; skin warm and moist; bowels not moved since yesterday evening; eructations much less, though singultus comes on occasionally. Has passed eight ounces of urine, possessing the same characters as before. Menstruation commenced to-day. Oct. 2nd.-Menstruation continues. Pulse 80. She takes nourishment, and is progressing favourably.
Chester-street, Belgrave-square, Oct. 1849.
REPORT OF A CASE OF CHOLERA SUCCESS-
The history of this case clearly shows that the diarrhoea and vomiting are not the most alarming symptoms, further than as they are evidence of great constitutional disturbance. The
FULLY TREATED. BY JOHN
GROVE, ESQ., Surgeon, Wandsworth. essence of the disease is something hidden from us for the preSEPT. 25, 1849. Mrs. B-, aged thirty-five. Attacked at sent. The theory which confines the fungous germs to. the two A.31., with diarrhoea, but without pain. This continued alimentary canal seems to be quite untenable, if the main
till seven A.M., when vomiting and severe spasms came on. At this time, application was made at my surgery, and my assistant sent a sulphur mixture, to be taken every half-hour,
until it should be retained on the stomach. At ten A.M., messenger was sent to me, stating that the patient was much worse, and required my immediate attendance. Her condition was as follows:—Countenance livid; eyes sunken; tongue and breath cold; hands blue, and sodden with a peculiar perspiration which pervades the surface in the collapse; pulse feeble; vomiting and diarrhoea incessant; spasms every now and then so severe in the extremities as to rouse her from the state of torpor in which she appeared to lie, and caused the voice to be elevated to a shrill scream, instead of the low whisper to which it was reduced; no spasm of bowels; thirst urgent. As the sulphur mixture* did not remain on the stomach, I administered a dose of ether and opium; this was retained, and some mitigation of suffering’ followed. The skin was rubbed all over with dry sulphur, and the patient laid between blankets. Bottles of hot water were applied to the body and extremities. Continued the sulphur mixture every hour.-At two P.M., much the same.At four P.M., the surface was becoming warm, and the perspiration gone, except on the hands, which still felt sodden, and retained their blue colour; breath warmer; countenance much the same; vomiting and spasms abated; pulse scarcely perceptible. Continued the sulphur mixture every half-hour. - Seven P.M.: The body warm, and every appearance of improvement, except that the hands remained cold and clammy; the skin and nails blue; no sickness. 26th.-Nine A.M. : She has had three hours’ sleep this morning; the sickness and cramps have entirely ceased; the surface of the body is warm, its livid appearance, as well as that of the nails, is changed to the hue of health; the tongue and breath quite warm; the pulse is soft and regular; the evacuations continue every half-hour; she complains of extreme exhaustion, and general soreness over the whole body. Continued the sulphur mixture every two or three hours. Arrowroot-water and brandy’and-water ordered as beverages. -Six P.M.: Pulse rapid and small; feet and body warm; hands cold; tongue warm; no thirst; bowels relaxed; evacuations still colourless; says she feels better. Continued the mixture. 27th.-Ten A.M.: Vomiting returned; the purging incessant; surface of body warm; no pulse at the wrist; constant pain in the epigastrium ; skin of its natural colour. Ordered carbonate of ammonia, five grains every hour.-Six P.M.: Face little flushed; surface of body warm; pulse 100, soft; two evacuations only since morning, of a bilious character; no vomiting; thirst urgent; no pain in epigastrium; she expressesI herself as being much better; her voice is firm; complains merely of a feeling of faintness and nausea; the urine has ’i appeared for the first time since the attack. Continued the ammonia, and occasionally a dose of sulphur, with opium, on relaxation of the bowels. a
facts of this case are considered in reference to it, for here the diarrhosa continued most urgent up to the third day, when thesickness returned, and yet the algide symptoms were gradually disappearing, though the pulse had become imperceptible at the wrist. Now, I conceive, according to the above theory, that the patient should have continued to exhibit the algide symptoms, or have sunk under the disease. This was not so, however ; and when the secretion of urine was restored, I placed some of it under the microscope, and detected the same appearances as are depicted in plate No. 1 of Dr. Brittan’s article in the Medical Gazette of a recent date. I will not pretend at present to say that these bodies are similar to those described by Dr. Brittan, though I strongly suspect them to be so. The urine was examined by another professional man, and he pronounced a positiveopinion as to the identity of the
~
objects. Supposing, however, the views of Dr. Brittan to be correct, the remedy used by me would be equally applicable, for whether the disease be in the blood or in the intestine, the sulphur is capable of coming in contact with the materies morbi, of neutralizing its effects, and of destroying its power over the body. Time, however, it is hoped, will throw additional light on this deeply interesting subject, but at the present our main object and paramount duty is, to occupy our time in alleviating suffering and combating the enemy; ourbest weapon is of more value than our eloquence or our arguments. Action, not speculation, should be now our watchword.
ON DR. AYRE’S TREATMENT OF MALIGNANT CHOLERA. BY JOSEPH
BULLAR, M.D., Southampton.
HAVING had an opportunity of closely watching the effects of small and repeated doses of calomel in malignant cholera, as recommended by Dr. Ayre, of Hull, I beg briefly to state the results, reserving the details for another occasion. There was a certain class of cases, in which calomel had no effect either way; it neither shortened life, nor prolonged it; the system was insensible to its presence. These were persons about or above forty years of age, whose previous health had been feeble or impaired by indisposition, or who had been exhausted by bodily fatigue, and in whom the collapse was sudden. When first visited, shortly after the seizure, they were pulseless, cold, covered with cold sweats, vomiting and purging by stool the rice-water evacuations, and painfully cramped. Such persons died in eight, ten, or twelve hours. In patients of the same class, where the collapse was not so sudden, the calomel was more effective; and several of these recovered who would have died otherwise. In younger persons and in children, even when the treatment was not commenced until they were in a state of decided collapse, with all the characteristic symptoms of the malignant type of the disease, the calomel, thus given, was strikingly beneficial. Not one of such patients died, although they were in the same state, in the same locality, and some in the same houses, in which others had sunk rapidly under different treatment. The dose given was one, and sometimes two, grains of 28th.-Improving. Diarrhoea and slight vomiting of bilious calomel, mixed with two grains of powdered white sugar, matter; singultus occasionally very distressing, as it causes every ten minutes, until the diarrhoea had ceased, the pulse eructations of bile; tongue slightly furred; no fever; pulse 90, had become perceptible, and there was some warmth of sursoft and steady. Continue sulphur-and-opium. face. When the stomach was so irritable as to reject everyx For an account of the thing, four or five drops of laudanum, or two or three drops this we refer the of mixture, composition of hydrocyanic acid, (L. P.,) in a teaspoonful of water, were to our review of a treatise by Mr. Grove, in the present number, pp. 430.
I
reader