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Treatment by Alcoholic and Saline Fluids.
269 in small and frequently-repeated doses, was the only medicine which appeared to have any influence in controlling and arresting the disease; indeed, so manifest was the advantage derived from the persistent administration of this drug, that he directed his assistants to remain with the patients as much as possible, and to give, every quarter of an hour, two or three grains of calomel; and thus relieving guard night and
pearance, and as soon as the warmth became more general, and the pulse was fully re-established, we enveloped him in a sheet wrnng out in cold water, and covered with several layers of blankets; hot bottles were applied to the pit of the stomach and calves of the legs and feet; a profuse perspiration was the speedy result. Allowing this to continue for upwards of an hour, we removed the sheet, and placed our patient in bed, enveloped in hot blankets. His pulse was then 120, quite firm, his skin warm and moist, his reason completely restored, and on his expressing a wish to sleep, we left him. On my visit in the morning, I was delighted to find him in every respect better. Some sickness and fever existed, but were speedily arrested by small doses of calomel-and-opium. Each day since he has gone on improving, and he is now con-
mel,
day, they frequently had
the
high gratification
of witnessing,
that as soon as the gums became a little sore, the patient was safe to make a rapid recovery. It is true that many died in four, five, or six hours, and others in a longer period; but certainly not one in whom the mercurial had produced its characteristic effect. Now my object in sending these few hastilywritten lines is by no means to detract from the credit justly due to Dr. Ayre, of Hull, for the efficient and successful manner in which he has, from 1832 to the present time, carried out a similar practice; on the contrary, I believe him to be entit.led to the utmost respect for the manly and unaffected recital which he has given in your pages of the results of his experience; all I would maintain is, that there is really no novelty or exclusive originality in this practice, and that seven-
respected teacher, Mr. Cornish, did, from independent thought and reflection, become convinced that calomel was the medicine, par excellence, in cholera, and that all other drugs, in point of efficiency, were separated from it, Zongo intervallo. In conclusion, I may be allowed, as a humble unit in the profession, to express my hearty assent to this dogma. teen years ago, my
-
(Letter from Dr. Badeley, Cjeelmsford.) have read most of the communications made by SiR,—I various medical practitioners to your valuable journal, respecting the treatment of cholera; and that which has been suggested by Dr. Ayre, of Hull, consisting of small and frequently-repeated doses of calomel, with or without a drop or two of tincture of opium, appears, in the aggregate, to have been the most efficient. Considering it right, in the conflict of medical opinions on the subject, that every one should contribute whatever his experience may have taught him to be calculated to oppose the fatal issue of this formidable disease, ’, I venture to state, in corroboration of the efficacy of calomel, that, in a very severe case of it, in which my assistance was invoked, and in which the patient was exhausted, cold, nearly pulseless, with the Stygian dew standing thick upon him, and all the characteristics of collapse manifesting themselves, I ordered a scruple of calomel to be given every hour, till I could visit him again..Three hours had elapsed, and a drachm had been swallowed, soon after which, although every remedy which had been tried by the able medical attendant had ended hitherto in disappointment, and all hope was nearly or quite abandoned, we were gratified to find a subsidence of all the our patient rallied, and recovered so rapidly, that symptoms; in a fortnight he was again at work in his garden. No salivation ensued, the calomel appearing to be solely occupied in combating with the disease, and no untoward consequence I am. Sir. vour obedient servant. resulted. ! J. C. BADELEY, M.D. Cantab.
I
valescent. This case but confirms me in the opinion I have long entertained, that saline injection into the veins, if adopted before the patient reaches too collapsed a state, is the most rational treatment, and one which, I feel assured, if a fair trial were given it, would be crowned with abundant success. It narrows itself, in my opinion, into a very small compass-demand and supply. The blood is generally deprived with intense rapidity of its serum, so as to leave it in such an inspissated state as to be, in a case I saw lately, thicker than treacle. What, then, so rational as to supply it with its fluid properties again, and that immediately ? Not by the slow process of absorption, which must of course be the more tardy the greater the collapse, but by introducing it at once into the circulation. I would urge my medical brethren to try the usual modes of treatment, particularly that of Dr. Ayre, in the first stages of the disease; should they fail, however, in arresting its progress, and collapse set in, not to lose a moment in employing venous injection, and the result, I am fully persuaded, will be the rapid diminution of deaths from that most fearful scourge, the I am, Sir, your obedient servant, cholera. HENRY HOWLETT. Treatment by Alcoholic and Saline Fluids. To the Editor cif’THE LANCET. readers SiR,—Your may be interested in the fact, that the cholera patient at the London Hospital, reported in your last number to have had 250 ounces of alcoholic and saline fluid injected into the veins, is walking about the wards, entirely recovered. Five others more or less completely moribund, injected with amounts of fluid varying from forty ounces to 100 ounces, were not permanently relieved by the process. A sixth patient, injected on the 28th inst., is going on favourably. These results of an experiment, instituted, not for "the cure of cholera," but intended as an additional mode of temporarily maintaining the functions of the heart and tissues, whilst the powers of the economy throw off the mysterious poison of cholera, may encourage further investigation, but not the indiscriminate use of venous injections resorted to in 1832. I am. Sir. vour obedient servant, W. J. LITTLE, M.D. ** We regret that this letter arrived too late for insertion last week.-ED. L. ____
Treatment of Cholera by Saline Injection. To the Editor of THE LANCET. SiB,—Iwas sent for on Tuesday, the 21st of August last, at twelve P.M., to visit Benjamin J———.aged fifteen years, of spare habit. I found him suffering from true Asiatic cholera. The rapid course. He was quite pulseless; the symptoms had run aand purging, vomiting, cramps, had been of a most severe character; the rice-coloured evacuations extremely profuse; thirst intense; the corrugated and blue skin strongly marked; and when I arrived he was in a state of collapse. Having, on the Sunday previous, witnessed the marvellous effectsproduced bysaline injection into the veins, I determined, without a moment’s hesitation, to employ this remedy; but not having been aware, till I arrived, that it was a case of cholera, some valuable time was lost in procuring assistance and the necessary apparatus. I called up my friend, Mr. Girdwood, who immediately accompanied me, and on reaching the patient, found the icy coldness of the body more decided, and the collapse more complete, and in my opinion he was decidedly immediately opened a vein in the arm, and moribund.a We of injected quart water at 980 Fahr., in which one drachm of common salt, and half a drachm of sulphate of potash were dissolved. In less than ten minutes our patient showed symptoms of resuscitation: the pulse returned, the brow became warm, the blue and corrugated skin resumed its natural ap-
On the
Pathology and Treatment of Cholera. Disturbance of the Spinal Centre 1’emed’Îed by Counter-irritation over the Spine. By WILLIAM REEVES, Esq., Surgeon, Carlisle.
Many considerations induced me, some years back, (vide THE LANCET, vol. i. 1845,) to entertain the idea that all the symptoms might arise from spinal mischief. At first, inflammation of the cord impressed itself on my mind, and from two examinations of the cord in fatal cases, I found great congestion of the membranes, and softening of the cord itself. Yet as it
would not be logical to deduce a general conclusion from two cases, I pass this over with merely a record. One gentleman wrote to me after I had stated my views to him, saying we may have cramp and dyspnoea, and suppression of urine, &c., without original mischief in the spine, therefore your view is open to objection. My answer is-Yes, we may have many such symptoms, as in English cholera, that do not directly spring from original mischief in the spine; but I view it in this way. In English cholera there is offensive matter in the bowels, which gives rise to great irritation of the mucous membrane, and through the connexion of the ganglionic, the irritation is conveyed to the spinal nerves, and thus excites Diarrhoea is a necessary symptom of this disease; cramp, &c. the irritation in the bowels begins the disease; but not so in Asiatic cholera. Diarrhoea and vomiting, though common, are not necessary symptoms in this latter disease; vital de-
270
I
pression, flaggiug of the heart’s action, numbness and cramp, spine with a solution of croton oil in turpentine-one drachm dyspnoea, sudden deprivation of life, and other such nervous to the ounce-for twenty minutes, and then apply a hot and symptoms, are the only ones present in many cases of this moist bran poultice, contained in a bag, so as to be applied disease. Therefore I argue, that as in English cholera we have with more convenience. The bag containing the bran must the nervous symptoms following the visceral derangement; so in be large enough to cover the whole back. This treatment Asiatic cholera we have the nervous symptoms preceding the soon shows its good effects; the benefit is astonishing. I have visceral. As we look to the viscera, and apply our treatment, seen all the symptoms cease, or become so materially dimipalliative and curative, to them in English cholera, so in nished under its use, as to relieve from anxiety or fear as to Asiatic cholera we look, or ought to do, to the nervous centres, the result. In cases of relapse the treatment requires a and apply our treatment, palliative and curative, to them. repetition. As soon as the effect of the blistering is removed, We find m this latter disease, spinal symptoms; direct atten- aud the skin restored, I examine the spine again, and if tion there, and indications of disease show themselves. I ne ver tenderness is present I blister the part again and again till all met with a case where spinal tenderness was not present. mischief is removed. I do think, that in examination of a In Asiatic cholera there seems to be a paralysis of the func- patient in many diseases, the spine ought to be looked to with tions of nearly all the important organs in the body; respira- as great minuteness as the pulse. Many cases of dyspepsia, tion is interfered with; secretion and the serous effusion into neuralgia, &c., would then meet with ready detection and the bowels and stomach may depend upon paralysis of the cure. Lastly, it may be mentioned, that the treatment of extreme vessels. Such are my views, and I found my treat- cholera should be compressed into the shortest possible space ment upon them. I could quote instance after instance of the of time, for as the treatment of other and less rapid diseases success attending irritation over the spine, but will content may be spread over days, so the treatment of one awfully rapid should not extend over as many half-hours. Counter-irritation myself with casually recording two instances. J. H--, a lad fourteen years of age, had been pros- over the spine fulfils this indication. trate, and cramped, and cold, and blue, with intense thirst and forcible serous evacuations, both from mouth and Treatment of Cholera on the Plan of Dr. Ayre. rectum, for some hours before I saw him. My impressions were unfavourable-so much so, that I almost left him in GEORGE BURTON PAYNE, M.D., Warwick-square. By despair. However, I applied a blister four inches wide whilst the pathology of cholera continues so disputed a along the whole spinal region, and strapped it on with adwhilst the disease is daily spreading, and adding to the’ hesive plaster, and otherwise secured it with bandages; point; number of its victims, to the opprobrium of the profession; him of a drinkable solution nitro-muriatic acid for and gave would it not be more serviceable for medical men simply to the thirst; and ordered frequent doses of beef-tea, made after record the success of any given mode of treatment, than to the plan recommended by Liebig, together with a dose of the of the disease, for the purupon the occult nature speculate stool:-Decoction of the mixture after each liquid following of establishing a supposed " rational" treatment ? pose I bark of pomegranate fruit, seven ounces; tincture of catechu I have much pleasure in bearing testimony to the and kino, of each three drachms; nitro-muriatic acid, forty success ofmyself the plan proposed by Dr. Ayre, of Hull, which I Mix. He was tincture of one drachm. now minims; opium, have steadily pursued, (occasionally modified,) and have lost left, enveloped in blankets, with strict injunctions to carry out but one patient (a boy) throughout the whole epidemic, the plan of treatment. The blister began to affect him in four I have had under my care very many cases, in all although and all the violent subsided. He had consehours, symptoms of the complaint. But one remarkable recovery instages cutive fever, but ultimately recovered under a continuation of duces me to send you a brief account of the case, which, if the above treatment. think worthy a place in your practical journal, is very you B. C-, aged about twenty-eiglit years, and a labourer by much at your service. trade, whose parents had heard of the repeated efficacy of Mrs. B-. Aug. 23. Came over from Lambeth to Westblistering the spine, was seized with cholera. After being ill minster, to see some friends, when she was suddenly seized for some hours, they sent for me. I found him pulseless and with vertigo, inability to stand, foltowed by vomiting and blue, with the peculiar voice and repeated evacuations, both purging, severe abdominal pain. She immediately took a The parents told me mixture and by mouth and anus, intense thirst, &c. of spirit of turpentine, and the tinctures of composed they had just applied a blister along the spine, as they knew capsicum and opium, (dispensed to some receipt.,) which had my treatment; so I had nothing to do but to order the nitrothe symptoms, and I found her, about eight o’clock muriatic solution for drink, and the beef-tea and pomegranate aggravated in the evening, vomiting incessantly the rice-water ejection, mixture, and then leave. I scarcely expected a recovery, yet with violent cramps in the feet and legs, constant involuntary he did recover. The consecutive fever was long and tedious; &c. Ordered sinapisms over the whole abdomen, but under a continuation of the above treatment, he, as I said purging, hot bottles to feet, &c, and to take chloride of mercury, two before, perfectly recovered. five minutes, followed by tincture of opium, five The decoction of pomegranate bark is much used in the grains every of ammonia, six minims; water, one minims; compound Brazils for Diarrhoea and dysentery; and I learn from my drachm.-At nine spirit o’clock, purging, and pains, much brother, at Rio de Janeiro, that it is very effectual. The relieved; a genial heat andsickness, breaking out nitro-muriatic solution is very grateful to the patients; it suc- over the entire surface of thegentle perspiration To continue chloride of body. in ceeds checking the thirst, and removes the clamminess one grain every half-hour, alone.-At three A.M., from the mouth, as well as clears from the tongue that creamy mercury, was called up, and found the woman cold, livid, pulseless at substance with which it is often covered. There seems a desire the the legs completely flexed upon the body. Ilad so for acids, and this one answers admirably; so does churn milk, far wrist, up to twelve o’clock, as to be able to sit up in improved, after it has become somewhat sour. and had then been persuaded to take a glass of brandy. bed, There has been some talk of the alkaline reaction of the The sickness and pains almost immediately returned, and conexcretions. I have found them alkaline in many instances; tinued with violence until the time I was called up. increasing yet I am not prepared to say that this is always the case, not Although believing the case to be hopeless,- so great was the having sufficient data whence to draw a satisfactory con- prostration,-I gave her ether, one drachm; tincture of opium, clusion. In mentioning the propriety of giving acids, ten minims, (one dose;) with chloride of mercury, two grains to check this alkaline predominance, I was met with the five minutes, placed upon the tongue without anything every answer-No; give alkalies to keep up the supply, they are all else. This was done punctually for two hours, and at seven leaving the body; it is not that there is an excess of alkalies o’clock I had the satisfaction of finding my patient sleeping, in the body, but an excess of loss. In the present state of our and in in a word, reaction was completely perspiration; profuse knowledge of this matter it is difficult to answer, yet experi- established. She took a grain and a half of calomel every two ence teaches me the contrary, and I find acids most useful. the day, and with attention to diet alone, recohcurs I have found alkalies often increase the sickness. Since 1844, vered,throughout without any ill effects from the quantity of chloride of the first year of the potato disease, though this disease was taken. not generally recognised till 1845, in my practice I have found mercury the urine of most of my patients loaded with urates, known by Treatment of Cholera by Abstraction of Blood. disappearing when the urine is warmed, and on the addition GEORGE By OLIVER, Esq., Surgeon, Newton-on-Trent. of nitric acid, also by appearances under the microscope. A solution of nitro-muriatic acid taken three times a day soon IN the year 1832,I first met with cholera, (although ordinary causes this sediment to disappear from the urine. I am bowel complaints had been frequent.) During the autumn of tenacious concerning the treatment of cholera by counter- that year, three cases of cholera fell under my care, the whole irritation over the spine, for I have found it effective. When of which terminated fatally. Since that time, I have had the case is urgent, my plan is to rub the whole region of the eleven cases of true spasmodic or Asiatic cholera, the syrap-
yet
-
pearance, and as soon as the warmth became more general, and the pulse was fully re-established, we enveloped him in a sheet wrnng out in cold water, and covered with several layers of blankets; hot bottles were applied to the pit of the stomach and calves of the legs and feet; a profuse perspiration was the speedy result. Allowing this to continue for upwards of an hour, we removed the sheet, and placed our patient in bed, enveloped in hot blankets. His pulse was then 120, quite firm, his skin warm and moist, his reason completely restored, and on his expressing a wish to sleep, we left him. On my visit in the morning, I was delighted to find him in every respect better. Some sickness and fever existed, but were speedily arrested by small doses of calomel-and-opium. Each day since he has gone on improving, and he is now con-
mel,
day, they frequently had
the
high gratification
of witnessing,
that as soon as the gums became a little sore, the patient was safe to make a rapid recovery. It is true that many died in four, five, or six hours, and others in a longer period; but certainly not one in whom the mercurial had produced its characteristic effect. Now my object in sending these few hastilywritten lines is by no means to detract from the credit justly due to Dr. Ayre, of Hull, for the efficient and successful manner in which he has, from 1832 to the present time, carried out a similar practice; on the contrary, I believe him to be entit.led to the utmost respect for the manly and unaffected recital which he has given in your pages of the results of his experience; all I would maintain is, that there is really no novelty or exclusive originality in this practice, and that seven-
respected teacher, Mr. Cornish, did, from independent thought and reflection, become convinced that calomel was the medicine, par excellence, in cholera, and that all other drugs, in point of efficiency, were separated from it, Zongo intervallo. In conclusion, I may be allowed, as a humble unit in the profession, to express my hearty assent to this dogma. teen years ago, my
-
(Letter from Dr. Badeley, Cjeelmsford.) have read most of the communications made by SiR,—I various medical practitioners to your valuable journal, respecting the treatment of cholera; and that which has been suggested by Dr. Ayre, of Hull, consisting of small and frequently-repeated doses of calomel, with or without a drop or two of tincture of opium, appears, in the aggregate, to have been the most efficient. Considering it right, in the conflict of medical opinions on the subject, that every one should contribute whatever his experience may have taught him to be calculated to oppose the fatal issue of this formidable disease, ’, I venture to state, in corroboration of the efficacy of calomel, that, in a very severe case of it, in which my assistance was invoked, and in which the patient was exhausted, cold, nearly pulseless, with the Stygian dew standing thick upon him, and all the characteristics of collapse manifesting themselves, I ordered a scruple of calomel to be given every hour, till I could visit him again..Three hours had elapsed, and a drachm had been swallowed, soon after which, although every remedy which had been tried by the able medical attendant had ended hitherto in disappointment, and all hope was nearly or quite abandoned, we were gratified to find a subsidence of all the our patient rallied, and recovered so rapidly, that symptoms; in a fortnight he was again at work in his garden. No salivation ensued, the calomel appearing to be solely occupied in combating with the disease, and no untoward consequence I am. Sir. vour obedient servant. resulted. ! J. C. BADELEY, M.D. Cantab.
I
valescent. This case but confirms me in the opinion I have long entertained, that saline injection into the veins, if adopted before the patient reaches too collapsed a state, is the most rational treatment, and one which, I feel assured, if a fair trial were given it, would be crowned with abundant success. It narrows itself, in my opinion, into a very small compass-demand and supply. The blood is generally deprived with intense rapidity of its serum, so as to leave it in such an inspissated state as to be, in a case I saw lately, thicker than treacle. What, then, so rational as to supply it with its fluid properties again, and that immediately ? Not by the slow process of absorption, which must of course be the more tardy the greater the collapse, but by introducing it at once into the circulation. I would urge my medical brethren to try the usual modes of treatment, particularly that of Dr. Ayre, in the first stages of the disease; should they fail, however, in arresting its progress, and collapse set in, not to lose a moment in employing venous injection, and the result, I am fully persuaded, will be the rapid diminution of deaths from that most fearful scourge, the I am, Sir, your obedient servant, cholera. HENRY HOWLETT. Treatment by Alcoholic and Saline Fluids. To the Editor cif’THE LANCET. readers SiR,—Your may be interested in the fact, that the cholera patient at the London Hospital, reported in your last number to have had 250 ounces of alcoholic and saline fluid injected into the veins, is walking about the wards, entirely recovered. Five others more or less completely moribund, injected with amounts of fluid varying from forty ounces to 100 ounces, were not permanently relieved by the process. A sixth patient, injected on the 28th inst., is going on favourably. These results of an experiment, instituted, not for "the cure of cholera," but intended as an additional mode of temporarily maintaining the functions of the heart and tissues, whilst the powers of the economy throw off the mysterious poison of cholera, may encourage further investigation, but not the indiscriminate use of venous injections resorted to in 1832. I am. Sir. vour obedient servant, W. J. LITTLE, M.D. ** We regret that this letter arrived too late for insertion last week.-ED. L. ____
Treatment of Cholera by Saline Injection. To the Editor of THE LANCET. SiB,—Iwas sent for on Tuesday, the 21st of August last, at twelve P.M., to visit Benjamin J———.aged fifteen years, of spare habit. I found him suffering from true Asiatic cholera. The rapid course. He was quite pulseless; the symptoms had run aand purging, vomiting, cramps, had been of a most severe character; the rice-coloured evacuations extremely profuse; thirst intense; the corrugated and blue skin strongly marked; and when I arrived he was in a state of collapse. Having, on the Sunday previous, witnessed the marvellous effectsproduced bysaline injection into the veins, I determined, without a moment’s hesitation, to employ this remedy; but not having been aware, till I arrived, that it was a case of cholera, some valuable time was lost in procuring assistance and the necessary apparatus. I called up my friend, Mr. Girdwood, who immediately accompanied me, and on reaching the patient, found the icy coldness of the body more decided, and the collapse more complete, and in my opinion he was decidedly immediately opened a vein in the arm, and moribund.a We of injected quart water at 980 Fahr., in which one drachm of common salt, and half a drachm of sulphate of potash were dissolved. In less than ten minutes our patient showed symptoms of resuscitation: the pulse returned, the brow became warm, the blue and corrugated skin resumed its natural ap-
On the
Pathology and Treatment of Cholera. Disturbance of the Spinal Centre 1’emed’Îed by Counter-irritation over the Spine. By WILLIAM REEVES, Esq., Surgeon, Carlisle.
Many considerations induced me, some years back, (vide THE LANCET, vol. i. 1845,) to entertain the idea that all the symptoms might arise from spinal mischief. At first, inflammation of the cord impressed itself on my mind, and from two examinations of the cord in fatal cases, I found great congestion of the membranes, and softening of the cord itself. Yet as it
would not be logical to deduce a general conclusion from two cases, I pass this over with merely a record. One gentleman wrote to me after I had stated my views to him, saying we may have cramp and dyspnoea, and suppression of urine, &c., without original mischief in the spine, therefore your view is open to objection. My answer is-Yes, we may have many such symptoms, as in English cholera, that do not directly spring from original mischief in the spine; but I view it in this way. In English cholera there is offensive matter in the bowels, which gives rise to great irritation of the mucous membrane, and through the connexion of the ganglionic, the irritation is conveyed to the spinal nerves, and thus excites Diarrhoea is a necessary symptom of this disease; cramp, &c. the irritation in the bowels begins the disease; but not so in Asiatic cholera. Diarrhoea and vomiting, though common, are not necessary symptoms in this latter disease; vital de-
270
I
pression, flaggiug of the heart’s action, numbness and cramp, spine with a solution of croton oil in turpentine-one drachm dyspnoea, sudden deprivation of life, and other such nervous to the ounce-for twenty minutes, and then apply a hot and symptoms, are the only ones present in many cases of this moist bran poultice, contained in a bag, so as to be applied disease. Therefore I argue, that as in English cholera we have with more convenience. The bag containing the bran must the nervous symptoms following the visceral derangement; so in be large enough to cover the whole back. This treatment Asiatic cholera we have the nervous symptoms preceding the soon shows its good effects; the benefit is astonishing. I have visceral. As we look to the viscera, and apply our treatment, seen all the symptoms cease, or become so materially dimipalliative and curative, to them in English cholera, so in nished under its use, as to relieve from anxiety or fear as to Asiatic cholera we look, or ought to do, to the nervous centres, the result. In cases of relapse the treatment requires a and apply our treatment, palliative and curative, to them. repetition. As soon as the effect of the blistering is removed, We find m this latter disease, spinal symptoms; direct atten- aud the skin restored, I examine the spine again, and if tion there, and indications of disease show themselves. I ne ver tenderness is present I blister the part again and again till all met with a case where spinal tenderness was not present. mischief is removed. I do think, that in examination of a In Asiatic cholera there seems to be a paralysis of the func- patient in many diseases, the spine ought to be looked to with tions of nearly all the important organs in the body; respira- as great minuteness as the pulse. Many cases of dyspepsia, tion is interfered with; secretion and the serous effusion into neuralgia, &c., would then meet with ready detection and the bowels and stomach may depend upon paralysis of the cure. Lastly, it may be mentioned, that the treatment of extreme vessels. Such are my views, and I found my treat- cholera should be compressed into the shortest possible space ment upon them. I could quote instance after instance of the of time, for as the treatment of other and less rapid diseases success attending irritation over the spine, but will content may be spread over days, so the treatment of one awfully rapid should not extend over as many half-hours. Counter-irritation myself with casually recording two instances. J. H--, a lad fourteen years of age, had been pros- over the spine fulfils this indication. trate, and cramped, and cold, and blue, with intense thirst and forcible serous evacuations, both from mouth and Treatment of Cholera on the Plan of Dr. Ayre. rectum, for some hours before I saw him. My impressions were unfavourable-so much so, that I almost left him in GEORGE BURTON PAYNE, M.D., Warwick-square. By despair. However, I applied a blister four inches wide whilst the pathology of cholera continues so disputed a along the whole spinal region, and strapped it on with adwhilst the disease is daily spreading, and adding to the’ hesive plaster, and otherwise secured it with bandages; point; number of its victims, to the opprobrium of the profession; him of a drinkable solution nitro-muriatic acid for and gave would it not be more serviceable for medical men simply to the thirst; and ordered frequent doses of beef-tea, made after record the success of any given mode of treatment, than to the plan recommended by Liebig, together with a dose of the of the disease, for the purupon the occult nature speculate stool:-Decoction of the mixture after each liquid following of establishing a supposed " rational" treatment ? pose I bark of pomegranate fruit, seven ounces; tincture of catechu I have much pleasure in bearing testimony to the and kino, of each three drachms; nitro-muriatic acid, forty success ofmyself the plan proposed by Dr. Ayre, of Hull, which I Mix. He was tincture of one drachm. now minims; opium, have steadily pursued, (occasionally modified,) and have lost left, enveloped in blankets, with strict injunctions to carry out but one patient (a boy) throughout the whole epidemic, the plan of treatment. The blister began to affect him in four I have had under my care very many cases, in all although and all the violent subsided. He had consehours, symptoms of the complaint. But one remarkable recovery instages cutive fever, but ultimately recovered under a continuation of duces me to send you a brief account of the case, which, if the above treatment. think worthy a place in your practical journal, is very you B. C-, aged about twenty-eiglit years, and a labourer by much at your service. trade, whose parents had heard of the repeated efficacy of Mrs. B-. Aug. 23. Came over from Lambeth to Westblistering the spine, was seized with cholera. After being ill minster, to see some friends, when she was suddenly seized for some hours, they sent for me. I found him pulseless and with vertigo, inability to stand, foltowed by vomiting and blue, with the peculiar voice and repeated evacuations, both purging, severe abdominal pain. She immediately took a The parents told me mixture and by mouth and anus, intense thirst, &c. of spirit of turpentine, and the tinctures of composed they had just applied a blister along the spine, as they knew capsicum and opium, (dispensed to some receipt.,) which had my treatment; so I had nothing to do but to order the nitrothe symptoms, and I found her, about eight o’clock muriatic solution for drink, and the beef-tea and pomegranate aggravated in the evening, vomiting incessantly the rice-water ejection, mixture, and then leave. I scarcely expected a recovery, yet with violent cramps in the feet and legs, constant involuntary he did recover. The consecutive fever was long and tedious; &c. Ordered sinapisms over the whole abdomen, but under a continuation of the above treatment, he, as I said purging, hot bottles to feet, &c, and to take chloride of mercury, two before, perfectly recovered. five minutes, followed by tincture of opium, five The decoction of pomegranate bark is much used in the grains every of ammonia, six minims; water, one minims; compound Brazils for Diarrhoea and dysentery; and I learn from my drachm.-At nine spirit o’clock, purging, and pains, much brother, at Rio de Janeiro, that it is very effectual. The relieved; a genial heat andsickness, breaking out nitro-muriatic solution is very grateful to the patients; it suc- over the entire surface of thegentle perspiration To continue chloride of body. in ceeds checking the thirst, and removes the clamminess one grain every half-hour, alone.-At three A.M., from the mouth, as well as clears from the tongue that creamy mercury, was called up, and found the woman cold, livid, pulseless at substance with which it is often covered. There seems a desire the the legs completely flexed upon the body. Ilad so for acids, and this one answers admirably; so does churn milk, far wrist, up to twelve o’clock, as to be able to sit up in improved, after it has become somewhat sour. and had then been persuaded to take a glass of brandy. bed, There has been some talk of the alkaline reaction of the The sickness and pains almost immediately returned, and conexcretions. I have found them alkaline in many instances; tinued with violence until the time I was called up. increasing yet I am not prepared to say that this is always the case, not Although believing the case to be hopeless,- so great was the having sufficient data whence to draw a satisfactory con- prostration,-I gave her ether, one drachm; tincture of opium, clusion. In mentioning the propriety of giving acids, ten minims, (one dose;) with chloride of mercury, two grains to check this alkaline predominance, I was met with the five minutes, placed upon the tongue without anything every answer-No; give alkalies to keep up the supply, they are all else. This was done punctually for two hours, and at seven leaving the body; it is not that there is an excess of alkalies o’clock I had the satisfaction of finding my patient sleeping, in the body, but an excess of loss. In the present state of our and in in a word, reaction was completely perspiration; profuse knowledge of this matter it is difficult to answer, yet experi- established. She took a grain and a half of calomel every two ence teaches me the contrary, and I find acids most useful. the day, and with attention to diet alone, recohcurs I have found alkalies often increase the sickness. Since 1844, vered,throughout without any ill effects from the quantity of chloride of the first year of the potato disease, though this disease was taken. not generally recognised till 1845, in my practice I have found mercury the urine of most of my patients loaded with urates, known by Treatment of Cholera by Abstraction of Blood. disappearing when the urine is warmed, and on the addition GEORGE By OLIVER, Esq., Surgeon, Newton-on-Trent. of nitric acid, also by appearances under the microscope. A solution of nitro-muriatic acid taken three times a day soon IN the year 1832,I first met with cholera, (although ordinary causes this sediment to disappear from the urine. I am bowel complaints had been frequent.) During the autumn of tenacious concerning the treatment of cholera by counter- that year, three cases of cholera fell under my care, the whole irritation over the spine, for I have found it effective. When of which terminated fatally. Since that time, I have had the case is urgent, my plan is to rub the whole region of the eleven cases of true spasmodic or Asiatic cholera, the syrap-
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