Causes

The medical world is still to a certain extent in obscurity, as it regards the cause of this fearful pestilence. It attacks people of all ages and of every condition in life, but is more frequent and fatal among those who are pent up in ill-ventilated rooms, exposed to the effluvia of decaying vegetable matter, uncleanly in their persons, and imprudent in their diet, or among that class, whose chief delight is in the luxuries of the table and the exhilaration of the wine-cup.

We cannot look upon this disease as a diarrhoea, for no foecal matter is seen in the discharges. It is rather a decomposition of the blood, occasioned by some unknown cause, aided by a variety of circumstances, such as fear, debility, as well as the causes mentioned above, in which the watery part or serum of the blood, separating from the coagulum, escapes from the blood vessels into the stomach and bowels from whence it gushes in torrents.

This decomposition may be the work of days or hours, or as in the cases of dry cholera, which are the most violent, and are unattended with discharges, be the work of a few moments, accompanied from the commencement with violent and continued cramps. These cramps are occasioned by a cessation of arterial action on the muscles and of course cease when that action is reestab. lished. Need we wonder then at the rapid prostration of the cholera patient, when we remember, that these rice-water discharges, which gush forth in such torrents, consist in reality of the white part of the blood?

Prevention

Cholera prevails as an epidemic, often desolating a town or city, while villages within the distance of a few miles entirely escape. By some it is con-7 sidered Contagious, but this view I think is entirely erroneous. In a somewhat extended observation of Cholera I have never seen or read any adequate proof of its contagion.

Cleanliness, pure air, a healthy diet, and above all, a calm and even mind, are of course essential in warding off the attack. Giving way to fear, in this, as in every other disease, debilitates the system, and thus renders a person far more liable to its fatal effects. The gates are opened by the trembling victim, and all the disease has to do, is to enter and take possession. Any thing which would have a tendency to weaken the system, should be avoided, and yet a healthy vigorous action of the mind and body are of the utmost importance.

A sudden breaking up of habits, injurious in themselves, yet long persisted in, may cause too violent a shock of the system at a period, when violent shocks are dangerous. Thus, persons accustomed for a long time to the use of liquors or tobacco, may continue to use them, but in diminished quantity. The diet should be plain and simple, yet nourishing. Beef, potatoes, and bread, also ripe and fresh vegetables and fruit should constitute the principal part of the diet - the latter in moderate quantities. - Melons and green fruit and vegetables are not to be used.

The best beverage as a general thing is cold water. It may be advisable to wear a flannel bandage over the bowels. The utmost regularity should be observed in all things, eating, sleeping, or exercise, and mental or physical excesses should be carefully guarded against.

Treatment

There is often previous, or after the attack, a diarrhoea with rumbling in the bowels, and a general feeling of prostration or uneasiness. This is called Cholerine, and is generally easily relieved. Where it has been occasioned by cold, and is accompanied with pain in the limbs, headache, shivering, etc, a few doses of Bryonia and Rhus, given in alternation every two or three hours, will produce relief. If occasioned by debilitating causes either mental or physical a few doses of Phos.-ac. or China, given at intervals of three or four hours, may be taken. If occasioned by fear, Chamo-milla would be indicated, and if there should be present much nausea, Ipecac. may be given. A dose every two or three hours.

When the attack fairly commences, the rice-water discharges being present, Camphor is the all-important remedy, and should be immediately given. The patient should be covered up in bed, and three drops of the tincture of Camphor given on a lump of sugar every three, four, or five minutes. As soon as reaction takes place, and the patient becomes warm, the doses may be given less frequently, and when full perspiration commences, cease entirely. A little brandy and water may now be given.

If after the use of Camphor headache should come on, a few doses of Belladonna will relieve it. Should however cramps commence, which are not removed, or are only modified by the Camphor, we must turn our attention to other remedies; these are Cuprum and Veratrum, which are the most important, and can frequently be given in alternation. The cramps, coldness of the body or extremities, prostration, and discharges, clearly indicate these remedies. Veratrum, particularly when the cramps are exceedingly violent in the calves and bowels, and Cuprum when the vomiting is preceded by spasmodic constriction of the chest. Vera-trum, two drops of the tincture may be dissolved in a tumbler of water, and a teaspoonful given in alternation with a powder of Cuprum, ten, fifteen, or twenty minutes apart, gradually increasing the intervals as the symptoms are relieved. If after five or six hours the vomiting has nearly or quite ceased, there are cramps in the extremities, particularly the calves, and the evacuations still show no trace of bile, the prostration and coldness still continuing, Secale, a drop dissolved in a glass half full of water, a teaspoonful of which may be given at intervals of half an hour, until three or four doses have been taken:

In This Stage Phos

ac. is often a valuable remedy, particularly where chest symptoms are prominent, oppression of breathing, pain in the chest and side, anguish and restlessness. Two drops of the first dilution may be mixed in a glass half full of water, and a teaspoonful given every fifteen or twenty minutes.

During this stage, the covering may be governed by the feelings of the patient, who generally prefers to be well covered. Small lumps of ice may be taken, the drinks may be either cold or warm, according to the feelings of the patient, and injections of cold water may be thrown into the bowels, when they are severely cramped. Friction also should be made with the warm, dry hand, particularly over those parts violently cramped. Should the disease pass into the last stage, or that of collapse, Arsenic, or Carb.-veg. are the prominent remedies. Veratrum and Secale may also be indicated, and Camphor, if that remedy has not before been given. This stage may last from a few hours to two or three days with but slight alteration, and terminate inconvalescence, death or some other disease, particularly Typhoid Fever.

Carb

veg. should be given every three hours, particularly if stupor is present, or there is oppression of the chest or head, and should there be a sensation of intense burning in the stomach, with frequent desire for water, it may be alternated with Arsenic every two hours, gradually increasing the intervals to six hours, as the returning pulse shows signs of reaction. Should the burning sensation be the prominent symptom, Arsenic may be given alone at intervals of an hour. Arsenic is also indicated when the disease sets in with great violence, and when there is violent burning in the stomach, bowels, and throat, with great thirst and .debility. The covering should be governed by the feelings of the patient, who generally prefers but little if any. The application of external warmth in this stage is entirely useless.

I have thus endeavored to delineate the development and progress of Asiatic Cholera, as well as the treatment I found most successful in my own practice during the prevalence of this disease in 1849.

As has already been seen Camphor, Cuprum and Veratrum are the prominent remedies, one or the other of which may be indicated in every stage of the disease, as well also as preventives. Phos.-ac., Ipecac., Arsenic, Carbo-v. Secale, Hellebore, are also important remedies and deserving of particular attention.

During the prevalence of this epidemic, every family should be provided with a small case, containing a vial of the tincture of Camphor, one of Veratrum, one of the powder of Cuprum, and another of Ipecac. The premonitory symptoms should be promptly checked. At the commencement of the attack, until the physician arrives, the friends should not hesitate in their course, but administer the remedies with promptness and decision.