/ 

18. PATIIOLOGY >? OF CHOLERA; ITS CAUSES, SYMPTOMS, 

AND 

TBEAT ME 35T T . 

Walter Raleigh Amesbury, Bt. Surgeon, 



Licentiate of Midwifery. 

CIVIL STTDBO-DEOIET 

HOOGIILY. 

<fฃntcuit;t: ฆ 

C. HAY and Co., 15, ESPLANADE ROW, 

AND 

2, CRESCENT PLACE, BLACKFRIARS, LONDON. 

1862. 







HIS EXCELLENCY GENERAL SIR HUGH ROSE, G.C.8., K.S.I. 

COMMANDER-IN-CHIEF IN INDIA. 

THIS TREATISE 

IS, WITH PERMISSION, 

RESPECTFULLY DEDICATED 

DY 

THE AUTHOR. 







PREFACE. 

Several of the works, which have been written on the subject of Cholera, are directed almost exclusively to the treatment of the symptoms of the disease, without giving attention to the morbid condition of the structure whence those symptoms proceed, and without considering the necessity of making the functions of the affected organs a material subject for investigation in considering the diseases of those organs. 

I If my views differ in some degree from c observations of others who have studied this subject, it is not that I have any intention of putting forward special theories; but that the facts and suggestions expressed in these few pages have risen forcibly and convincingly to my mind, while contemplating the symptoms 



presented by individual cases. They are acknowledged to be very imperfect, but, incomplete as they are, they may have the 

effect of drawing" the attention of others to 

o 

the subject. 

In submitting the following pages to publication, I have been guided by a desire ,o draw attention to the causes and treatment of this distressing and fatal malady, and o condense under one point of view the little ye know of the general pathology of Cholera, particularly the formations of acid poisonous >rinciples, generated in this disease by disrganization of the digestive functions, acted n by Miasma. However this subject may lave been handled by the profession, these ew pages are suggestive of considerations too important to be disregarded. They point to the causes of the disease, and the views maintained in them are founded upon observations 

ii 

PREFACE. 





El a large field, several thousand cases come under my notice during the past 1 years. In 1848-49-54, when Cholera raged so fearfully in England, I made it my particular study at several of the London Hospitals ; and during the eleven years I have been in this country, eight in Medical charge of European and Native Regiments, and the last three in charge of Civil Stations with large Jails, I have had great opportunities of treating this disease ; in four hundred cases of iliich I kept accurate notes, as well as of the suit of forty-two dissections of cases in rich it terminated fatally. 

Whether my object has been gained, must be left to the judgment of those into whose hands this treatise may fall, and who may feel inclined to interpret the phenomena of Cholera by the illustrations which it contains. 

iii 



LI have thought it desirable to lengthen s work by the publication of a few cases from which my opinions have been deduced. 

HOOGHLY, ) The Uth April 1862.) 

iv 

PREFACE. 



CONTENTS. 

CHAPTER FIRST. )efinition of Cholera ... ... 2 Oxalic Acid ... ••• 3 iactic Acid ... ••• * 'redisposing Causes ... ••• 6 Exciting Causes ... ••• ? Blood ... — 7 Serum ••• ••• Bile ... ••• ฎ State of the Skin ... ... 11 CHAPTER SECOND. Hepatic Circulation ... ... 11 Capillary Vessels in the Lungs ... ... 12 The Appearance of the Lungs after death ... 12 Gall Bladder ... ... 13 Bilious Diarrhoea ... ... 13 Case of Bilious Diarrhoea ... ... 14 Cholera Case, No. 1, with Treatment ... 16 



Premonitory Symptoms ... ... 18 Difference between the premonitory symptoms of Cholera and simple Diarrhoea ... 18 The manner in which Cholera commences ... 11) CHAPTER THIRD. Symptoms and Diagnosis ... ... 19 Termination when fatal ... ... 20 Case No. 2 ... ... 20 Treatment of Case No. 2 ... ... 21 Producing principle ... ... 22 Exciting principle ... ... 23 Generation ot Cholera Malaria ... | ... 23 That Cholera poison is soluble in water ... 23 Healthy persons living in the neighbourhood more or less affected ... ... 24 Cholera itself is not infectious"' ... ... 24 CHAPTER FOURTH. Illustrative of the advantages of moving away from the poison ... ... 25 Another illustration ... ... 26 The Active Principle of the poison produced by 

ii 





Contagion ... ... 29 Termination ... ... 30 Morbid Anatomy ... ... 30 After effects of Cholera ... ... 31 Duration of the Disease ... ... 31 Unfavorable Prognosis ... ... 31 CHAPTER FIFTH. Jactation ... ... 32 Voice ... ... 33 Favorable Prognosis ... ... 33 The seasons when Cholera is most prevalent ... 33 To preserve health in time of Cholera ... 34 A moderate supply of Spirit beneficial to Troops 34 Sour Beer ... ... 34 Fish served to Troops ... ... 35 CHAPTER SIXTH. Vegetables and Fruit ... ... 36 Bread and Flour ... 36-37 •"ice ... ... o/ 

m 





Moog Dall ... ... 37 Clothing for European Troops ... ... 38 Exercise ... ... 38 Situations for cantonments ... ... 38 Barracks ... ... 39 Conservancy Arrangements ... ... 40 Bathing ... ... 40 Early Parades ... ... 40 Immoderate use of Tobacco ... ... 40 Its effects on the Digestive System ... ... 41 CHAPTER SEVENTH. Treatment ... ... 41 Castor Oil ... ... 42 Olive Oil ... ... 42 Electricity ... ... 42 Calomel and Opium in large doses ... 43 Injecting Salt and Water into the veins ... 43 Opium ... ... 44 Ipecacuanha and Tartar Emetic should be avoided 45 To sooth the irritability of the stomach ... 45 Alcohol. ... ... 46 CHAPTER EIGHTH. Neutral Alkaline Salts ... ... 47 Mercury ... ... 49 

iv 

CONTENTS. 



Pages. The action of Chlorides of Potash and Soda and Muriate of Ammonia on Calomel ... 50 Mercurial Inunction ... ... 50 Counter Irritation ... ... 51 Drink ... ... 51 Warmth ... ... 52 Cold to the Head beneficial ... ... 52 

CHAPTER NINTH. Nitrate of Silver Injections ... ... 52 Stimulant Friction ... ... 54 Fomentations to Bladder ... ... 54 Internal Stimulants ... ... 54 Secondary Fever ... ... 54 Bedding ••• ... 54 Recapitulation of Treatment ... ... 55 

CHAPTER TENTH. Cases ... ••• 57 

v 

CONTENTS. 





THE PATHOLOGY OF CHOLERA; ITS CAUSES, SYMPTOMS, AND TREATMENT. 

CHAPTER FIRST. 

Icfinition of Cholera — Oxalic Acid — Lactic Acid — Predisposing causes — Uzciting causes — 8100d — Serum — Bile — Urine — State of tlte Skin. 

One would suppose Cholera from its name derived from two Greek words, xฐM bile> and pen, to flow, to be an unnaturally profuse secretion of bile. The word epidemic, generally prefixed, signifies prevalent, or strictly speaking, " among the people" ctt* among, Siifios, a people ;. the former word could not convey a greater error, for instead of an abnormally 



2 

|3i*eased secretion of that fluid, it is altogether susnded ; and in these few pages I shall endeavour to ow, that it is a disease caused by decomposition of c blood produced by derangement of the digestive *ans, causing the stomach to throw out quantities abnormal acid compounds of a poisonous nature, rich require only to be acted on by a peculiar state 

Definition of Clio- of the atmosphere to produce lera. HVinlpra. Thp lilnnrl fircnlfi.tincr 

Cholera. The blood circulating 

through the body should be alkaline abounding in Phosphates of Soda and common salt. Lactic Acid also enters into it, but is in health at once consumed by the process of respiration. I cannot but express my belief that Cholera is a disease connected with the development of oxalic, lactic and other indefinable acid principles, acting on and decomposing the blood, excited by a malarious, or 'heavy poisonous gaseous principle, analogous to malaria diffused, through the lower regions of the air. Its high specific gravity, and feeble dispersive powers, retain it in near proximity to the earth, hence its prevalence in low and marshy stations, and in Jails surrounded by high walls like the Hooghly Jail. From such situations it takes a long time to escape, and after a few hot days where it is generated, it may be called into. action by a good shower of rain, when it becomes rarefied and ascends higher off the ground infecting those pre-disposcd to its attacks. On the outbreak 



3 

ICFiolcra, or when tlic disease has been raging, have noticed as a curious fact that iateritions posits are not often seen in the urine even of althy persons living in the neighbourhood, which esents the peculiar appearance characteristic of alic acid, viz., the urine being generally transient and uncommonly devoid of sediment, of a ,le yellow color and specific gravity about 1020. 

Not that I am aware this acid has been distinctly found in a free state in the 

Oxalic Acid. 

stomach or intestines (excepting in cases where it iias been intentionally taken). In health, as soon as formed, it becomes neutralized and rendered harmless by the alkalines it meets with in the secretions. Still we know it is formed in the system in small quantities, and is excreted rapidly by the urine and does not remain in the body. In Cholera it may be produced in abnormal quantities and retained, for we are aware that in an ovei dose of this substance vomiting and collapse are the chief symptoms, in connection with a scarcely perceptible pulse, and labored respiration — symptoms very analogous to those exhibited in the disease under our notice. Besides oxalic and lactic acids, other abnormal principles of a poisonous and acid nature are developed during certain derangements of the assimilating functions, in some cases resulting from a positive disorder of the converting function of the stomach. 



4 

M. M. Bernard and Barreswil have found that 

if the gastric fluid be sufficiently concentrated by evaporation, 

Lactic acid. 

effervescence takes place with carbonate of lime, proving the presence of some free acid which Dr. B. D. Thompson, Lehmann and Rterichs consider to be lactic acid which is also Liebig's opinion. M. M. Melseus and Dumas have also proved the existence ta free acid produced by the gradual solution of rtions of carbonate lime placed in the gastric fluid, sspecting the nature of this free acid, whose presence is thus proved, the discrepant results suggest a supposition, that the source of the acidity of the gastric fluid may vary at different times in the same individual. The existence of hydrochloric acid in the gastric fluid has been clearly demonstrated by Danglison, Enderlin and others, which renders it probable that the gastric fluid requires some acid to give it digestive properties. These acids in certain derangements of the digestive functions may either be secreted in supw-abwndance, or being vitiated. assume a poisonous principle which acts deleteriously on the blood. 

All indigestible food on being received into the stomach irritates that viscera, and causes it to throw out a large abnormal quantity of the different sorts of acids I have above mentioned, giving rise to Gastdynia 



5 

( pain in the stomach, from ygrrri'ip the mach and 6svi>ri pain ), which is often accompanied by ejection from the stomach of an acid watery fluid. The acids are in a great measure derived from the food, and in themselves often excite painful Colic and Diarrhoea. In ague, during the sweating stage of the paroxysms, acid in large quantities is given off from the skin. The saliva also is generally very acid, and in the severest and most malignant disease we have of this type, Yellow Fever of the West Indies, not only the saliva, but the blood itself is observed to be acid. The matter ejected from the stomach receives its color from blood mixed with acid, which turns the former black. Of the exact nature of these unnatural principles or spontaneous creations of poisons, little is known ; but it is certain that, when these abnormal acids are absorbed into the system and are acted on by Miasmata, malignant fevers or other diseases of one sort or another are the result. In like manner when they are acted on by the Miasma, which I will denote " Cholera poison," that disease is engendered. 

The blood in health contains little or no sugar, yet saccharine matter enters largely into most articles of our diet, especially those of a farinaceous description ; that saccharine matter must therefore be 



6 

fftain constituents of that fluid, and our greatest lysiologists contend that this change of saccharine Dperties is carried on by a separate and peculiar ocess. This, like every other function of the human dy, is liable to be disordered or altogether suspended, le consequence of the former is the creation of many isonous products within the system. The matter icted from the stomach in Yellow Fever of the est Indies is powerfully acid (so is the saliva freently in Cholera) supposed to be muriatic, but 3st likely the greater portion is lactic. 

The predisposing causes which give rise to the 

derangement of this digestive 

I'redisposing causes. „ , . ซ... function are anything affecting c health, especially anything of a depressing ture, — intemperance, weakening the stomach, more rticularly that produced \>j the poisonous stuff sold the bazars, — over-crowding, — long encampments of )giments on the same ground, especially after a od shower of rain, when large quantities of feculent iman, as well as animal, matter is washed into the nks and wells, — sudden changes of temperature' Id, damp, and miasma ; but much more frequently 3m unwholesome diet of a farinaceous kind, particularly new rice, if bad of its sort, I mean not properly developed, — acid and unripe fruits, or putrid 



7 

short time in the sun. By eating such things, the poison is really taken into the system ready formed and gives rise to epidemic diseases of various kinds, 

tand only requires a peculiar state xciting cause. ot the atmosphere, containing the olera miasma, to develope this direful disease in its rst form and character. 

It must be borne in mind that the blood is the 

general material from which all the secretions of the body are 



derived. There are two sorts, the arterial contained in the arteries, and left side of the heart, which is. of a bright red color, and the venous contained in the veins, and right side of the heart, which is purplish black, but converted into florid blood on its passage through the lungs, where it becomes oxidised from exposure to the air. The condition of the blood in a Cholera patient is the point under consideration at present. It is in the majority of cases of a thick treacly consistence, and of a very dark color, nearly approaching black. The longer the disease, continues, the thicker and darker the blood becomes, circulation in the extremities ceases, and the patient is pulseless. This thickness, as shown by the analysis of Lccanu, is caused from the watery portion or Serum, which forms 78015 in every 100000 parts 



8 

of healthy blood, passing off in large quantities in the rice water evacuations. 

The Serum seems to exude either from the small 

capillaries or most minute pores 

Serum. 

in their sides, which in their 

natural state are not large enough to admit the passage of the red corpuscles ; therefore healthy blood, when these vessels are in health and integrity, is unable to exude through them, or any unbroken texture of the body. But when the fluid is chemically changed, the watery portions pass in large quantities, which constitute the rice water stools, and the vessels themselves may become debilitated or relaxed ; but as we are altogether ignorant of the natural condition of these minute outlets, it is difficult to reason about the abnormal alterations they may undergo in this disease. This hypothesis is supported by the occasional good effects of astringents, but I am rather inclined to believe that the change takes place in the composition and consistence of the blood itself, which becomes attenuated, and so allows the serous portions to pass through orifices that healthy serum cannot penetrate. This is illustrated in Sea-scurvey. Blood drawn from Cholera patients, when it can be procured, coagulates, but I have never seen it produce the buffy coat. In post mortem examinations I have nearly always 



9 

found the arterial blood, and that contained in the left side of the heart, quite as dark as venous blood, which leaves, I think, little doubt that, although in a few cases the patients seem to breathe without inconvenience, the blood on passing through the lungs is not properly oxidised. 

The absence of bile, which contains large pro- 

portions of chlorides of sodium 

Bile. 

and potassium, acts on the blood 

laterially from the absorption of biline again into it rough the intestines. Salts also found in healthy ood. Biline is especially useful in the preparation 1 carbon and hydrogen, that those substances may i removed from the blood. 

The secretion of urine is nearly or quite .arrested. 

in Cholera. Urea, and uric acid, and perhaps some other con- 



stituents existing ready formed in the blood, and which ought to pass into, and be carried off by the urine, still remain, and I have my doubts also if some of the other salts which properly do not exist in the blood, but only in the urine, I mean the acid phosphates and sulphates, are not taken up by the blood. In health the blood is purified in its passage through the kidneys. In Cholera, their 



10 

action being stopped or nearly so, the blood passes on !"thout being separated from its impurities. There•e I think the inference we may come to is, that b blood is not in its normal state in this disease, t contains less oxygen, serum, and neutral salts, d more hydrogen and carbon ; and that it is also pregnated with urea, uric acid, and perhaps with id phosphates and sulphates. It is well known at nothing is more poisonous and pernicious in its "ects, than urea retained in the blood ; and when > consider that thirty-six ounces of urine, ordirily passed in 24 hours, contain no less than 227 lins or nearly half an ounce of urea, we can hardly surprised at the impure state of the blood in Cholera, the secretion of urine being arrested and the poison retained in the blood. Excessive acidity I the ccecum is sometimes the cause of complete ppression of the bilious discharge. The individual that case would suffer from nausea, headache, Ld perhaps diarrhoea. That bile is not secreted in lolera is certain, from the many proofs we are ile to adduce, although I am aware several high ithorities hold the contrary opinion. My reason for is assertion is that, in genuine cases of Cholera, ere are no appearances of bile in the rice-water evacuations, nor in the matters ejected from the stomach, or in the urine, if any is secreted, which 



11 

The natural action of the skin is suspended, and gives place to cold clammy sweats : — State of the Skin. r J 

not that this condition is always 

present, but generally it is, which is the cause of that peculiar death-like sensation experienced on touching the skin of a Cholera patient. But it is a curious fact, which I have noticed in many cases, that on the re-appearance of bile in the secretions, this characteristic state of the skin subsides, giving place either to natural perspiration, or increased heat, which I think shows the affinity between the functions of the skin and the liver. 

CHAPTER SECOND. 

Hepatic circulation — Capillary vessels of the Lungs — Appearance of Lungs after death — Gall Bladder — Bilious Diarrhoea — Case of Bilious Diarrhoea — Cholera Cast No. 1, with treatment — Premonitory symptoms — Difference between premonitory symptoms of Cholera and simple Diarrhoea — The manner in which Cholera commences. 

In the liver, we must not forget, the venous blood Hepatic circulation. from the viscera un- 

dergoes a process of arterializa- 

tion, previous to mixing with the venous blood from other parts of the body. Before entering that 



12 

important organ it has been deprived of much f its vital principle, and requires by the aid of the lepatic system to be separated from all its unatural and deleterious matters ; the portal vein and lepatic artery, which are enveloped in a loose areolar ssue, coalesce ; and from the blood thus mixed, the )ile is separated and conducted through the hepatic nets to the gall bladder. In Cholera this does not ,ake place. The blood certainly flows through the lepatic vessels, but how ? — unarterialized, vitiated, nd containing all its unnatural and deleterious tatters. In this state it passes into the vena caya t nd from there it flows into the right auricle, and lence into the right ventricle. There it enters the pulmonary artery and its branches to the capillaries ; 

Capillary vessels in but from its thickened and vitiated the lungs. o+ofo U./vniir/n/vWaWZoj onfora tliom 

state it only partially enters them, 

and that which penetrates is retained, choking up these minute vessels, which become gorged with black unoxidised blood, — the lungs after a short time losing 

Appearance of the their elasticity, and ( as seen by Lungs after Death. mortem examination) characteristic appearance, assuming more that of the liver or spleen. This is, however, not always the case, for sometimes it seems as if the thickened blood could not enter the capillaries at all. The lungs then are found extremely collapsed and less than half their natural size, lying in a cavity on each side of 



13 

the vertebral column, leaving the interior of the test almost empty, giving the appearance of having en forced down by some external pressure, overming the resistance of the atmospheric air contained in them. The blood in this state of the lungs is always very black. 

In the majority of cases in which I performed 

a post mortem examination, I 

Gall bladder. 

found the gall bladder filled 

with black bile, — a proof that it was not afresh secretion ; but I never yet discovered any bilious accumulations either in the stomach or intestines. In all cases where there is bile, either in the evacuations, or in the matter ejected from the stomach, the case properly comes under the denomination of (lious diarrhoea rather than cholera, is tractable, and hen properly treated seldom proves fatal. In the orst cases of cholera the re-appearance of bile may be considered the very best sign that could occur, for it is soon followed by a secretion of urine, and when that takes place the distressing symptoms gradually subside, and the patient may be looked upon as convalescent, but still requiring the greatest care and management. 

Bilious diarrhoea often resembles cholera in all respects, with the exception of Bilious Diarrhoea. x . „ , . 

the character of the evacuations, 



14 

which are always tinged more or less with bile ; Ed if there is any vomiting, the matter ejected m the stomach is generally of a yellowish or senish colour. I could furnish many instances istrative of this disease, but shall only adduce the following which occurred among many in the Hooghly Jail. 

Baboo Lund Woopadho, caste Brahmin, aged 38, 

Case of Bilious Diar- was admitted into the Hooghly rhcea. T o :i TTnsnit.nl mi iha lat MnrpJi 

Jail Hospital on the Ist March 

!i62, with diarrhoea, which attacked him suddenly day-break. At 7 o'clock A. m. I saw him. He ,d passed several watery stools of a dark yellow lour, and complained of pain in the abdomen, 3 ompanied with a sense of sinking in the epigastric slight cramps in the feet and hands, had mited a greenish fluid twice before, and once after his admittance. — Ordered — 

Hydrarg : Chlorid : gr. xv. 

Pulv : Opii gr. |. 

Fiantpil. iij. Sumat j. ter die, si diarrhoea permaneat. 

Acid Sulph. dil. n\, xv. 

Aquae minth. pip. |i. 

1* 

I* 



15 

I Passed water freely, but of rather a darker colour m natural, skin moist and warm. 

t March 2nd. — Passed a restless night, skin hot, still ght twitchings of the toes, diarrhoea and vomits' ceased, passes water freely, pulse 98, tongue rred. — Ordered — 

01 : Ricini |ss. Tr. opii. nj, x. 

statim 

Three bilious evacuations were the result. 

I March 3rd. — Passed a comfortable night, skin tural, no twitchings or pain in the abdomen.— 

IV 

I Inf. Chirettse gj. ter die sumend. et. — Sago, milk, and arrow-root. 

1 March 4th. — Nearly well — repeat tonic, combined th sodse carb. — half diet. 

March sth. Much the same as yesterday, bowels moved once naturally. 

March 6th. — Discharged, cured. 

I* 



16 

The difference between this and genuine Cholera, which is often unattended by premonitory symptoms, will be seen at a glance from the following cases :—: — 

Mokaree Shaik Mahomed, aged Cholera, Case No. 1. , . . 

24, was admitted into the Hooghly 

Jail Hospital early on the morning of Bth March. He stated that an hour before he was brought to hospital he was seized with vomiting, and almost simultaneously had a copious discharge from the bowels, which made him feel very faint and exhausted. Very shortly after he was admitted, he had some rice-water stools untinged by colour, scarcely marking the cloth, skin cold and clammy, and a continual ejection from the stomach of a thin flaky watery fluid. 

11l o'clock A. M. — Complains of an unpleasant nsation in the ears, giddiness, cramps in the fingers id toes, — pulse small, quick, but perceptible, — me suspended from the commencement of the tack, — tongue furred, moist, brown, and cold. 

1 o'clock P. M. — Very restless, throwing his limbs about, tongue cold to the touch, eyes sunken, conjunctiva congested, voice slightly altered, rice-water evacuations not so frequent, vomiting less. 



17 

Treatment. 

Treatment, ordered on admission. 

R 

Hydrarg : Chlor : gr.ij Sodo3 Carb : gr.iij Camphorce gr-j 

M. Fiant pil duoe, singulis horis sumend : — et 

X 

Potass : Chloratis 3iij Sp : Sacchari งxij Aq ; dist งxiv 

IM. Fiat mist : cujus sumant cochl. iv. mag'n post amquamque sed : moll : — et 

Inungatur hypochond : dext : 51J Ung : Hydrarg : fort:— 

And water ad lib. to quench the great thirst, in which a small portion of aq : calcis and chlorate of potash had been added to the pint. 

6 o'clock P. M. — Patient decidedly better, vomiting and diarrhoea stopped, — the last stool was at 4 o' clock, and slightly tinged with bile, — not so restless, pulse stronger. 

10 o'clock. — Much the same as when I last saw him, — felt inclined to sleep. 



18 

March 9th. — No evacuations during the night, vomiting ceased, has passed some light coloured urine, tongue furred moist and warm, pulse much stronger, eyes still blood-shot, face not so anxious. 

t Ordered. — Mist. rep. every three hours, omitting c other remedies. 

March 10th — Ordered. — 

R. 

01 : Ricini jgss 

Tinct : opii m. xv. 

Statim. 

kFive bilious motions were the result, — passes iter freely. — Ordered soup, sago, milk, &c, and omit medicines. 

March 11th. — Convalescent, — half diet. 

March 12th.— Discharged cured, but placed for a few days on the convalescent list. 

I stated previously that cholera in this country was frequently unattended by Premonitory symp- * /" 

toms. 

previous vomiting,, or other pre- 

Difference between monitory symptoms ; but when the Premonitory symp- , , 7 toms of cholera and they occur, there is a marked simple Diarrhoea. ?-, , , ay,™, „ i 





19 

simple diarrhoea. In Cholera the whole alimentary canal seems to be emptied at once, and this always leaves the patient more or less exhausted. He vomits the contents of the stomach, suffers no pain, but feels dejected and low, and complains of depression of spirits and giddiness ; and not unfrequentiy twitching* of the extremities take place. This state of things may continue for several hours or even days, the cholera poison not being concentrated sufficiently to develope the disease, or enough not having been into the system to act on the abnormal principles of a poisonous nature, which are produced spontaneously by the derangement of the converting functions of the stomach. 

CHAPTER THIRD. 

Pns and Diagnosis — Termination when fatal — Case — Treatment of Case No. 2 — Producing 'principle — ing principle — Generation of Cholera Malaria — Cholera Poison is soluble in Water — Healthy Perivinj in the neighbourhood more or less affected ฆ •ซ in itself not infectious. 

When cholera sets in, collapse speedily ensues, frequently ending in death. The general order of the attack in India is purging, vomiting, collapse, 



20 

accompanied with a rumbling in the stomach, but lith no pain, excepting from the cramps, which mmence in the toes and fingers, gradually extending along the entire limbs, and very frequently affecting the muscles of the abdomen. The evacuations are issed without straining or tenesmus, and on pressure 3 abdomen is free from tenderness ; the eyes sink their sockets, the conjunctiva becomes highly consted, the whole countenance seems as if it were iched up, the face has an anxious expression, and cold clammy condition pervades the whole body ; c pulse becomes very small and thready, very often iperceptible at the wrist, axilla or nock, yet notwithstanding the coldness of the patient, he complains of heat in the epigastric region, and great thirst, and hardly remains a minute in the same position. There is generally incessant jactation, the breathing 

I Termination when becomes labored, the voice alters, tal. - the nrinp. iซ sin-mvpsswl tlin 

the urine is suppressed, the 

ttient retains his faculties to the last, and death sets frequently without a struggle. 

Binod Shaw, caste Soory, aged 40, was admitted 

into the Hooghly Jail Hospital, March 30th 1862.— At day-break 

Case No. 2. 

passed several colourless serous stools, and is constantly ejecting a quantity of watery fluid from the stomach — complains of great rumbling in the abdomen, 



21 

Icompanied with no pain or tenderness on presre — painful cramps in the feet, legs and arms ; es much sunk and surrounded by a dark halo, the itures contracted, urine suppressed, skin clammy d cold, temperature of the body 76ฐ, pulse imperptible, tongue moist, saliva slightly acid, great irst and jactation — collapsed. 

110 o'clock A. M. — Still collapsed, breathing oppress, other symptoms as in the early morning. 

I March 31st. — Still collapsed, cold, breathing more bored, has passed no urine, diarrhoea and vomiting opped. 

April Ist. — The same as yesterday. Died at IP. M. Treatment of Case On his admission, he was given 

No. 2. 

a saline and mustard emetic, and 

I sinapism applied to the pit of the stomach. — tiered — 

& • 

Hydrarg : Chlor. gr. iij Potass : Chloratis, gr. vj M. 

to be taken at ฉnee, the calomel to be repeated in 



22 

10 o'clock A. M. — Ordered — 

3. 

Ammonia) scsquicarb : sss. Potass : Chloratis, jjss 

Sjss. 

Sp : Oryzas, 

gss. 

Aq : dist : 

งij. M. 

tne ounce for a dose to be repeated every hour, rdered — 

Strong hot broth, giij at a time, to be repeated I very hour with h)j Sodas Chlorid : in each dose ; and 3 quench the great and continual thirst, boiled water olding in solution $j of Salt and "ฃ) j Potass : Chloratis } the pint ad lib :—: — 

Two drachms of Ung. Hydrarg : fort : to be well Ebbed in over the region of the liver, turpentine ctions to the extremities, and mustard poultices to c inside of the legs. 

On the 31st the Calomel was omitted. 

April Ist, treatment continued — died 1 P. M. 

I have endeavoured to prove two principles — 

Ist. — That Cholera is produced by poison, caus_ , . „ . . , ing disorganization of the blood, Producing Principle. ฐ ฐ 

caused by the derangement cf a 

peculiar function in the assimilating or digestive 



23 

process, whereby all the saccharine portions of food are converted into oxalic, lactic, and other abnormal compounds of a poisonous nature and acid tendency. 

Indly. That, when the blood is in this state from the above causes, it only re- Exciting Principle. . ... 

quires a certain malarious condi- 

tion of the atmosphere to develope the disease. 

This Malaria 'peculiar to Cholera, being of a 

The generation of Cholera Malaria. 

hi S her S P ecific g ravity than the 

surrounding air, is generated in 

low swampy ground, drains, cesspools, and such places, where decomposition of animal, vegetable and gaseous matters is continually taking place; and it only requires to be set in motion by the wind (especially after it has been rarefied by the steam caused by rain, or vapours rising from drains, tanks or jheels,) and to be driven to other localities where it affects those already predisposed from the causes enumer- 

I have no doubt also from experience, that That Cholera poison Cll ฐ lera Pฐ isOn is nOt SS 1 ™ 11 

is soluble in water. o ff from, but is very soluble in water, and may be taken into the system through 



24 

Healthy persons living in the neighbourhood 

„ ? where Cholera exists, are more or Healthy persons living in the neigh- l ess influenced by the vitiated bourhood are more or _ less affected. state of the air or water. In 

upport of this argument, it will be remembered iow prevalent bowel complaints and other similar isorders are during the seasons of epidemic Cholera ; mt the blood of such persons, being in a healthy ate from the digestive organs performing correctly leir separate functions, throivs off the inhaled poison ith other excrementary matters without its affecting le individual, except perhaps by causing only slight isorders of the system. 

It must therefore be apparent to every one 

Cholera is not in- that > although Cholera is not infectious in itself, fectious in itself, it behoves all who possess the power, to remove to another locality. Very often a few miles will be sufficient to evade its tract, in evidence of which I will mention a circumstance which occurred during the time I was serving with the Sarun Field Force. 



25 

CHAPTER FOURTH. 

I'uslrative of the advantage of moving away from the poiso — Anotlier illustration — The active principle of the poison produced by rain — Contagion — Termination — Morbid A natomy — After effects of Cholera — Duration of the disease — Unfavourable prognosis — Hiccup. 

In March 1858 the Regiment of which I had the medical charge, the Bengal Illustrating the advantajro of moving Yeomanry Cavalry, alter a forced away from the poison. , . - march, picketted their horses at about 7 o'clock p. M., for the night, on some low ground near a Jheel. I advised that the Regiment should be removed to a higher situation a mile or so off, as I feared from the aspect of the place, Cholera poison might be there ; but as the men and horses were knocked up by their journey of some forty -five miles, it was thought the few hours they would remain on the ground (we were to march at daylight) could be attended with little or no risk. However, before 12 o'clock the same night, one Officer, three Troopers, and four Dooley bearers were attacked with Cholera. There were also several cases of bowel complaints. Within half an hour we received orders to march, and encamped some four miles to windward, and the result was, not another case occurred. However, four natives and one Trooper died, and Captain G. recovered after a very severe attack. 



26 

The other five soon regained their health. I think this is sufficient to prove the expediency of removing Troops whenever Cholera makes its appearance. This remark is equally applicable to prisoners in Jails. 

Another illustration of the same fact occurred 

in June 1857. — At the time of the Allahabad mutiny, when all 

Another illustration. 

Europeans, Sikhs, etc., were confined within the Fort, no case of Cholera had occurred. But three or four days after the arrival of a Wing of the Ist Regiment Madras Fusiliers, under the command of the late General Neill, Cholera broke out suddenly in the Barracks occupied by these men, the upper part of which building was tenanted by Officers, some gentlemen connected with the Railway, and their wives and families. These quarters were not overcrowded, but those occupied by the Troops were as full as possible. This lower range also contained the Hospital. The rations were bad, although the best obtainable ; and as all food was very scarce, the men did not have their proper rations er allowance. In fact the chief diet that could be supplied to the sick was chuppatties. This Wing suffered great fatigue and exposure in getting into the Fort, having to fight their way ; this, coupled with the excessive heat of the weather, and improper food, predisposed them 



27 

Inerated in this Barrack, which was not exposed to free current of air from the river, but stood in the ntre of the Fort. The well also from which the irrack was supplied was situated immediately in its rinity, and so absorbed the Cholera poisonous inciple, contained in and around this particular lilding, to which locality it was confined by the still L d sultry state of the atmosphere. 

After a heavy shower of rain, the disease made its 

I appearance in its worst and most Plie active principle * the poison produced virulent form. Between fifty and • J. J.J. 1 1 -xl 

sixty persons were attacked at the 

Ine time, (only five cases occurred in the upper ry of the Barrack) the first morning after its apirance. I, being Acting Garrison Surgeon, and also medical charge of these men, strongly urged that non-combatants should be at once turned out of i Garrison, and encamped on the glacis in front of i Fort ; and although this was protested against ปst vehemently by those who thought their only iurity was within the walls, my suggestion was mediately carried into effect, and not another case occurred amongst tltem afterwards. 

I represented also the urgent necessity that the men should be at once removed, and they were accordingly ordered out of the Barrack into the square 



28 

of the Fort, until tents could be pitched for their accommodation. Large fires were lighted on the floors of most of the lower rooms, and all drains were thoroughly cleansed ; lime mixed with dilute acid was thrown into them, and the water from that particular well was not allowed to be used. Notwithstanding all these precautions, an alarming number of the men, besides some ladies and gentlemen, who had inhabited this barrack, and inhaled the poison, were attacked, being predisposed to it from the hardships, and the bad and scanty food they had been subjected to ; no less than seventy-two, or nearly that number, out of some 256 cases, died within three days and nights. The other buildings, barracks, tents, &c, in the Fort, which were supplied with water from other wells, remained entirely free from the disease, although they were equally crowded ; which strengthens my opinion that this poisonous gaseous principle is readily absorbed by water, and through it can be conveyed to the system as well as by the air. With the exception of two cases, — Lieutenant Gordon, late 6th Regiment Native Infantry, whose duty it was that day to visit the barracks and sick, and who, after being in a collapsed state for several hours, recovered ; and my own kidmutghar, who brought me some breakfast to the hospital tent, and who died within two hours from the commencement of the disease — no more cases occurred in any other part of the 



29 

Tort. Many of the men attending on the sick were ttacked, and upwards of twenty dooly -bearers died, ho were employed carrying away the dead; but as an nstance that those, who are not previously disposed n themselves to be affected by cholera poison, though xposed to the same influence, escape the actual isease, yet may be more or less disordered by it, ly own case is sufficient proof : for although I never eft the hospital tent day or night, being in constant ttendance, and taking no rest, as I was the only Medical Officer, yet these causes which produced the Cholera in others, / not being predisposed, had only le effect of making me feel a sensation of giddiness nd sickness, which lasted about twenty-four hours. 'here is no doubt, had it been possible to have marched the men out of the Fort for even a very lort distance, the disease would have ceased ; that is ,o say, there would have been no fresh seizures, as as the case with the non-combatants who were emoved out of the Garrison. 

From my experience I do not consider Cholera to 

be contagious, that is, communicable, from a diseased to a heal- 

Contagion. 

thy person ; but should cholera evacuations, or matter ejected from the stomach, be allowed to flow into common drains, and from thence be carried, or washed into wells or tanks, all persons drinking such water 



30 

would imbibe cholera poison, more or less diluted, and render themselves liable to this disease ; — these matters, therefore, should be at once removed and carried to a distance from any habitation wells or tanks, and buried deep enough to prevent any effluvia arising. 

Cholera runs its course, and if it be not fatal, 

speedy or slow recovery takes place ; but this disease is often 

Termination. 

followed by gastric irritation, dysentery, or fever of a low and typhoid character, each requiring its own peculiar treatment. 

The general appearances I have met with in post 

mortem examinations are, the 

Morbid Anatomy. , lungs highly congested with dark blood, — sometimes these organs are contracted, but I have not seen that so frequently ; — the alimentary canal is often distended by gas, and generally contains a whitish serous fluid, — no bilious secretions are found in the intestines, — there is an absence of any solid foecal matter, — the mucous lining of the intestines sometimes presents congested appearances in small patches often very defined, — the arteries and veins generally contain small quantities of dark treacly blood, — the gall bladder is usually gorged 



31 

liver highly congested, the spleen small but apparently healthy, the urinary bladder so contracted as sometimes nearly to obliterate its cavity, and the brain occasionally congested, more frequently in cases where large doses of opium had been administered, which I think in some measure had tended to produce this effect. 

Many patients really recover from Cholera, but die 

After effects of frOm its after effectS '> I mean IoW Cholera. fp.vpr n.nd nt.lipvr prmp.nmitn.nt. 

fever, and other concomitant 

evils, in which cases the post mortem appearances would be different from that above described. 

The quickest fatal cases I have myself witnessed, 

have lasted about an hour and a half from the commencement of 

Duration of disease. 

the attack, but from two to forty-eight hours is the average duration; if the patient lives as long as this, he generally recovers in from four to ten days, should no unfavorable symptom occur. The disease may, however, be followed by some of the other complaints I have mentioned, in which case recovery may be of course very protracted. 

I consider the prognosis unfavorable at the com- Unfavorabio prog- mencement o f the epidemic, when 

nosis. 

the cholera poison is concentrat- 

Ed ; also when it attacks men habituated to the use 



32 

I intoxicating liquors in excess, or those weakened t previous sickness or old age, or when extreme llapse sets in, especially when in that state vomitg and purging are suddenly arrested. 

Hiccup very frequently occurs in Cholera, where 

that disease has lasted some hours, but I do not, as in some danger- 



ous illnesses, think it an unfavourable symptom, as I have often seen it, in comparatively slight cases, last for two or three days, notwithstanding every thing was done to relieve it. It as often takes place in cases that terminate favorably, as in those that end fatally. It arises partially from the remedies used, and also from acidity of the stomach. 

CHAPTER FIFTH. 

relation — Voice — Favorable prognosis — The seasons token Cholera is most prevalent — To preserve health in time of Cholera — A moderate supply of Spirits beneficial for Troops — Sour Beer — Meat — Fish — Fish served to Troops. 

This peculiar restlessness called jactation, throw- 

ing about the limbs, and allowing them again to fall heavily by the 

Jactatiou. 



33 

Eis a sure sign of the greatest prostration of vital powers, and must always be looked upon most alarming symptom ; and I have invariably rved, that when this restlessness is excessive, case generally terminates fatally. 

The voice partakes of the general debility, be- 

comes feeble, and in unfavorable cases almost inaudible and 



hollow in sound. 

The prognosis of cholera is favorable after the 

disease has been some time in 

( favorable prognosis, the same locality. As will be evint, the poison slowly becomes diffused and scatred, and so loses its power. The favorable sympms generally occur in the following order. The miting and purging gradually lessen, bile re-appears the evacuations, cramp disappears, urine is n3reted, and the patient regains his natural ter- 

The seasons of the year when cholera is more 

rife than at others in Bengal are Tho seasons of tho , year when Cholera is March, April, September, and most prevalent. . ~_ i _, _ lxl , ?. „ _ 

October, although this scourge 

may make its appearance in every month of the year. It behoves Commanding Officers particularly to impress 



34 

on their men, that nothing tends to predispose |.c system to this disease so much as the abuse of toxicating liquors. All spirituous compounds snerally sold in the Native bazars cannot be too strictly avoided, and the Civil authorities should assist the Military in having all such shops within the reach of the men closed immediately on the outbreak of cholera. 

To preserve health in this and indeed all countries, 

To preserve health temperate habits should be adheriu time of cholera. e( ] to# The use however iii moder- 

ation of good wholesome spirit, issued in proper quantities by authority, is rather beneficial than otherwise to troops. 

The Canteen Sergeant should daily examine the 

Beer in use, and report it at once, if the least acid or unsound, 

Sour Beer. 

to the Officer on duty, who should take the necessary steps to have the consumption of such Beer immediately stopped ; for nothing tends to disarrange the hepatic system so much as bad and sour Beer, and the sooner it is condemned and destroyed the 

Officers examining the daily rations should be 

even more strict than usual that the meat is perfectly untainted 

Meat. 



35 

lid of the best procurable quality ; for if it appears ack and moist on the surface, it has been exposed r some time to the sun, and the outside has in a easure become decomposed. The meat should not ok sodden, flabby, or of dark dingy red colour, it bright red and of a fine grain, which shows it to ! good meat and fresh killed. 

Fish in this country, in cholera times, should be 

eaten sparingly of, as mostly com- 

Fish. 

ing from the rivers, which are the 

|3cptaclcs of dead putrid bodies of persons, many of 10m may themselves have died of cholera, not to eak of other descriptions of filth. River prawns espeilly should be eschewed as being unclean feeders, ley have been known to produce irritation sickness d purging, sometimes so severe as to give rise to the spicion of poison. I saw one case of a soldier who, ber eating largely of them, was seized with giddiss and unconsciousness, followed by coma, which sted for several hours; this was succeeded by headhe and vomiting, and it was some days before he Lite recovered. If fish is served to Troops at those nes it should be procured from tanks or lakes ; — not at I for a moment mean to assert that river fish will give cholera, still I do not consider it the most wholesome food that can be eaten during the preva- 



36 

CHAPTER SIXTH. 

Vegetables and fruit — Bread and flour — Rice — Moog daU — Clothing for European Troops — Exercise situations, for Cantonments — Barrack Conservancy arrangements — Bathing — Early parades — Immoderate use of tobacco — Its injurious effects on (lie digestive system. 

The choice of vegetables and fruit also requires 

careful attention. That issued for 

regetables and fruit. . . use should be the best of its sort and well grown, and of fruit the ripest should be selected, and both used in moderation during the prevafce of cholera. The most wholesome vegetable is potato, which, when good and well boiled, may used with much greater freedom than green food, brinjawls, pumpkins, cucumbers and all esculent tjetables bordering on decay, are capable of exciting: all times pain, vomiting, and purging. 

That universal article of food, bread, from being 

in a mouldy state, has frequently caused symptoms resembling those 



produced by cholera ; — not that all descriptions of mould are poisonous, but as it is impossible to distinguish the. noxious from the innoxious kind of mould, the use of all bread in such a condition should be 



37 

The flour from which the bread for Troops is made 

should occasionally be examined, and strict care taken that it is not 

Flour. 

kept in a damp place, for researches have shown that inferior descriptions of flour are very prone to produce the red or orange coloured mould (penicillium roseum) which is poisonous. 

Rice is another article of food, which I must not 

forget. Although consumed in small quantities by European 



E>ops, it forms the staple commodity of food for our tive Army, and is the chief article of diet in our Is. When new it is most unwholesome ; it therefore should never be served either to Europeans or Natives before it is at least one year old, and if two, so much the better. This grain should be clean, long, thin, and of a pearly white colour — this is the best description, but being much more expensive than the new and inferior sorts, it is seldom if ever ฆ supplied by Regimental Contractors ; it can however always be obtained in any quantity and should invariably be had for the use of the sick. 

In Jails the Moog dall ("JlSt) when cholera is 

prevalent, should be given to all the prisoners, being much more 

Moog dall. 

digestible than the different sorts of mutter dalls. 



38 

Jhave tried this dall in the Hooghly Jail during olera epidemics with much benefit. 

Flannel should always be worn over the abdomen, 

Clothing for Euro- chest > and loinS ' at all seasons of pean Troops. t h e y eaFj by Officers and men, and all persons liable to sudden exposure by day or night ; as it prevents the serious effects of the sun's rays striking on important internal organs, and also, by keeping the body at an even temperature, prevents chills and all their concomitant ailments. 

Exercise and all manly out-door amusements in 

moderation should be encouraged, but not so as to produce fatigue, 

Exercise. 

in the cool of the mornings and evenings ; and, during the hot months, reading and some quiet occupation in the day, to keep the mind employed when Cholera is about, are most desirable. 

In selecting situations for Cantonments, where 

Situations for Cau- circumstances allow it, a high,dry, tonments. onr] sn.mlv Innn.ii+.w elirvnld lw* 

and sandy locality should be 

chosen if practicable. All low ground, although apparently dry on the surface, at some periods of the year retains moisture beneath ; and when it is acted on by the sun after rain, Malaria, often of the worst kind arises, especially where decaying vegetation 



39 

tregnates the soil. As open a place as possishould be fixed on for Cantonments. There is no objection to grassy land, provided there is a sufficient inclination of the ground to allow it to be 111 drained. It is absolutely necessary that there mid be a supply of pure water near. If good ings exist, it is almost a guarantee that the spot fit for the occupation of Troops. Avenues, when 3 trees are thick and running parallel to Cantonmts, are certainly objectionable, as they impede a ie circulation of air, thereby preventing the station ing properly ventilated. The same objection, wever, does not apply to topes of trees, as the : circulates round them. In fact they are rather vantageous than otherwise, as they afford immeate shelter to Regiments marching through, or riving at the Station. 

I have pointed out that Cholera poison is of a 

heavier specific gravity than the surrounding atmosphere. I have 

Barracks. 

also designated the situations where this Malaria is generated; and the facts adduced shew the very great necessity of having all permanent Barracks, Jails, and Hospitals^cmMe storied. A great decrease of mortality amongst European Troops would soon amply repay the extra expenditure. Not only would the upper stories be, comparatively speaking, exempt 



40 

ti Cholera, but all Malarious Fevers would greatly ease. 

It is not my object to enter into the detail of 

Enservancy ar- conservancy arrangements of Barents, racks, Jails, &c. It is obvious that strictest cleanliness is absolutely necessary, if the iase is to be prevented or got rid of. A small ntity of lime should daily be thrown down drains, r they have been thoroughly cleansed with water, for Barrack and Jail privies I have been in the habit of using lime mixed with a dilute acid with great advantage. 

Bathing should be encouraged among troops, and 

their under linen should be frequently washed and changed. 

Bathing. 

Regiments, if it can be avoided, should never, when 

t Cholera is amongst them, be allowirly Parades, ed to march or attend early parades quite an empty stomach. Taking a small portion food of some sort or other previously, strengthens stomach and enables it to resist miasma. 

One other remark before I conclude this subject. It is on the immoderate use of tobacco, which is one of the 

E. . , most poisonous drugs in nature: vet he immoderate use \ to ' J 'obacco. such is the fascinating influence 

such is the fascinating influence 



41 

tthis noxious weed, that mankind of all nations resort it in every form and mode they can devise, to ensure stupifying and pernicious agency. Smokers will ฃue to the contrary, but it disorders the digestive ictions, and by the continual and frequent use of 

Ilta effects on the the Pฐ ison the POWerSP 0WerS ฐ f the St ฐ" jestive system. mach become weakened, the liver 'morbidly excited, and the individual assumes a .chectic appearance, and suffers more or less severefrom the worst of all evils, Dyspepsia. To smokers say — restrict yourselves to three Cheroots or two pcs a day, which is ample allowance, and more nnot be taken with impunity. To non-smokers — nCt commence, or you will live to repent it. 

CHAPTER SEVENTH. 

I-eatment — Castor oil — Olive oil — Electricity — Calomel and Opium in large doses — Injecting salt and water into the veins — Opium — Ipecacuanha and Tartar Emetic s/tould be avoided — To sooth the irritability of the stomach — A Icohol. 

Every drug in and out of the Pharmacopoea, and 

every application, hot and cold, that could be applied to the hu- 

Treatment. 

man body, has been in its turn recommended and 



42 

used as a specific in this disease, and as often, alter lamentable failures, abandoned as worthless. 

When I visited England in 1854, Cholera was rag- 

ing, and the cure at one of the head London Hospitals was castor oil, 

Castor oil. 

in doses of a table spoonful, repeated at short intervals to insure vomiting and purging being freely kept up, under the idea of assisting nature in getting rid of morbid secretions or preventing their formation. At another London Hospital a tea cup full of olive 

oil, repeated every half hour, with the notion that it would glaze 

Olive oil. 

or varnish the intestines, and so allow the poisonous secretions to flow over them with impunity. Both these treatments had their advocates and admirers. I had opportunities of seeing numerous cases treated with the first or castor oil plan by Dr. George Johnson, but I am sorry to say the numerical returns were not such as to recommend this mode of treatment, although I must say I have seen patients recover under both plans. 

Electricity was another favorable method, with the 

impression that the atmosphere was deficient in that fluid, and the 

Electricity. 

poor patients, some in the last agony of death, were made to undergo all sorts of extra torments. 



43 

Again, in some cases, Calomel in large doses of 

calomel and Opium 9J SS - combined with five grains in la*ge doses. o f n -ni 11Tr , Wfl c, QrlTninistPrPfl nn 

of opium, was administered on 

seizure and repeated every two hours. In one case I saw as much as ninety grains of Calomel and fifteen of solid opium given in six hours, or a little longer perhaps. The Cholera certainly was cured, but the man died a few hours afterwards in a state of complete coma. On post mortem examination a large portion of the mercury was found lining the stomach. 

Injecting warm salt and water into the veins, 

Injecting salt and whell complete collapse has set in, water into the veins. j s gOOg 00( j m theory and practice, for it supplies the watery portion of the blood, and gives instant relief to all the distressing symptoms. It is a powerful adjunct to the remedies which attack the cause of the disease, but by itself is incapable of curing it, for the cause is still going on, and the water injected passes off in the evacuations, and the blood is left in a worse condition than previously. Stop the cause, — and then the best results will ensue from diluting the thickened blood in this manner. 

Cholera is a disease of a highly congestive nature, in which the brain sympathizes, as proved by the occasional vertigo, singing in the ears, &c, and this renders it, in my opinion, very doubtful whether in its 



44 

treatment wo are justified in using opium at all ; we 

are certainly not justified in using it in such large quantities as usu- 

Opium. 

ally prescribed. Coma is not a common termination in Cholera, but when it takes place it is always the forerunner of the case ending fatally ; and then death can, I f.nk, generally be traced to large doses of opiates, ;ing on certain morbid states of the brain, procing stupor more or less profound. The sensiity to outward impressions is destroyed, respiration becomes slow and irregular, voluntary breathing is lost and at last fails, the blood is no longer iierated, and death ensues ; but as the causes which destroy the perceptions leave no traces of their operation, I think it difficult to determine whether death is the result of Cholera or opium. 

I have endeavoured to prove that, in Cholera, the blood is not properly arterialized. It is well known that imperfect arterialization of the blood either results from, or conduces to, a state of coma. In all such cases opium is a drug that ought to be given with great care and discrimination, and then only in small doses, such as the \ or \ of a grain, for the purpose of soothing the irritability of the stomach. 

Tlip nrinrinlp of trpatmpnt to bp kpnt in vipw 



45 

rational. There is no time to lose, — the old saying that " Cholera commences by killing a man" is not very far from the truth. What is to be done ? The first idea that suggests itself is to control the diseased action, and try and subdue the results of that actio — there is no leisure when called to attend a Cholera patient to consider the cause, which appears to give occasion to the symptoms. The mind must have been already made up on that subject beforehand, so as to be prepared to administer remedies without one moment's delay. The cause is at first principally in the stomach, which organ must be cleared of foreign and abnormal secretions : I find nothing so beneficial for that purpose as a free use of saline and mustard emetics. 

Ipecacuanha and tartar emetic should be avoided, 

for they very frequently produce Ipecacuanha and , tartar emetic should excessive nausea, and greatly inbo avoided. , ....... „ , 

crease the irritability of the 

lomach. A desert spoon-full of mustard and the same common salt in a tumbler of warm water, may be yen to the patient every five or ten minutes, accordg to the effect produced, that is when the stomach perfectly cleared of all it contains. After their action, the great and next object is to soothe the irritabi- 

To soothe the irrita- lity of that organ, to enable it to bility of the stomach. retam the medicines administered, 



46 

as it is through it that we hope to reach the hepatic system and the blood. This most desirable effect may frequently be accomplished by administering two to three drops of dilute hydrocyanic acid, with ten minims of tincture of hyoscyamus or laudanum, given in a wine glass full of warm brandy and 

Alcohol is very speedily absorbed 

Alcohol. 

into the system, and according 

;o M. M. Bouchardat and Sandras passes undecom>osed into the blood, and is not eliminated by any cretory organ, a small portion only escaping by the ungs. The quantity of brandy or other spirit may )e three or four drachm doses, with the same uantity of water, repeated every half hour. If given n larger doses, so much becomes absorbed, that it lelps the arterial blood to retain the colour of venous. ' administered in great excess, it may give rise to sphyxia, although I have never seen a case of Cholera where spirit had been pushed so far. All that required is its stimulant action as a help to the agging vital powers. 

Applying a large mustard poultice over the epigastric region is often of great service. It is now the aim to counteract the morbid secretions again accumulating in the stomach, (for it is not in the 



47 

power of medicine to stop them, though it may alter leir character,) and to try and remove the congestion the liver, to enable it again to secrete bile. To complish this, we must first get rid of the un/tural material, the effects of which it is necessary to viate ; and, secondly, we must endeavour to chemilly neutralize the acid unnatural products thrown ฆ in and by the stomach, and to counteract the action that organ of acids already formed, and thus prevent their secondary effect on the system which shews itself in increased irritation of the bowels. But it must be recollected, that any alkaline medicines we can prescribe have no effect in preventing the formation of acid products, but only in neutralizing them. 

CHAPTER EIGHTH. 

Neutral Alkaline Salts — Mercury — Calomel — The action of Chlorides of Potash and Soda and Muriate of Ammonia on Calomel — Mercurial inunction — Counter irritation — Diet — Drink — Warmth — Cold to ilie head beneficial. 

The most effective remedies for the purpose 

Neutral Alkaline of neutralising the acid products baits. r\f +V>a ofrimQoVi ara cor+aiTi -non- 

of the stomach are certain neu- 

tral salts, and those naturally contained in the 



48 

blood and bile seem the best suited for the purpose — viz., chlorides of potassium and sodium to which may be added potass, carb., nitre, and soda carb. The more effective way of administering these saline medicines is to combine them with some stimulant, or to exhibit them in large draughts of weak lime water. I generally give the chlorate of potash in preference to the chloride. — chlorate of potash, KO,CLO 5 is soluble in about two parts of boiling and 20 of cold water. The crystals are tabular, flat and anhydrous, and in taste not at all unlike saltpetre. When heated, oxygen gas is set free from both acid and base, the residue being the chloride of potassium. By arresting the decomposition when the evolution of gas begins, and re-dissolving the salt, liyperchl orate of potash and chloride of potassium may be obtained. The latter closely resembles common salt in appearance, crystallizing in the cubic form, and dissolving readily in three parts of cold and less of boiling water. The crystals are saline in taste, slightly bitter and anhydrous, fuse at red heat, tat a high temperature are volatilized. These c medicines act in two ways, in neutralizing abnormal acid products, and in diluting the I. The alkaline carbonates, i. c. potash, soda, and ammonia, supposing the stomach or intestines to contain oxalic acid in minute portions, would certainly neutralize it, but at the same time it 



49 

would be converted into another poisonous salt, the soluble oxalates of the above alkalies being themselves poisonous. But the oxalic acid, if it t3urred, would be converted into the insoluble oxite of lime by the liquor calcis. The remedies must adapted to operate by exciting in the system an ion capable of neutralizing that established by any acid poison, that may possibly be generated and retained in the system. 

The other great object is to bring on the action of the liver. Nothing seems to answer better than calomel, although small doses of the Hydrarg. c. creta may be prescribed with advantage. 

Mercury, when administered under any form, acts in 

several ways, by stimulating the various secreting organs, the mv- 

Mercury. 

cus membrane of the bowels, liver, and salivary glands, increasing the flow of bile and saliva, and causing watery evacuations from the intestines. It not only acts on these, but upon all the secreting surfaces of the body, altering the condition of the capillary circulation. It is supposed to equalize the circulation by causing the blood to be diffused throughout the several organs at the same time, and therefore obviates pro tanto its excessive congestion, or collection in any one organ. This is our object in giving mercury. 



50 

Calomel is slightly sedative in its action, and is just 

as well kept in the system in 

Calomel. 

Cholera without the assistance of 

Opium ; it is the best form in which mercury can be given. Three grains at the commencement of the attack, and a grain every hour afterwards for twelve or twenty hours, should be administered. 

In giving the chloride of sodium, chlorate of potas- 

The action of Ohio- sium, or muriate of ammonia in SeSanSo^SS eS anS 0^Sr d of solution, in conjunction with caloammoniaor calomel. mel^ the latter substance \a partially transformed into corrosive sublimate, a most poisonous drug, and into metallic mercury. This decomposition takes place at the natural temperature of the body in the course of a few seconds, and the quantity formed depends upon the amount of alkaline chlorides taken. These facts are important in giving calomel in conjunction with the alkaline chlorides ; ฆ — not that all the calomel administered is thus converted, but only a small portion, so that only a little corrosive sublimate is produced. 

The liver and skin having such sympathy, mercurial inunction Ung. Hydrarg. Fort. 51. Mercurial inunction. 

(two drachms contain one of 

metallic mercury) should be used, the mercury being well rubbed into, the right hypochondriac region. 



51 

Kiis should be done in the sun, or before a fire, to sure the speedy absorption of the mercury. 

Counter irritation by means of a good blister or 

sinapism to the epigastric region Counter irritation. r r ฐ ฐ 

Kis not only perfectly safe, but of c greatest possible benefit. 

To a patient laboring under Cholera, I only allow 

in the way of diet, hot broth, strong, and well made, perfectly 



free from grease, as more easily retained in the stomach. If ejected, it may be again repeated, and so on as often as the sickness occurs, about a wine glass full at a time. It is less likely to turn acid in the stomach than anything else, containing no saccharine matter, supporting the strength by its nutritious qualities, and being an excellent vehicle for the administration of the alkaline salts. When the patient has recovered from the acute attack, I restrict him for some three or four days to farinaceous food, such as sago, milk, arrow-root, &c. I allow a patient to drink as much pure water 

as he likes, i. c., rain, boiled, or distilled, and afterwards filtered, 

Drink. 

cold or warm according to choice, in which |a small quantity of liquor calcis and chlorate of potass 3j to the pint has been added. 



52 

Warmth should be applied to the trunk and extre- 

mities by means of bags of hot salt 

Warnith. 

or sand, or bricks wrapped in 

flannel. I object to hot bran as soon liable to emit tLpleasant odours, which are alike disagreeable to c patient and attendants. 

Cold to the head C ฐ ld a PP lied t0 the head is a beneficial. o-rpn.f vplipf rmrl ViPTiP.fi nia.l. 

great relief, and beneficial. 

CHAPTER NINTH. 

Nitrate of Silver injections — Stimulant Frictions — Fo- Smtations to Bladder — Internal Stimulants — Secondary ever — Bedding — Recapitulation of Treatment. 

After vomiting has ceased, it sometimes happens 

Nitrate of silver in- that the Watei T evacuations still jectums sometimes continue, as if the mouths of the very useful. 

small capillary vessels were un- 

able to recover their tone. In such cases I prescribe the following : — 

ft 

Argenti Nitratis 9j. Aquoe Astrictae oj. 





53 

Of this I sometimes administer as much as six tits at a time, and repeat it every three or four urs. Or — 

S> 

Aluminis $48. 

Aquae destillatse oj. 

Misce. 

Fiat injectio. Given in the same quantity. 

The only distress to the patient is caused when the injection reaches the ilio-coecal valve ; and, to prevent its being at once ejected, it is generally necessary to have the nates of the patient firmly compressed on the injecting tube. In these cases, when astringents are indicated, Chlorodyne will be found a valuable medicine, either given in fifteen minim doses in a little warm brandy and water, or combined as follows :—: — 

& 

Mist, cretse 

Sv. 

Liq. Ammonite 

sj. 

Chlorodyne 3i and 3ij. 





54 

Turpentine oil and ginger finely pounded makes 

an excellent liniment, to be used with friction to the extremities. 

Stimulant friction. 

It not only tends to determine the circulation to the surface, but also alleviates the distressing cramps. Sinapisms must be applied to the calves of the legs and interior of the thighs in bad and almost hopeless 

I have also found, when the patient is recovering. 

hot fomentations to the region 

Fomentations to Bladder. 

of the bladder of service in pro- 

moting the flow of urine, when it is again secreted. 

Internal stimulants, such as chloroform and sulphuric aether, carbonate of am- Internal stimulants. , , ? 

monia, camphor, and assafoetida 

may be given in five grain doses at discretion. 

The secondary fever which 

Secondary Fever. . ensues must be treated in the ordinary manner. 

I need hardly mention that the bedding in this, 

as in all cases of sickness, should be kept scrupulously clean, that 

Bedding. 

all soiled linen should be at once removed, and that all matters ejected and passed should be immediately 



55 

The following recapitulation gives, in a few lines, the treatment 

Recapitulation ฆof treatment. 

I pursue. 

iit once place the patient in bed, administer a le spoon-full of mustard and the same of common in a tumbler of warm water, repeating the dose ry five or ten minutes till the stomach is 'perfectly ired. Meanwhile have the patient well rubbed ti flannel, wetted with turpentine or brandy, or, if y be not procurable, country spirit. 

When the emetic has been ejected, apply a large mustard poultice to the pit of the stomach, and give 3 drops of dilute hydrocyanic (Prussic) acid with ten of either the tincture of hyoscyamus or laudanum in half a wine glass full of brandy and water. This is to be immediately followed by ilj • grains of calomel put dry on the tongue, and washed down with a little weak lime water, in which ten grains of chlorate of potash have been dissolved. Repeat the calomel in two grain doses every two hours, or one grain every hour, and give the chlorate of potash increasing the dose to fifteen grains in lime water half an hour after the calomel ; and at the same time let one or two drachms (a piece about the size of a hazel-nut) of the ung. hydrarg. fort, or strong mercurial ointment, be well rubbed in over the region of the 



liver. Continue these remedies (omitting the mercurial ointment) until re-action takes place, and the circulation has again returned to the surface. 

To quench the thirst, potations of warm weak chickn or other meat broth, in which a tea spoon-full of ommon salt and five grains of saltpetre have been dded, may be drunk ad lib. When the heat returns >erceptibly to the surface, and the motions become nged with bile, the great danger has ceased. The medicines however should be continued for some lours, decreasing the doses and increasing the ntervals. 

For further particulars on this subject I refer the reader to Chapter Nine, this recapitulation only being intended to show the treatment in case of any sudden emergency. 

56 



CASES 

Admitted consecutively into the Hooghly Jail Hospital, from the IGth to the 3lst March 18G2. 

Case No. 1. — Nobin Samonto, caste Agooi-ee, aged 40, limitted into the Hooghly Jail Hospital, 16th March \62 j at 8 o'clock a. m. passed several watery stools and •mited frequently. Before his admission, stated that he d not feel well the previous evening, and could not ,t, slept pretty well, but shortly after getting up waa ized with sickness and purging ; was taken to Hostal about an hour and a half afterwards ; pulse very eble, body cold and covei'ed with a clammy perspira- Mi, purging incessant. — Ordered a saline and mustard netic, given with plenty of warm water, followed by — 

S> 

Acidi Hydrocyanicidil. rปliii Tinct: Opii, nx x. 

Aquae Dcstillatoe, f fj, 

Misce. Fiat haustus, statim sumendus. A mustard poiiltice was applied to the pit of the stomach, and the following prescribed :—: — 

Hydrarg : Chlorjd : gr. iv. 

Put dry on the tongue and washed down with — ฆ 

n 



58 

& 

Potassse Chloratis, gr. viij. Sodii Chloridi, gr. x. 

Sodse Sesquicarb : "j)i. 

Dissolved in a wine-glassful of rum and water. 

One grain of calomel to be repeated every hour, and the saline medicines to be given half an hour after- 

112 o'clock. — Body cold and clammy, urine suspended, ngue moist, but cold to the touch, vomiting and purgg much less — the medicines to be continued with the Ldition of— 

Spirit: JEth: Nitrici, nj,x. 

And, to quench the thirst, hot broth with Potass. Chloratis 5j and 3ss of Sodii Chloridi to the pint, ad : lib. 

117 th. 6 o'clock a. m. — Quite collapsed, diarrhoea and miting ceased, eyes sunken. — Ordered the Calomel to discontinued, and the following to be given: — 

$ 

Potassse Chloratis, gr. x. Camphorce pulv : gr. ij. Spirit : Nitrici, r*i xv. 

Sp : Sacchari, Aquae Dest : |ij. 

Misce. Fiat haustus, omni hora sumend. 



59 

I o'clock p. m. — Better, cramps much less, no vomiting or purging, continue the medicines prescribed in the morning. 

6 o'clock p. m. Pulse distinctly felt about 96ฐ, thready and small. 

18th. 7 o'clock, a. m. — Much better, — Ordered — 

& 

Olei Ricini, ?ss. 

5 

Mucelag : Acacias, q.s. 

Aquse Month: pip: Tinct : Opii, ttixv. 

Misce. Fiat haustus, catharticus. 

12 o'clock a. m. — Had two watery evacuations of a kght yellow color, and passed about four ounces of ne for the first time. — Ordered — 

& 

Potass : Chloratis, sj. Nitratis, 3ss. 

Camphoroe, gr. xij. Aqua) Destillatae, ssxij. 

Misce. Fiat mistura, de qua capiat ceger cochl. iij ampla tertia quaque hora. .. ฆ . ฆ : . 

Diet. — Soup. 

19th. Much better, secretions natural.— Ordered 



60 

5. 

Decocti Cinchonse, 3 ij. Liquor : Ammon : Acet : 5 ij. 

Sp : Nitr : 5L 

Misce. Fiat haustus, quartis horis repetendus. 

Diet. — Sago, Milk, Rum. 

20th. — Continuantur remeclia. 

21st. — Cont. rem. — ordered half diet. 22nd. — Ordered— 

$ 

Quininse Disulph : gr.ij. 

Acid : Sulph : dil : m,iv, Mist. Camphorse, giss. 

Misce. Fiat haustus, tertia quaque hora sumendus. 

23rd.— Repetatur — and so on to the 30th. 30th. — Discharged 'cured. 

Case No. 2. — Akadusee Doss, aged 35, was admitted into Hospital about 6. o'clock on the morning of the 18th March 1862 ; had several watery stools attended with vomiting before admission. — Complains of rumbling in the abdomen ; hands, ears and feet cold ; great prostration of strength ; evacuates the regular " conjee stools" filled with mucous flakes floating in the serous part of the evacuation : the matters ejected from the stomach did not seem to differ much from that passed from the intestines — cramps in the hands and feet, but not very severe, —^Ordered- — 



61 

?. 

Hydrarg : Chlor : gr. iij 

to be put on the tongue dry, and washed down with two ounces of the following mixture :: — < 

5> 

Liquoris Calcis, งiv. Potassse Chloratis, siss. Sp : Oryzse, งss. Aq : Destil : gij. 

The Calomel to be continued in one grain doses every hour, and a table spoon 'full of the above to be given at intervals of half an hour, an hour, or two hours, as may seem necessary during the day. 

& 

Ung : Hydrarg : fort: -gj. Camphorae, sj* 

Misce. Ut fiat unguent um. — 

sij to be well rubbed into the right side over the region of the liver. 

6 p. m. — Cramps certainly less, vomiting stopped and purging nearly so ; has passed no urine ; seems very low ; has drunk nearly two quarts of hot chicken broth during" the day, with the following in solution to the pint :: — • 

5> 

Sodii Chloridi, 

Potass : Chloratis : a a, 3ss. Sodae Carb : gr. viij. 



62 

19th. — Much better, no vomiting or evacuations during the night, — cramps disappeared, — passed urine this morning before my visit. — Ordered to discontinue all the remedies but the- neutral salts, which are to be given in half the quantity, and at longer intervals. 

20th. — Body natural to the touch, — has had no relief from the bowels since the evening of the 18th. — Ordered. — 

3> 

Olei Ricini, Tr : Opii, n\x. 

Sp : Pimentse, 3i. Aq : destil : งj. 

Misce. Fiat haustus, statim sumend. 

Diet — Sago, milk, &c. 

6p. m. — Has had two or three bright yellow watery stools from the medicine. 

21 st. — Quite convalescent. — Ordered — • 

& 

Infusi Chiraytee, งviij. Sodse Carbon : sj. 

Misce. Sumat cochl. ij. vel iij. ter die, 

24th. — Discharged cured. 

Case No. 3.— Fukeer Mahomet, aged 54, was admitted into Hospital on the 19th of March 1862 at daylight, with 



63 

vomiting and purging. The matters voided were untinged with bile ; extremities cold, tongue clammy, cramps in the feet and hands, urine siippressed, no pulse. — Ordered a saline emetic, and a large mustard poultice over the epigastric region, followed by — ฆ 

ซ. 

Hydrarg : Chloridi, gr. iii. 

given in powder and washed down with the following draught : — ฆ 

s. 

Liquor : Calcis, siv. Potassse Chloratis, siss, Sodii Chloridi, gr.x Sp : Oryzse, |ss. Aquae dest : |ii. 

Misce. Fiat haustus. Two grains of Calomel to be repeated every hour, and the draught every half hour. 

Diet. — Soup, given hot, about four ounces at a time with — ฆ 

& 

Sodii Chloridi, 

Potass : Chloratis, a a 3ss. Sodte Carb ; gr. x. 

In solution ad : lib : — Complains of intolerable thirst. 

6 o'clock, p. jr. — Pulse feeble, great thirst and cramps, conjunctiva congested, eyes sunken, vomiting ceased ; purging still continues, but not nearly so frequent, and altered in color being tinged with yellow bile; urine suppressed. 



64 

20tli. — Better; pulse small, thready, but much stronger ; thirst not so great, cramps nearly gone, no vomiting or purging during the night; has passed a few ounces of limpid urine. 

21st. — All the distressing symptoms have disappeared, conjunctiva still congested, no motion since the evening of the 19th.— Ordered— 

S> 

Olei Ricini, 

gss. 

Mucelag : Acacise, q.s. Aquae Menth : pip : Jj. Tine : Opii, n^xi 

TT^XV. 

Misce. Fiat haustus statim sumend 

22nd. — Two bilious stools, gums slightly affected by the mercury. — Ordered — 

Acidi Nitrici dihiti, n^xxx. Inf : Cliiraytoe, <j งiss- 

Misce. Fiat haustus, 4ta quaque hora, sumendus. Half Diet. 

. 26th. — Discharged, cured. 

Case No. 4. — Sombor Rajwar, aged 29, admitted March •19th at daybreak, stated that he had had five watery evacuations, and had frequently vomited before being brought to Hospital ; when I saw him soon after 6 o'clock a. m., 



65 

I found him cold, pulseless and collapsed, his forehead covered with a slight cold perspiration ; urine suppressed, eyes sunken, cramps in the arms and legs, very restless, and complaining of great thirst, but immediately ejecting anything taken into the stomach, the rice water evacuations running from him involuntarily. — Ordered — 

& 

Acid : Hydrocyan : gtt. ij. Liq : Morph : Acet : gtt. x. 

Sp : Oryzse, 

Aquse Dest : ana %ss. Misce. Fiat haustus. 

to be immediately followed by — 

$ 

Hydrarg : Chloridi gr. iij. 

put dry on the tongue and washed down with — 

& 

Liquor : Calcis, siv. Potassse Chloratis, gr. xv. Sp : Oryzee, gss. Misce. 

one grain of Calomel to be repeated every hour, and the above draught to be given immediately after. 

S> 

Ung : Hydrarg : fort : sj. Camphorse, 3j. 01 : Terebinth : gss. 

Misce, ut fiat unguentum. 

to be well nibbed on over the liver, and — 



66 

ft 

Emp : Lytta?, gij. 

Acid : Aceti, งss. Misce. 

to be well rubbed in over the pit of the stomach — friction to be applied to the extremities with flannel dipped in Turpentine. 

6 o'clock p. m. — Re-action taken place, body not so cold, pulse quite perceptible at the wrists, — complains of great thirst, no vomiting, stools frequent, allowed to drink water with Potass: Chloratis 5j and 2;j of Rum to the pint ad: lib: — 

20th. — Pulse better, the corners of the eyes filled with matter, no cramps, purging continues, vomiting stopped. 

6 o'clock p. m. — Better, passed a small quantity of urine. — Ordered the following enema :— 

ft 

Argenti Nitratis, 3jss. Aquse Frigid : Oj- 

two quarts to be injected at one time. 

21st — No purging since injection was given, slept some hours — all the distressing symptoms disappeared. 

22nd. — Slight secondary Fever, — treated accordingly. April 7th. — Discharged cured. 

Case No. 5. — Gonish Bagdee, iaged 52, was admitted early in the morning of the 20th March 18G2. He had been 



67 

taken ill in the night, with purging and vomiting ; when brought to Hospital he was in a complete state of collapse, slight cramps, no pulse in the axilla, tongue cold, eyes sunk, the face had the appearance of being lengthened, urine suppressed, great jactation, and thirst. — 

Hydrarg : Chloride gr. iiij immediately, one grain to be repeated every half hour, washed down with — 

So 

Sp : Compositi, sss. Potass : Chloratis, gr.x. Mist : Camph : 3-ss. 

Tinct : Cardam : Camp : 3i. Misce. 

Fiat haustus statim sumendus, et repetatur bihorio. 

Body to be rubbed with turpentine and ginger, hot bricks to the inside of the thighs, &c, potations of hot broth with 3ij Chlorate of Soda to the pint ad : lib : 

2 o'clock p. m. — Vomiting and purging all stopped, no reaction taken place since admittance. Ordered t continue the medicine with the addition of Carb : monise gr.v. to each dose, and substituting half an ice of Rum for the Camphor Mixture. 

This patient never rallied, and died at 4 o'clock p. m. 

Case No. 6. — Horish Colly, caste Koiboot, aged 25, admitted at the same time as the former case — was sudden Jv 



68 

seized towards morning with vomiting and purging. Oil admittance passed conjee stools every ten minutes, — ฆ cramps very severe, abdomen rumbling and uneasy but not painful, pulse imperceptible at the wrists, but feebly felt in the axilla, tongue cold and moist, urine suppressed. — Ordered a mustard and salt emetic immediately, a large mustard poultice over the stomach, and — 

S> 

Acidi Hydrocyanic : dil: nyij. 

Tinct: Opii, Aqua) dest : 

rr\x. 

5-i. Misce. 

I Fiat haustus statim sumendus. Ten minutes after,rds to be given Calomel gr. iij, — a grain of which to repeated every hour and — 

S> 

Potassse Chloratis, sjss. Camphorse pulv : gr-xij 

Spirit Mth: Nitrici, sjss. Sp : Sacchari 

Aqua? dest : a a 2-vj. Misce. 

Fiat Mistura, cujus sumantur cochlearia tria magna post singulas dejectiones liquidas et 

Inungatur Hypochond : dext : 3j. 

Ung : Hydrarg : fort : lla hora ante meridiem et i post meridiem,, 



69 

The extremities to be well rubbed with pounded ginger and turpentine, a tea-cupful of hot broth with 3jj of salt to the pint, ad : lib : to quench the thirst. 

6 o'clock p. m. — Vomiting and purging stopped, no pulse, eyes sunk, voice altered, collapsed. — Ordered the treatment to be continued through the night. 

21st. 6 o'clock a. M. — No diarrhoea or vomiting since last evening, — has passed no urine, still collapsed, — treatment to be continued. 

ti o'clock p. m. — Slight re-action, thirst less, no mol from the bowels ; has drunk during the day 5 pints broth, no sickness — conjunctiva not so congested, le still suspended. — Ordered — 

5. 

Pul : Opii, gr. ง Hydrarg : Chlor : gr. ij. 

Miace. 

Fiat pulvis- hora decubitus sumendus. 

122 nd. — Much better, passed urine twice during the jht, slept for several hours, eyes looking much better, t still blood -shot. — Ordered — 

& 

Olei Bicini, 

gss. 

Mucelag : Acacese, q. s* Tinct: Opii, m.xv 

ntxv 

Aquae dest : 

Si' 





70 

Fiat haustus, statim sumendus. 

5 o'clock p. m. — -Four bilious stools, — passes water freely, all unfavorable symptoms gone, pulse 93ฐ, — temperature of body natural. — Ordered — 

To repeat the powder. 

23rd. — Placed on the convalescent list. 

• Case No. 7. — Bonomally, Jalaya, aged 42, — was admitted also on the same morning, having been attacked an hour before with vomiting and purging. When I saw him at 6 o'clock a. m., he had had four rice water stools, and vomited a clear flakey fluid, — •hands, feet, and ears cold ; forehead covered with a cold perspiration ; temperature of body 75ฐ; pulse very weak, small and thready ; cramps in the extremities, — complains of a burning at the pit of the stomach. — Ordered a saline and mustard emetic, and a mustard poultice to the pit of the stomach. 

Hydrarg : Chloridi, gr. iv. in powder, washed down with — 

& 

Potassso Chloratis, 

Sodii Chloridi, aa. gr. x. 

Sodse Sesquicarb : "j^j 

dissolved in a cupful of hot Bum and water — half a grain of Calomel to be put on the tongue every half hour, find the medicine repeated every hour to quench the 



71 

thirst. — Hot weak Chicken broth with Sodii Chloridi and the same quantity of the Chlorate of Potass : to the pint ad : lib :. 

6 o'clock p. m. — Urine suppressed, cramps less, diarrhoea and vomiting stopped — continue the medicines through the night. 

J2lst. — The same as yesterday evening. 6p. m. — Better, s passed a little urine twice during the day. 

K22nd. — Much better, gums slightly affected, — omit the ercury, continue the saline medicine. No relief from the •wels. — Ordered — 

$ 

Olei Ricini, ฃss. Aquse destil : ฃj. Sp : Pimentse, 3 jo Liq : Potassse, gtt. xx 

Misce. 

Fiat haustus, statim sumendus. 

6 p. m. — Four bilious watery motions, functions all natural. 

23rd. — Better. — Ordered the following tonic 

B. 

Inf : Gentiance Comp : gv. Tinct : Cardam : Comp : |j. 

Sodae Subcarb : 3ss. Misce. 

Fiat Mistura, cujus sumat cochl : ij. mane et meridie. 



72 

124 th. — Continue the medicine prescribed yesterday, et, sago, milk, and soup. 

25th, 26th, 27th. — Progressing favorably. 

28th. — Discharged cured. 

Case No. 8. — Dhoney Sheik Mohamed, aged 50— admitted March 20th — was taken ill in the night and brought in. collapsed — no pulse, hands shrivelled, body severe cold, cramps in the extremities and stomach, jactation, complains of thirst, eyes sunken, incessant vomiting, congee stools passing involuntarily. — Ordered a saline and mustard emetic, followed by — 

Hydrarg 1 Chloridi, gr. iij. 

in powder, half a grain to be repeated every half hour. 

s> 

Potassse Chloratis, gr. viii. Sodii Chloridi, gr. x. Sodse Sesquicarb : 

Aquae Calcis, งiv. 

Misce. 

Fiat haustus omni hora vel post singulas sedes liqui das sumendus. 

& 

Ung : Hydrarg : fort : 3ij. Camphoree, • 3j. 

5J- 

Misce, 

Ut fiat unguentum. 



73 

A small piece the size of a liasel nut to be rubbed in over the region of the liver and 3j of Emp : Leyttse to be rubbed in over the pit of the stomach, — hot broth with salines in solution ad : lib : — friction with flannels dipped in Turpentine and pounded ginger to the extremities. 

IG p. m. — Much the same, no pulse, still collapsed, miting stopped, purging less. — Ordered the following 

injection :—: — 

& 

Argent : Nitratis, '^ss. Aquse Frigid : Oj- 

Three quarts to be injected at one time, — to continue te saline medicines every two hours, diminishing the [use Calcis and giving two ounces of Bum instead. 

21st. — Conjunctiva highly congested, corners of eyes filled with matter, vomiting and purging stopped, — still I a very precarious state — no pulse, no urine passed. The sdicine to be continued as ordered yesterday evening, itting the injection. 

6p. m — Still no pulse, — continue the remedies. 

122 nd. — Pulse perceptible at the wrist, temperature body risen considerably, tongue coated but clearing at the edges, cramps disappeared, no vomiting or diarrhoea. 

6 p. m. — Much the same, has passed no water. — Ordered — 



74 

ft 

Potass : Nitratis, gr. v. 

to be added to the medicine. 

23rd. — Pulse stronger, passed water during the night. 

— Ordered. — 

ft 

Pulv : Rhei, BJss. Conf : Aromat : gr. xx. Aquse : Menthse pip : |ij. 

Misce, fiat haustus statim sumendus. 

G p. m. — Three or four bilious briglit yellow motions. Skin natural, all bad symptoms disappeared, improving rapidly. 

24th. — Better, slight secondary Fever, — treated accordingly. 

t27th. — Discharged cured — placed for a few days on c convalescent list. 

Case No. 9. — Chidam Bowrey, aged 56, admitted 20th Earch 1862, pulseless, and quite collapsed, — no water -ssed, evacuations incessant, continual vomiting, great stlessness and thirst, tongue cold to the touch, temperature of body 74,ฐ urine suppressed, eyes sunken and surrounded by a dark halo, cramps in the stomach, hands und feet shrivelled. — Ordered. — 



75 

Hydrarg : Chloridi, gr. iv. 

In powder placed on the tongue, one grain to be repeated every half hour, and — 

Potass : Chloratis, 3jj. Sodii Chloridi, gr. x. Sp : iEtlm : nit : 31J. 

Campliorse, 

gr. xij. 

Sq : Saccharin! Ap : Calcis 

a a gvj. 

[isce. Fiat Mistura, cujus sumantur coclilearia tria Ligna post singulas liquidas dejectiones, et, 

Inungatur hypochond : dext : 3U- 

Ung : Hydrarg : fort : undecima hora ante meridiem. 

Extremities to be well rubbed with turpentine and powdered ginger, cold lotion to the eyes and head. 

16 p. m. — Much the same as in the morning — continue c treatment. 

21st. — Hardly any visible improvement with the exception of vomiting and purging having stopped — Diet only hot broth with salines in solution ฃj to the pint — no pxUse. 





76 

22nd. — Twice purged, motions tinged with bile, urine Ijreted, skin moist and more natural, pulse easily felt the wrist — continue the remedies. 

6 p. m. — Much the same as in the morning, pulse if anything rather stronger, 97 — continue the treatment. 

Esrd. — Incessant hiccup, and inclination to vomit — es water freely, two motions in the night, pulse ager still, 95 — tongue much furred. — Oi'dered — 

Capiat coch : ij ampl : aq : menth : pip : omni hora, donee singult. et nisus ad vomit : cessav. 

24th. — Hiccup still contimxes, — repeat the medicine and apply a mustard poultice to the pit of the stomach. 

25th. — Hiccup still continues. — Ordered — ฆ 

$ 

Camphorse gr. iij. Ammon : Sesquicarb : Extr. Hyoscyami a a gr. iv. Mucilag : q. s. ut fiant pil. iij. 

Devoret roger j bis in die hora decima et hora secunda. 

30th, G p. m. — Hiccup stopped. 

31st. — No return of hiccup, which had greatly annoyed the patient, from the 23rd to the evening of the 30th with hardly any intercession ; he suffered rather severely 



77 

from secondary fever, and was not discharged cured until the 7th April. 

I Case No. 1 0. — Obhoy Moochee ' admitted the same •ruing as the preceding case. On my visiting Hospital* bund that during the night he had been drained of irly all the fluid portion of his blood ; his appearance s pinched, respiration oppressed, the countenance sunken d livid, and the circulation flagging in the extremities, other words he was collapsed, with painful cramps in the )mach and limbs — Jactation was severe, but only at ties, urine suppressed, and great thirst. — Ordered — 

Hydrarg : Chloridi gr. iv, followed by — 

& 

Potassfe Chloratis gr. xv. Sodii Chloridi gr. x. 

Sodsc Sesquicarb : gr. xx. 

Sp : Sacchari |ij. Aquae Calcis งij. 

Misce : Fiat haustus, omni liora vel post singulas sedes liquidas sumendus. 

Ung: Hydrarg: fort: 3ij. 

Camphorse 3i. Misce: ut fiat unguentum. 

3ij rubbed in over the region of the liver, and Emp : 



78 

Lyttse si, softened with acetic acid, rubbed over the cpigastrum. 

One grain of Calomel to be given every hour followed by the medicine, and turpentine and ginger friction applied to the extremities. 

Hot broth with gij of salt to the pint ad lib 

G p. m. — Much the same, vomiting and purging stopped, respiration easier. 

21st. — Re-action taken place, pulse distinct at the fist, body slightly warm, tongue furred and white, passno urine, cramps less. 

Ei p. M. — Three motions tinged w T ith bile, passed about )e ounces of limpid urine, skin more natural, great stration. — Ordered — 

$> 

Chloroformi, 

rtiv. 

Potass : Chloratis, 

gr. x. 

Mist : Camph : 

ฃi- 

Tinct : Cardam : Comp : sss. Misce : fiat haustus statim sumendus et bihorio repetatur. 

22nd. — Passed water in the night, head not quite clear, seems as if sinking into coma. 

Cold applied \\ — continue the medicine ordered yesterday evening. 



79 

6 p. m. — Pulse stronger but intermittent, about 96 — Feverish, head much the same, no relief from the bowels since the evening of the 21st. — Ordered — 

$ 

Olei Eicini, |ss. Aquse dest: Sp: Pimentse, sj. Liquor Potass: nxxx. 

Misce : fiat haustus statim sumendus. 

23rd. Bowels moved twice freely, head much better, gums slightly affected, — treated for low fever, and placed on the convalescent list on the 6th of April, a few days after which he was discharged cured. 

Case No. 11. — Hatto Dome, aged 40, was also admitted on the 20th March, much in the same condition as the patient in the preceding case. The disease commenced towards morning. — Ordered the same medicines as in the former case, with the addition of a saline and mustard emetic on admission. 

6 P. m. — Pulseless, vomiting ceased, only three motions since commencing the medicine, cramps much less ; — continue the remedies. 

21st. — Still pulseless, great prostration, no urine passed ; no vomiting, stools, or cramps ; great thirst, to allay which he drinks potations of hot broth with 5j of salt and 3j of Chlorate of Potash and 4 ounces of Rum to the pint ad : lib. 



80 

6 p. m. — Continue the medicine. 

22nd. — Better, one bilious motion, passed a little urine, pulse distinct at the wrists. 

23rd. — Functions natural, but inclined to Diarrhoea, having had several watery bilious motions in the night. — Ordered — 

s. 

Aluminis, 

gss Qi. 

Aq : Dest : 

Misce. 

Fiat injectio — 

Six pints to be administered at once with a Eead's 

syringe and — • 

$ 

Sv. 

Mist : Cretse, 

Liq : Ammonse Carb : 3j. 

Chlorodyne 

SU- 

Fiat : Mist : cujus sumat cochl : ij p. R. n*. 

24th. — Secondary fever, treated accordingly. 

7th April. —Discharged cured. 

Case No. 12. — Momeen Shaik, Mahomedan, aged 40, admitted March 21st, with vomiting, purging, and cramps in the extremities, a rumbling feeling in the stomach, respiration distressed . — Ordered — 



81 

Saline and Mustard emetic, — followed by — ฆ 

Hydrarg : Chloridi gr. iv. statim, 

I be repeated in j grain doses every hour, after purging vomiting, with the following draught : — 

Potass : Chloratis, gr. xx. 

Sodii Chloridi , gr. v. Sodse Sesquicarb : gr. x. 

dissolved in a wine glass full of hot rum and water. 

16 p. m. — Decidedly better, cramps ceased, vomiting d purging stopped. 

22nd. — Passed urine in the night, skin natural, no mo- 



23rd. — Better, no relief from the bowels. — Ordered — 

$ 

Olei Ricini, งss. Mucilag : Acacise, q. s. Aq : Menth : pip : งi. Tinct : Opii, nx- xv. 

Misce : Fiat haustus statim sumendus. 

25th. — Discharged cured. 

Case No. 13 — Peroo Khan, Mahomedan, aged 50, admitted 23rd March, had several watery motions in the night, 



82 

accompanied- with vomiting. When brought to Hospital E3 cold and pulseless, suffering from severe cramps. — lered a saline and mustard emetic immediately, after ich, to allay the irritation of the stomach, a large stard poultice to the epigastric region and — 

& 

Acidi Hydrocyanici, dil : n^iy. 

Tinct: Opii, 

TH.X. 

Aquse dest : 

Sj. 

Misce : Fiat haustus statim sumendus, followed by — 

$ 

Hydrarg : Chloridi, 

gr. iii. 

put dry on the tongue, and washed down with — 

So 

Potassae Chloratis, 

Sodii Chloridi, a a gr. xv. Sodse Sesquicarb : gr. x. 

dissolved in a couple of ounces of hot rum and water — 

Hydrarg : Chloridi, gr. xij. 

Assafcetidso, 

gr. xviij. 

Camphorse, 

gr. xxiv. 

Misce : et div. in pil. xii — 

one to be given every hour, always followed by a dose of the prescribed medicine — 

Inungatur Hypochond : dext ; 



83 

tuiig : hydrarg : fort: lla liora ante meridiem et 4ta meridiem. 

112 o'clock. — Collapsed, eyes sunken, complains of great Lrst and cramps. — The limbs to be rubbed with turpentine and ginger, potatious of hot weak broth with salines introduced ad : lib : — continue the medicines. 

6 p. m. — Vomiting and purging ceased, no pulse, conjunctiva congested, breathing labored — continue medicines through the night. 

24th. — Passed water early in the morning, one motion during the night — pulse perceptible at the wrists, skin more natural, cramps gone — continue medicines. 

25th. — Two bilious motions in the night, was unable to ป3op, and this morning complains of nausea and great clination to vomit, with hiccup. — Ordered — 

s. 

Capiat cochl : ij amp : aq : menth : pip : 

omni hora, donee singult : et nisus ad vomit : cessav, 

6 p. m. — Eestless. — Ordered a cup of sago made with milk, and the following pill at bedtime :—: — 

& 

Pulv : Opii, gr. iv. 

Extr. Hyoscy 

Extr. Conii ana gr. xv. 

Misce, ct divide in pil. x quarum j nocte sumat. 



84 

26th. — Better, makes water freely — progressed favourably till the 7th of April, when he was discharged cured. 

(Case No. 14 — .Burmedi Raj war, aged 40, was admitted the morning of the 24th March 1862, felt unwell and out spirits the preceding evening, had a copious motion in the night accompanied with vomiting, which exhausted him very much. When brought to Hospital he was pulseless, Ehad frequent rice water stools, vomiting, and cramps .o stomach and extremities. — Ordered a mustard poulto the stomach, and four grains of Calomel to be adstered at once, and the following pill every hour: — 

5> 

Hydrarg : Cliloridi, gr. xij. AssafootidiE, gr. xviij. Camphorse, gr. xxiv. 

lisce : et div. in pil xij, washed down by the following aught :— 

5ฐ 

Potassse Chloratis, 

Sodii Cliloridi, aa — gr. xv. 

Sodse Sesquicarb : gr. x. 

dissolved in a couple of ounces of hot rum and water. 

12 a. m. — Stomach so irritable that he throws up the medicine as soon as swallowed. — Ordered to be given instead of the former,— 



85 

& 

Potassoo Chloratis, gr. viij. Sodii Cliloridi, gr. xx. 

Sodso Bicarb : 

lisce : fiat haustus, cum acid, tart, gran, quindeciin in use semifluiduncia solutis, in impetu effervescontiae mendus. 

s> 

Ung : Hydrarg : fort : 3ij. 

Camphorao 3y* 

Misce : ut fiat unguentum, infricatur lateri infecto — continue the Calomel and effervescing draughts. 

6 P. M. — Vomiting and purging ceased, cramps, thirst Id jactation, urine suppressed, no pulse, — continue c medicines through the night, hot chicken broth with j Chlorate of Potash in solution ad : lib. 

25th. — Much the same as yesterday, partially collapsed, no urine passed, — continue medicines. 

Cp. M. — Cramps less, no relief from the bowels, — repeat edies through the night. 

26th. — Pulse felt at the wrist, passed a little urine, raps disappeared, complains of a bursting feeling in ears — 6 p. m. — Ordered — 



86 

5> 

Pulv : Rhei, xvj. Potassse Sulphatis, ana 

Aquae Menthse pip : Sjjss. Sp : Ammon : Arornat : 3ss. 

Misce : fiat haustus eras mane sumendus. 

i!7th. — One copious bilious motion, passes water freely, appearance of Cholera ceased, — to take the effervescing ught three times during the day, discontinuing other licines, — diet — sago, milk, soup, etc. 

28th. — Better. — Ordered, — 

Inf : Chiraytec =fviij. SocUe Carbon : sj. 

Bmistura cujus sumat partem sextam bis die. — pril 7th. — Discharged cured. 

Case No. 15. — Soorkoor Mahomed, aged 55, was admitted at daybreak on the morning of the 25th March — was seized in the night with vomiting and purging ; when brought to Hospital was in a complete state of collapse, cold and pulseless, cramps in the stomach and extremities, eyes sunken, urine suppressed, voice unnatural — Hydrarg : Chloridi iv grains immediately, and one grain to be repeated every half hour, with the following — 



87 

& 

Potass : Cliloratis, 

Sodii Cliloridi, aa sss. Ammon : Carb : gr. v. 

t solved in ฃj Rum and the same quantity of water, to given each time after the Calomel. 

lEmp: Lyttse, mixed with a little acetic acid, to be rubi in over the pit of the stomach ; — to quench the thirst, water previously boiled, with sij Chlorate of Potass: the pint — ad: lib: 

6 p. m. — Pulse perceptible; diarrhoea, vomiting, and cramps disappeared, — continue remedies. 

26th. — No return of the diarrhoea, vomiting, or cramps, — continue the medicines every two hours, omitting the mercury. 

6 p. m. — Moved twice during the day, passed urine twice, feels uneasy in the bladder. — Ordered fomentation. 

Diet — Sago, milk, and soup. 

L27th. — Feverish, tongue furred, treated with gentle natives and tonics. 

7th April. — Discharged cured. 

Case No. 16. — Horish Bowri, aged 30, was admitted collapsed and pulseless and with severe cramps, eyes sunken, respiration much distressed. The same treatment was pretribcd 



88 

as in the foregoing case, but ho never rallied, and ed soon after his admission. 

Case No. 17 — Rajoo Sheik, aged 52, admitted into Hospital, March 28th 18G2, at 10 o'clock a. m. — had had four rice water evacuations accompanied with vomiting, had cramps in the hands and feet, no pulse, skin cold and clammy, forehead covered with cold perspiration, tongue 

112 o'clock a. m. In a state of collapse. — Ordered four ains of Calomel on admission, one grain to be repeated cry hour, followed each time by — 

& 

Liquoris Calcis, งiv. Potass: Chloratis, 3i ss - Sodii Chloridi, gr. x. Sp: Oryzeo, งss. Aq: Dist: งiss. 

Misce : Fiat haustus, omni hora sumendus, 

A mustard plaster to the epigastric region, and two drachms of the strong mercurial ointment to be well nibbed in over the liver. 

q p # ji, — Pulse perceptible at the wrist, vomiting and diarrhoea ceased, no urine passed. — Ordered to continue the medicines during the night. 

29th.— The same as last evening, has passed no urine. 





89 

2 p. m. — Has passed water twice since morning, no relief from the bowels since the evening of the 28th. — Ordered a mild laxative to be given at once. 

IG p. m. — Two copious motions of bright yellow colour, Is much better ; — gradually regained his strength and s discharged cured, April sth. 

I Case No. 18. — Chukur Raj war, aged 40, admitted into ospital 28th March, with purging, vomiting, and severe amps in the extremities ; no pulse, very restless, throwฃ his arms about, and craving for water. By 12 o'clock •ฆ was in a complete state of collapse, sunken eyes, tered speech and white appearance, apparently past all ipe of recovery. — Ordered on admission — 

t Saline and mustard emetic with plenty of warm water ; blister to the pit of the stomach ; sij Ung : Hydrarg : ฆt. to be well rubbed in over the region of the liver ; the dy to be kept warm with hot oils applied to the inside the thighs ; and friction with flannel, dipped in turpene and powdered ginger, over the extremities. 

Eour grains of Calomel to be given in powder, followed icdiately by the following saline draught : — 

$ 

Aqute Calcis, Sjj. Potass : Chloratis, gr. xv. Sodii Chloridi, gr. x. Sp : Oryzro, ฃss. 

Misce. 

Fiat liaustus omiri hora sumendus ; ct : — 



90 

5. 

Hydrarg: c. Creta gr. xij. 

Assafcetidse 

gr. xviij. 

Camphora 

gr. xxiv. Misce. 

Div. in pil xij — One to be given every hour. 

5 p. M. — Cold and collapsed, no pulse, urine suspended, no vomiting or purging, drinks 4 ounces of hot broth with salines in solution every half hour, — repeat the medicines through the night. 

129 th. — No return of vomiting or purging, pulse not rceptible at the wrist, urine still suspended, five grains tass : Nitratis to be added to the saline draught. 

J6 p. m. — Slight re-action, pulse small and thready, lerwise much the same as in the morning. 

30th. — Passed water several times in the night, one yellow motion in the night, head uneasy. — Ordered 01 : Iticini งss. 

Diet — Sago, milk, soup. 

11st and 2nd April. — Progressed favorably. — Ordered nio mixture three times a day. 

3rd. — Slight diarrhoea — Ordered — 

& 

Mist. Cretoe, gj. Tinct : Catechu, $ss. Opii, tix x. 







91 

4th. — Better, but slightly feverish. Treated with mild laxatives and tonics to the 7th April, when he was well enough to be placed on the convalescent list. 

I Case No. 19. — Banoo Sheik Mohamed, aged 40, admitted th March 1862, had before admission five rice watery )tions accompanied with vomiting, had slight cramps, ry shortly afterwards sunk into a complete state of [lapse, eyes sunken, no pulse, etc., great thirst and restlessness, continually calling out for water. — Ordered on admission a saline and mustard emetic, followed by — 

S> 

Acidi Hydrocyanici, dil : gtt : iv. Potass : Bicarbonatis, gr. 

gr. x. 

Tr. Zingiberis, 

ฃss. 

Aq : Dist : 

giss. 

Misce : Fiat haustus statim sumendus. — 

and a few minutes after to have Hydrarg : Chloridi gr. iv, and the following pill : — 

& 

Hydrarg : c. Cret&, gr. xij. Assafcctidoo, gr. xviij, Camphorjc, gr. xxiv 

Misce : Fiat pil. xij — One to be given every hour (to t immediately repeated if ejected) washed down by the owing draught ; — 



92 

& 

Aquae Calcis, 

giss. 

Potass : Chloratis, gr. xv. 

Sodii Chloridi, 

gr. x. 

Sp : Oryzse, 

gss. 

Fiat haiistus omni hora, sumendus. 

K6 P. m. — Still purging, vomiting ceased, motions yelv, pulse feeble, body cold. — Ordered an astringent ection to be given at once. 

$ 

Aluminis, giij. 

PAquse Frigid : Ovj. injectio. — 

Misce 

Ed 15 or 20 drops of Chlorodyne in a little warm rum d water, to be repeated in half an hour, and discontinue !ier medicines. 

129 th. — Better, passes water, all bad symptoms dispearing fast. 

30th.— Better— Half diet. 

7th April. — Discharged cured. 

Case No. 20. — Kabby Sheik Mahomed, aged 50, was admitted into Hospital 28th March 18G2, in a collapsed state. Before admission he is stated only to have had four watery stools, and to have vomited twice. When I saw 



93 

him at 6 a. m. he was cold and pulseless, severe cramps in E stomach and limbs, incessant jactation, eyes sunken, jee motions passing involuntary. 1 o'clock p. m. much same, quite collapsed. 

29th. — Vomiting stopped, cramps less, great thirst, no pulse to be felt in the axilla. 

6 p. m. — The same as in the morning, no urine passed, temperature of body 74ฐ, tongue cold, speaks with a sepulchral voice. 

30th — Slight re-action, pulse perceptible in the axilla, head symptoms, a tendency to coma, no urine passed. G p. m. much the same, passed a little urine, body warmer, — cold applied to the head. 

(31st. — Tongue brown and thickly coated, sordes on the cth, passes water, and had one bilious dark stool. This orning 6 p. m. sinks off the pillow, pulse 104, small, thready, and intermittent. 

Ist April, 6 a. m. — Lies in a partial state of coma. Died in the evening just before my visit. This patient was treated in the same manner as the other cases up to the 30th March, when low typhoid fever set in. This patient really recovered from Cholera in the true sense of the word, but sunk from the after 



94 

Case No. 2L, — Tajim Majee, aged 30, was admitted II the morning of the 30th March. On opening the il Ward he was found in a state of collapse ; when en by me half an hour after his admission, he was cold id pulseless, suffering severe cramps in the abdomen id extremities. He only vomited once in Hospital. 

Hydrarg : Chloridi, gr. v. 

Opii, gr. !• Fiant pil. ii statim sumend : 

and the following pill to be given every hour, or after a motion. 

Hydrarg: Cliloridi, gr. xij. 

Assafoetidse, gr. xviij. Caniphora;, gr. xxiv. 

Misce : fiat pil. xij quarum cap : i omni hora, vel post singulas dejectiones liquidas, followed by — 

& 

Aquoc Calcis, งiss. Potass: Chloratis, gr. xv. Sodii Chloridi, gr. x. 

Sp : Oryzas, gss. Misce. Fiat haustus omni hora, sumendus — Mustard plasters applied to the inside of the thighs and calves. The body was also rubbed well with the following stimulant, — 



95 

& 

Liq : Amon : fort : 

Spirit : Rect : 3;ss. 

P. Camphoric, งij. Fiat Linimcntum. 

12 o'clock a. M. — Quite collapsed, cold and pulseless, norc-action. Death shortly after closed the scene. 

The case seemed hopeless from the time I saw him. He then appeared to bo in the very last stage of collapse, and he never rallied. 

Case No. 22. — Modoo Dome, aged 3G, was admitted into Hospital on the 30th March 18G2, at 7 o'clock. On his admission he was cold, pulse hardly perceptible, passing rice water evacuations and vomiting large quantities of water which he had drunk — Ordered a mustard poultice to the epigastrium, and two grains of calomel, followed by 

Potassse Chloratis, gr. xx. Sodii Chlor : gr, x. Sp : Sace-hari, Sjss. 

Aq : Dist : 



M. 

Fiat haiistus" statim sumendus, — and friction with turpentine and ginger to the extremities. A grain of calomel to be given every hour, always followed by the saline draught proscribed. 



96 

1 o'clock p. m. — Collapsed, no pulse. Five grains of carb : amraon : ordered to be added to the draught, half an ounce of which to be taken every half hour ; occasionally hot soup to be administered, and one drachm of strong mercurial ointment ordered to be rubbed in over the region of the liver. 

6 o'clock p. m. — Purging and vomiting ceased, eyes sunken, extremities cold, has made no water since admitted ; — the above remedies to be continued during the 

31st. G o'clock a. m. — Body warmer, pulse just perceptible at the wrist, complains of great thirst, has slept a little, passed no urine — Ordered, to omit the calomel, the potash and soda to be given in hot broth instead of rum and water, half an ounce to be taken every half hour. 

110 o'clock p. m. — Cramps disappeared, body warmer, 38 blood shot, tongue moist, passed a little limpid me at 12 o'clock — continue treatment. 

16 o'clock. — Makes water, but in small quantities at time, no relief from the bowels — treatment to be ntinued through the night, but at longer intervals. 

April Ist. 7 o'clock a. m. — Slept better, eyes more natural, pulse 96, complains of headache, — ordered, half an ounce of castor oil immediately, all other medicines to be discontinued. 



97 

1 o'clock p. M. — Had had three watery Mious stools, ปd was very weak. Administered a little aromatic spirit ammonia in rum. 

6 o'clock p. M. — Had had several watery bilious stools, symptoms of Cholera all gone, — ordered, 20 drops of chlorodyne in a little chalk mixture. 

April 2nd. — Tonics prescribed, — patient progressed favorably till the 6th, when he was placed on the convalescent list for a few days to recover his strength. 

Case No. 23. — Kanoo Shaik, aged 32, was admitted into Hospital on the 31st March 1862. Before his admission he had passed several rice water evacuations and had vomited many times. When seen by me at 6-30 a. m. he was cold and nearly pulseless. — Ordered, two grains of Calomel to be given immediately, followed by Chlorate of Potash 20 grains, 5 grains of Carbonate of Ammonia in one ounce of Rum and water, one gi-ain of Calomel followed by the draught to be repeated every hour. 

1 o'clock p. m. — Quite collapsed, vomiting ceased, purging not so frequent. — Ordered to omit the Calomel, and the draught only to be repeated every half hour, one drachm of strong Mercurial Ointment to be rubbed into the right side over the liver. 

9 p. m. — Pulse perceptible, Diarrhoea and vomiting stopped. 



98 

April Ist, 6 a. m. — Slept a little, pulse 9G, no return of Eiting or purging. — Ordered a dose of the medicine cribed yesterday to be given every three hours. — , hot soup. 

BC p. m. — Body warm, tongue furred but clean at the ges, pulse 90. Has passed no urine since admittance. 

S April 2nd. — Has passed a restless night, no relief from c bowels, passed a little urine. — Ordered half an ounce Castor Oil combined with 15 drops of Laudanum. 

6 p. m. — Two bright yellow motions, passes water freely. 

I April 3rd. — Slept well, slight fever, complains of adache. 

G p. m. — Feels much better. — Ordered half diet. 

April 4th. — Ordered Tonics. 

April 6th. — Placed on the Convalescent list, and a few days afterwards discharged cured. 

Case No. 24. — Shaik Kuky Mooddeen, aged 45, waa admitted into Hospital on the same day and at the same time as the preceding case. He was suffering from all the symptoms of Cholera, rice water evacuation continually, 



99 

almost flowing involuntarily from him, lie had very Ile vomiting, but the matter ejected from the stomach 3 watery untinged with bile — body cold, violent cramps the extremities, pulse imperceptible. — Ordered Calomel 3 grains to be given immediately, Turpentine friction the extremities, one drachm of the strong Mercurial ltmeut to be rubbed over the region of the liver, one bin of Calomel to be repeated every half hour, followed Carbonate of Ammonia grains five, Chlorate of Potash grains twenty, dissolved in a wine-glass full of hot Rum and water. 

1 o'clock p. m. — Collapsed, eyes sunken, tongue cold, no vomiting, but the purging still continuing. — Ordered the treatment to be continued, and hot broth w T ith plenty of salt to be given two ounces at a time to quench the great thirst. 

9 o'clock P. M. — Much in the same state as when I last saw him, but purging stopped — the treatment ordered to be continued through the night. 

April Ist, 6 a. m. — No return of the purging, or vomiting, cramps disappeared, pulse feeble 92. The medicine to be given every hour, omitting the Calomel, hot fomentations to the region of the bladder. 





100 

medicines repeating them every two hours— diet, hot soup. 

G o'clock p. m. — Very weak, countenance anxious, tongue dry, skin warm, he has had no sleep during the day. — The medicine ordered to be given once during the night. 

April 2nd. — Passed water twice, no relief from the bowels, since the evening of the 31st ultimo. — Ordered half an ounce of Castor Oil combined with 15 drops of Laudanum, omitting all other medicines. 

1 o'clock p. m. — Three bilious stools, passes water freely, has taken a good basin of sago. 

6 P> M . — Rapidly improving, but complains of headache. 

April 3rd. — Slept a little during the night, pulse 104. body feverish. — Medicines ordered accordingly. 

3r3 r( j. — Much the same as yesterday. 

16th. — Convalescent, and a few days afterwards he was [charged cured, but exempted from work for a fortnight. 

The above twenty-four cases are arranged in chronological order, and have been compiled from the notes of fifty cases of Cholera, in which the patients were admitted into the Hooghly Jail Hospital, in the months of March and April 1862. — Four only of these cases proved fatal from the actual disease, and one from low fever.