y> Iaj-^ /I>-trX2^u -^._- • -'-t^y Oeru^eJL 4/Mc OFFICIAL PAPER ON CHOLERA. REPRINTED FROM THE LONDON MEDICAL GAZETTE. Council Office, Central Board of Health, 9th May, 1832. Precautionary Hints to Persons residing in Places suffering, or likely to suffer, from Cholera,- with Concise Directions for the Treatment of those threatened with or actually at- tacked by the Disease, in Situations where Medical Advice cannot be immediately obtained. Heads of families living in the country, and benevolent individuals wishing to afford remedial assistance in this de- structive malady, ought to provide themselves with the fol- lowing articles, viz.— lbs. oz. Tincture of opium (laudanum) 0 2 ----of catechu ----of assafoetida - } Aromatic spirit of ammonia Compound spirit of lavender Oil of peppermint Castor oil Ipecacuanha in powder Mustard in do. (best Durham) Compound chalk powder Sulphate of quinine 0 4 0 4 0 4 0 2 0 0* 2 0 0 2 0 0 0 4 0 1 Pills, No. I. CCalomel, 2$ grains ^ Six dozen < Opium, $ grain >in each pill. ^.Cayenne pepper, 2 grains j Three dozen No. II. Calomel ? of each 2£ grs. . Comp. Ext. Colocynth 5 in eacli pill. No. III. oz. Three dozen i Blue P!11' 2 gra!ns I in each Dill i nree dozen £ Rhubarb) 2 grain3 $ "» eacti pill. Powders, No. IV. Calc. Magnesia, 2 parts, ~\ ., Rhub. in powder, 2 parts, f ^ "z Ginger in powder, 1 part, C carefully mixed, ) No. V. Calomel, 1 grain } James's powder, 2 grains C - 0 OJ Nitre in powder, 5 grains j Liniment, No. VI. Comp. Soap Liniment, T| with opium, 8 parts C - 0 3 Tinct. Cantharides, 1 part J Mustard Poultice, No. VII. The mustard poultice is made by mixing equal parts of mustard powder and crumb of bread into a paste with hot ■water; or by mixing equal parts of mustard powder and thick porridge. Bags or stockings to hold heated bran or salt. Stomach and feet warmers. Enema syringe. A graduated glass measure (1 oz.) A set of scales and weights (grain.) The above supply is calculated for the number likely to be attacked in a population of 500; and in price, as esti- mated by a London chemist, will not exceed 31. 3s. 3 Precautions. 1. The Clothing should be warm. Woollen stockings ought to be worn, and flannel next the skin—at least over the belly and loins. 2. Diet.—Avoid, above all things, overloading the sto- mach. Indigestion, however produced, disposes the body to this disease. If in easy circumstances, take for dinner a moderate quantity of roast meat in preference to boiled, with stale bread or good potato, two glasses of wine with water, or an equivalent of weak brandy or whiskey and water, or of sound porter or ale. Eat garden stuff and fruit sparingly, and avoid fat luscious meats. In short, whilst un- der apprehension of cholera, use a dry, nutritive diet, spar- ing rather than abundant; observe great caution as to eating suppers, for cholera most frequently attacks about midnight, or very early in the morning. In case of costiveness, take one or two of the pills, No. 3, going to bed; or one or two of the pills, No. 2, in the morning, should no effect be produced by No. 3; but avoid salts, senna, and all cold, drastic purgatives. 3. Exercise.—Moderate exercise in the open air, in fine weather, is conducive to health; but the greatest care should be observed by all, more especially by the weakly and the aged, not to carry that exercise to fatigue or profuse perspi- ration, nor to sit down with wet feet or wet clothes. Treatment of the Premonitory Symptoms of Cholera. 4. In a very large majority of cases, the attack of cholera is preceded by a looseness of bowels of longer or shorter duration, say twenty-four hours. It is in this stage that reme- dial assistance is most efficient, and that life may be saved with the most certainty, by checking the disease in its com- mencement. When, therefore, the bowels become relaxed without an obvious cause, where cholera is prevailing at the time, the following measures should be adopted without loss of time:— 5. In the case of adults, previously healthy, let blood be taken from the arm to eight or ten ounces, or by ten or twelve leeches to the pit of the stomach, or by cupping. Should the loose motions be of a darker colour than natu- ral, give two pills of form No. 2, and four hours after a table- spoonful of castor oil, floating on half a v^ine-glassful of gin 4 and water, brandy and water, or cold coffee, with ten drops of laudanum if there be griping pains. Confine the patient strictly to bed, and give the following draught at night:— Cinnamon or peppermint water, half an ounce;* laudanum, twenty-five drops. 6. When the purging is of the ordinary, bilious, and fecu- lent kind, with griping and flatulence, give ten drops of laudanum and forty of tincture of catechu in the same vehi- cle, every hour, for five or six hours; or twenty grains of the compound chalk powder every second or third hour, should relief not be obtained sooner. A warm bath for half an hour, followed by rubbing with flannel or flesh brushes; warm fomentations to the belly by means of bladders half filled with hot water, or flannels soaked in hot spiced wine, or in hot spirit and water, will afford much relief. 7. When there are cramps, a dessert-spoonful or two of the liniment No. 6 should be assiduously rubbed on the part affected. 8. If there be nausea or sickness, without acute pain at the pit of the stomach, give an emetic of twenty-five or thirty grains of ipecacuanha in half a pint of warm water. 9. When giddiness and pain at the pit of the stomach arc present, bleed as above, and give a tea-spoonful of the ape- rient powder No. 4. 10. Let the diet in all these premonitory stages consist of light farinaceous preparations: sago, tapioca, panada; chicken broth and tepid drinks, to promote perspiration. 11. Should debility, with chills and sweats, remain, give two grains of sulphate of quinine three times a day for two or three days. This medicine will often be found to check the relaxation of the bowels. First Stage of the Attack—Treatment. 12. When the motions have lost the appearance of fecu- lent matter, and have put on that of rice-water or chicken- broth, with vomiting of similar liquids, spasms, intense thirst, irregular, slow, and weak pulse, give an emetic of half-a-pint * Peppermint water may be made by rubbing down five drops of oil of peppermint with half a tea-spoonful of sugar, adding a table-spoonful of water by degrees. 5 of a solution of common salt, as strong as it can be "made, with a tea-spoonful of mustard powder. Place a mustard poultice, No. 7, over the whole stomach, belly, and front of the short ribs, having previously rubbed the parts with the liniment. Give one of the pills, No. 1, every alternate half- hour, and in the intervals two table-spoonsful of weak brandy or whiskey and water; cold if preferred. Let the patient drink cold water or iced water if it can be had, allowing no more than two or three table-spoonsful at a time, or bits of ice the; size of a nut may be given to be swallowed whole, to allay the burning sensation at the pit of the stomach. Let bags or stockings,'filled with heated bran or sand, be placed along the patient's spine or sides, and feet warmers applied to his feet. Let him be kept still, if possible, wrapt in warm blank- ets, but not oppressed with heat or coverings, particularly over the chest and neck. Second Stage of the Attack. 13. If, notwithstanding these measures, the patient should appear to be sinking, the pulse becoming weaker, the skin colder, the breathing more laborious, the individual appear- ing less anxious about his own situation, then, in addition to the steady application of the measures already recommended, let an injection be thrown up the rectum, consisting of two or three pints of water, as warm as the hand can conve- niently bear, with a small wine-glassful of brandy or whiskey, to be repeated, if thought necessary, at intervals of an hour. Third Stage. 14| When the pulse at the wrist has ceased, or become almost imperceptible, with coldness of the extremities, and perhaps blueness of the surface, particularly of the lips, hands, and feet; irregular breathing, loss of voice, suppres- sion of urine, ghastly countenance, without delirium; al- though under these awful circumstances there is but little. room for hope, our exertions should not cease. 15. At this stage of the attack the vomiting and purging will generally have ceased, or at least be much diminished; the belly will be drawn in, and pain, sinking, and death-like oppression will be felt about the heart. 16. Let the hot water injection be repeated, with two or three drachms of the tincture of assafcttida, and retained for some minutes by means of a napkin. 6 17. Let mustard poultices be applied to the inside of the thighs and calves of the legs, in addition to that on the belly, which may be removed to the sides of the chest or back; let the limbs be diligently rubbed with warm cloths; let small quantities of light cordials be given at intervals—such as a tea-spoonful of compound tincture of cinnamon, or of aro- matic spirit of ammonia, in a table-spoonful of water—and let the treatment ordered for the second stage be continued until the pulse becomes distinctly perceptible at the wrist.* Stage of Re-action, or Fever. 18. When the pulse has begun to rise, and the heat and natural colour begin to return to the surface, keep the pa- tient perfectly quiet, but let him be carefully watched, for a sudden sinking of the powers of life not unfrequently occurs at this period of the disease. Opiates of all kinds must now be withheld; and wine, brandy, and other stimulants, used very sparingly, and withdrawn altogether as soon as the pulse and heat are steadily re-established; when mild tepid drinks are to be substituted, and the powder No. 5 given every hour, instead of the medicines hitherto used, should the bowels be torpid. 19. Under this treatment a warm copious sweat often breaks out, or a more healthy discharge takes place from the bowels, or some urine is passed, which, of all others, is the most favourable sign. When such is the case, the pa- tient, with proper care, will often pass into a state of con- valescence, without further difficulty or danger. 20. It often happens, however, notwithstanding all our * The following plan of treatment, proposed by Dr. Ste- vens, and acted upon under his direction, has excited some notice, and is stated to have been attended with very con- siderable success in all stages of the disease:— Supercarbonate of soda, half a drachm. Muriate of soda (common salt) 20 grains. Chlorate of potass, 7 grains. To be given in half a tumbler of water every hour, until the patient begins to recover from the collapse. Dry heat, frictions, mustard poultices, and injections of hot salt and water, were used at the same time. 7 care, that the re-establishment of the pulse and heat are closely followed by symptoms of fever, or by some degree of stupor, or by great oppression of breathing, or by disten- tion and tenderness of the belly; all of which indicate dan- ger. 21. The moment such symptoms appear, bleed from the arm, or from the part most affected, by leeches or cupping, to ten, twelve, or sixteen ounces, according to the effect produced by the bleeding. Reduce the temperature of the patient's room, give cool drinks, and apply cold wet cloths, or pounded ice in bladders, to the head; and give the pow- ders No. 5, as already ordered. 22. When convalescence has begun, observe the strictest care as to diet. At this period a full meal has, in numerous instances, brought on a relapse. Indeed, animal food, even in small quantity, under these critical circumstances, has often been attended with dangerous consequences to those just recovering from cholera. To such, even the mildest articles of food should be given in much smaller quantities, and at shorter intervals, than to those in health; and their ordinary diet and habits should be very cautiously resumed. W. PYM, Chairman. Printed and Sold by L. R. Bailey, 26 North Fifth Street.