EPIDEMIC CHOLERA. The following suggestions were intended for circulation in Branfe script, among the families accustomed to look to the writer for meafefe^ advice. They were prepared as a guide to them, until a physician could be obtained, in the event of being assailed by this fearful disease. In compliance with the recommendation of several professional and other friends, the document is now presented in this more convenient form. It is not claimed that the treatment recommended is that only which has been, or can be successful; but the writer having seen almost every method tested, in 1832 and 1833, and believing his views correspond essentially with the experience of medical men from the Ganges to the Mississippi, is convinced the plans herein proposed, are among the most reliable. It is worth} of note that during the supposed approach of the Epidemic, there is in the community, for weeks or months before its outbreak, a general tendency to derangement of the digestive organs, with the occurrence of cases so resembling the disease, that rumors of its advent become rife, and fears and discussions agitate the public mind. In advance of an atmosphere strongly impregnated with the infection, we are probably breathing it in a diluted state, and are therefore but slightly impressed ; yet, if incidental causes induce disordered bowels, individuals may be precipitated into a full development of the disease. The warning is kindly sent us and should be wisely taken. There is another fact worthy of remembrance. The prevalence and virulence of the pestilence, depends not alone on the amount of poison in the air, but much also upon the ever varying influence of weather season, latitude, personal and local circumstances. As its effects maybe thus variously modified, medical men not unfrequently find it necessary to vary their treatment. This accounts in some measure, for diversities observed in the practice oi experienced persons, at places distant from each other; and teaches us that it would be hazardous to rely 2 Epidemic Cholera. upon plans pursued under circumstances materially differing from our own. It would be unjust too, to condemn as erroneous, modes of practice declared by competent men to have been successful under their own eyes, because not corresponding with what we have seen. Let it be borne in mind however, that while in some details there may be diversities in practice, it has been found that the peslilence, in all essential points is every where the same, and that the Medical Profession, agree almost unanimously, as to the chief remedies, and the mode of their application. Quackery makes a thousand absurd pretences, and gives a thousand false assurances. Symptoms. For convenience, we may consider the disease in three stages The Ist, or that of common diarrhoea; of which the usual intimation is a loose discharge from the bowels, moderate in amount and natural in color, without pain or uncomfortable feeling. Such discharges may be often repeated. They are however sometimes large, occur in quick succession, and accompanied by a sense of nausea and debility. The 2d. or that of choleric diarrhoea, in which the discharges are thin and light colored, sometimes resembling dirty soap suds ; or it may be are watery, with a sediment resembling well boiled rice. In this stage the skin is fast losing its heat and color; the pulse fails as the case advances ; while thirst, vomiting and cramps of the extremities, come on with fearful violence. The 3d, or stage of collapse, characterised by an aggravation of all the distressing symptoms of the second. The skin cold and livid, is covered wilh a clammy sweat; the voice feeble and strangely altered; the pulse scarcely discernible; the hands and feet blue and shrivelled. The duration of these stages is not uniform. The first may quickly pass into the second, the second into the third, or either may be protracted, the first, even for days. Between the discharges, there may be intervals of only a few minutes, or of hours; but mark, each is more liquid than its predecessor, and generally more free, and each is usually of a lighter hue. If they continue of a natural color, there is less danger; as they become thinner and lighter colored, the disease is advancing, and there is no time io be lost. Notice two common errors. Epidemic Cholera. 3 First, That a state of constipation is favorable. It has often led to a sudden reverse. Rather consider it a premonitory symptom, to be removed by some gentle medicine. Secondly, Th:.t the attack always begins in some violent manner. It is rarely so in our country. I have met vviih many cases, in full development, or hastening to a fatal issue, which might have been easily arrested in the beginning, had not the victim been deceived by the too prevalent notion, that the attack is known by some painful or deeply distressing symptom from the commencement. When asked why they permitted the diarrhoea to continue for hours, or days, without proper attention, the common reply is " why, doctor, I felt as well as I ever did in my life, I had no pain, and had no sickness at the stomach." Our common cholera morbus generally makes its onset suddenly, but this foreign invader is but too frequently insidious and deceptive. Means of Prevention. Whatever gives strength, is a means of prevention; whatever enfeebles, is a predisposing cause. THE MIND.. It should be calm. There is reason for composure, seeing that Providence has given us the means of safety, if we apply them correctly. FOOD. A full supply is necessary; yet moderation is ever a good rule. — If the tone of your stomach is impaired, and in cholera times it is apt to be so, eat less. Light bread, crackers, rice, tender meats and such vegetables as agree best with you, may be used. Articles found not to agree, should be carefully avoided. Fruits in every form, and nuts it is best to shun. Most persons in our country cannot safely use them, and it is best to hazard nothing. DRESS. That should correspond with the season; when cold and damp, flannels and warm clothing are important. Keep the body warm. 4 Epidemic Cholera. EXERCISE. Take it freely. Avoid exposure to the hot sun of summer, and all unreasonable bodily exertion. SLEEP. A full amount is demanded. It promotes the health of every organ. Have an extra blanket to draw over you, if your chamber is liable to become cold as the night advances; it is dangerous to be cold while sleeping. BATHING. A daily, or at least a weekly tepid salt bath, with active frictions over the body, is a great preserver of health. The cold bath is best for those who feel warmed and refreshed by it. BUSINESS. It is unsafe to abandon our regular avocations; and the height of folly for families to break up hastily, and fly from a pestilence that may overtake them anywhere, and which will be likely to keep them on the wing for years. During its former visitation, we had it in our city three successive seasons. Many then perished in their flight, far from home, and beyond the reach of friends and medical attendants. Means of Cure. Send promptly for a physician, is the first injunction. Until he arrives, what is to be done ? Consider for a moment three of the leading characteristics of the disease ; loose bowels, loss of strength, loss of heat. What does daily experience dictate in such a state of things? To go directly to our beds, and cover warmly. Disorder of the bowels, everybody knows, is increased by going about, even by standing on the feet, and is much relieved by lying down. That position best preserves the strength, also, and in it we can most readily retain the heat of the body. If the bowels are restrained, the strength preserved and the heat retained, where is the disease ? It is gone, and will not return unless the patient leaves his bed too soon. But the recumbent posture, without which all other remedies will probably be unavailing, although sometimes adequate to the cure, ought not to be exclusively trusted. Medicines are necessary. If the discharges are moderate and unaltered in color, as in the first stage, a teaspoonful or two of Paregoric, or a Camphor and Opium Epidemic Cholera. 5 pill, will usually suffice ; or if the patient from constitutional peculiarities, wiohes to avoid the use of Opium, five or six grains of Gum Camphor may be taken as a substitute, or a teaspoonful of the cam- . phorated tincture, prepared as directed below, and diluted, if too strong for the patient, in a little water. The dose to be repeated every hour or two, if the bowels are still moved. If the discharges are large and thin, let two Camphor and Opium pills be taken at a dose. Should the discharges become lighter colored, indicating the approach or presence of the second stage, let the pills containing Calomel be used, one or two each hour, according to the urgency of the symptoms. The light colored discharges are evidence that the disease is gaining, and its course is so rapid, that in such circumstances, it is not safe to rely upon remedies less potent than Calomel. Of all medicines I deem jt the best adapted to relieve that condition of the system, ever present when the discharges from the bowels are passing from the natural in color to those of lighter hue, or are assuming the rice water appearance. If the second stage is fast tending to ihe third ; or if the third is present with all its fearful features, then you should give each hour, ten grains of Calomel, with two of the pills of Calomel and Opium, making twenty grains of the former to one of the latter. Still larger doses may be given, if deemed expedient by a physician. I know there are strong prejudices in some minds against Calomel, and I know it has often proved injurious in the hands of reckless or careless men; rightly used, I believe there is no medicine more valuable or more safe. There are some so peculiarly susceptible to its evil effects, that they ought never to use it, but with the utmost caution, or in great emergencies. In Cholera, it is of all medicines the most reliable. If the case is taken early, however, little if any is required. If the disease is far advanced, I am persuaded no remedy can avail as much. In a condition so critical, and with time so limited, I would hazard much as to subsequent injury. Whenever the discharges are arrested, or are becoming darker, there will be some amelioration in the case, and the Calomel at least, should be withheld. Indeed, no medicine is likely to be needed for some hours. There is danger in attempting too soon to " work off" what has been taken. When the pulse is rising, warmth of surface returning, and the discharges are dark colored, brown, green or black, convalescence has begun ; but great caution is necessary to prevent relapse. Epidemic Cholera, 6 At any stage, if there is nausea or vomiting, a large mustard plaster should be placed over the stomach and bowels. When cramps occur, brisk frictions with the hands, or with dry flannels, will relieve. If the skin is cold, warm spirits of turpentine, or warm tincture of Cayenne pepper, may be applied by friction. The rubbing should be done, as far as practicable, without uncovering the patient. Hot bricks, bottles of hot water, and hot flannels or blankets, should be called into requisition whenever there is loss of heat in the surface. Brandy may be given in any stage of the disease, but with most advantage in its earliest period; but if the stomach throws up everything, then resolutely withhold ail drinks. A bit of ice may be put into the mouth, and allowed to dissolve gradually. Some have advised a little brandy daily, as a preventive. In certain conditions it may