CHOLERA, WITH A SIMPLE AND ECONOMICAL MODE FOR ITS SUBMITTED WITH CONFIDENCE FROM REPEATED SUCCESS IN ITS APPLICATION. BY WILLIAM HENRY WILLIAMS, M. D, F. L. ฆ? FELLOW OP THE ROYAL COLLEGE OF PHYSICIANS, AND PRESIDENT OF THE IPSWICH CENTRAL BOARD OF HEALTH. SECOND EDITION— REVISED AND ENLARGED. " In faith and hope the world will disagree; 11 But all mankind's concern is Charity." Pope. I PS WIC H.: PRINTED AND SOLD BY E. SHALDEfIS, WESTGATE-STREETJ SOLD ALSO BY SIMPKIN AND MARSHALL, STATIONERS 1 HALL COURT, LONDON} AND BY ALL BOOKSELLERS IN TOWN' AND COCNTRY. lKtt. SIR HENRY HALFORD, Bart, G.C. H., PHYSICIAN IN ORDINARY TO THEIR MAJESTIES, AND PRESIDENT OF THE ROYAL COLLEGE OF PHYSICIANS, THE FOLLOWING TAGKS RELATING TO A DISEASE WHICH HAS RECENTLY BEEN THE SCOURGE AND TERROR OF VARIOUS FOREIGN STATES, AND WHICH NOW SERIOUSLY AFFLICTS MANY PARTS OF THE BRITISH EMPIRE, EXHIBITING A CONCISE VIEW OF THE NATURE OF CHOLERA;. IND DISCLOSING A SIMPLE AND SUCCESSFUL MODE OF TREATMENT, ฎvt Eitsmfcrtf WITH SENTIMENTS OF ADMIRATION FOR HIS PROFESSIONAL TALENTS, AND WITH FEELINGS OF UNFEIGNED ESTEEM FOR HIS UNVARIED PERSONAL KINDNESS, BY THE AUTHOR. Ipswich, July :!3kd, lb'3-2. EFFECTUAL IN ANY GENERAL DISEASE, THAT IS NOT CHEAP, AND THAT CANNOT EASILY BE MADE UNIVERSAL." (Account of the Bilious Yellow Fever in 1797. By Benjamin Rush, M. Z)., Professor of the Institutes, and of Clinical Medicine in the University of Pennsylvania. — Page 125.) ON CHOLERA. When the combined skill and efforts of learning, experience, and zeal, have been long exercised in vain to accomplish the removal or mitigation of any afflicting malady, it is too apt to generate a belief, that relief is impracticable, and thus to relax both research and experiment. It is also observable, that continued disappointment, in the expected effects from the use of varied and complicated prescriptions, has a tendency rather to produce despondency, than to suggest a trial of more simple remedies. Thus, the Cholera, having so generally baffled the skill of medical practitioners of the highest character for talent and experience, an impression has too generally prevailed, that occasional recoveries are providential, and that the disease is incurable by human means. The alarm and dismay consequent on so pernicious 6 Id erroneous a belief, predisposes to the malady d aggravates it. Perceiving the inefficacy of >re elaborate and complicated remedies, on ing myself called in to some Cholera patients, I is resolved to try more simple means to subdue d eradicate this frightful disease. llt may not be unimportant to remove a too pular and mischievous impression, that the sease is new in this country ; and that, theree, the medical world are inexperienced and un?pared for its treatment — an impression that has, doubt, assisted in promoting the dismay and spondency so injurious in accelerating or agtvating the disorder. Els far back as the year 1609, the Cholera was requently known in London at the close of inner and the beginning of autumn, that Dr. Sydenham, a Physician of deserved celebrity, in a chapter upon Cholera Morbus, quaintly alledges the visits of that disease, at those seasons, to be as constant as the appearance of swallows in the spring, or cuckoos towards midsummer. His description of the Cholera Morbus of 1069, represents with sufficient accuracy, nine cases in ten of the Cholera of the present day. That a particular or transient state of the atmosphere, or 7 the peculiar constitution or irregular habits of a few individuals, may occasion a peculiar malignity or singular symptoms in the disease, is not inconsistent with the fact, that the great majority of cases of the present day are identically the same as those described by Dr. Sydenham a hundred and sixty years ago ; and it should be remarked, that Sydenham never intimated, that Cholera was then a new disease ; but declares, that the disease was more epidemic in the year 1G69, than he had ever known it before. This eminent man thus described the signs by which the disease was known in that day :—: — " 1. Immoderate vomiting, and adiseharge of vitiated humors by stool with great difficulty and pain. 2. Violent pain and distension of the abdomen and intestines. 3. Heart-burn, thirst, quick pulse, heat and anxiety, and frequently a small and irregular pulse. 4. Great nausea, and sometimes colliquative sweats. 5. Contraction of the limbs. 6. Fainting. 7. Coldness of the extremities, and other like symptoms, which greatly terrify the attendants, and often destroy the patient in twenty-four hours."* — (Sydenham's Works, translated by Swan, page 137, chap. 2.) • Any five, or even four, of the symptoms, enumerated by Dr. Sydenham, occurring at one and the same time in a more or less rapid succession, I feel disposed to consider as constituting the Cholera of the present day. 8 After reading this description, it is riot too much to assume, that the disease of 1669 is the disease of 1832. It is obvious, that the suddeniiess of the seizure, the rapid progress of the disorder, and the fearful nature of the spasms, are calculated to excite alarm or despondency in the attendants, which perniciously aggravates the fears and malady of the patient. In every practicable degree to diminish the injurious effects of such alarm, the Practitioner should firmly interpose a cheerful confidence and assurance of hope; to soften fear and soothe excitement, is in a measure to allay the disorder, and to prepare and predispose the Patient to submission and comparative tranquillity, a great auxiliary to any remedy that may be afterwards prescribed. The Professional Man has been perplexed and thwarted in his attempts to subdue this frightful malady, by continually perceiving that many important and potent medicines, when administered in this disorder, have failed of their wonted effects. Some have revolted the stomach and augmented the pain and excitement they were designed to remove or diminish ; and opiates, having disappointed the intentions and expecta- 9 tion of the Practitioner, in consequence chiefly of the mode of exhibiting them, led me to attempt some new method of administering them in this complaint. It occurred to me, that if an opiate., sufficiently powerful to allay the dreadful irritation and excitement of the system which characterize this disease, could be introduced into the bowels, in a shape that would gradually, but increasingly mitigate, and early subdue the painfully excited state of the alimentary canal, that the pains and cramps in various parts of the body, together with the vitiated secretions and irregular action of the stomach and bowels, would soon cease. Whether this reasoning be correct or defective, it induced me to resort to a method of administering opiates through the medium of the lower bowel, and at the commencement of the disorder, which in my humble judgement, has been attended with effects so strikingly salutary, and so immediately remedial, and eventually so successful, that I dare venture to congratulate the suffering community on its discovery. Long practice, and the frequent disappointment of justifiable expectation, make me mistrustful of my own judgement and timid in predi- X 10 eating successful effort in a malady that seems to have mocked the art and science of medicine, and to have multiplied its victims by the dotiion of early terror and despondency. 1 trust m not too sanguine in my belief of having acnplished what all have so intensely desired. I will briefly state the nature of my remedy, and then narrate the cases in which its efficacy has been decidedly manifest. Its simplicity, and its resemblance or approach to the nature of any other attempted remedy, will not disparage it with the learned and eminent practitioner, or the humane philanthropist ; the former will possess a familiar recollection of the signal benefits conferred on mankind by accidental discoveries which have been often touched, but never before grasped ; and the latter will forget the humble pretensions of the discoverer in a grateful ac^ ceptance of the benefit to his afflicted fellow creatures. IPhe remedy, then, which I propose, is the roduction into the Rectum, or lower bowel, i mild but efficient Opiate ; consisting of one ,m of the best soft crude opium, not dried poivdered, and seven drams of hard soap, ich being intimately blended together from 11 having been well pounded in a mortar, forms a solid paste,* of which the quantity introduced into the Rectum on each application, is about 2jgrains of soft opium, and 17 j grains of soap. The shape of the Paste, which, if requisite, may be reduced to a smaller size, should be agreeably to this plate, and forms, what is technically termed, a Suppository — Irovided the bowels be severely excited, it will desirable to delay the application of the iste till some pause or relief in such excitement ie place, or till after such exhaustion or weakss be felt. In either event, the Anodyne Paste ty be safely inserted into the Rectum, either the patient or nurse, with the fore-finger and imb ; the smaller end of the paste being first reduced. I As the expense attending the purchase of it for one family Id be very trifling, every house in the kingdom may be provided li it; the wealthy and respectable having it in readiness for nselves and their families ; it may be desirable for them in this hour istress to provide the same for their labourers and poorer neighrs, who, without such assistance, might be unable to procure it. additional expense of having the paste properly divided for difnt ages, and enclosed in a light box, would add but little to the of it. 12 In case the paste should be removed by any evacuation of the bowels, or other cause, before the desired relief be effected, the application of a similar quantity, in a similar shape, should be repeated ; and again in one, two, four, six, or eight hours, as may be required by the continuance of pain, spasm, vomiting, or purging. The size and quantity of the paste is for a person exceeding eighteen years of age ; whilst two-thirds will be sufficient between six and eighteen ; and one-third for those from infancy to six years old. The salutary effects of the Anodyne Paste has exceeded my most sanguine hopes ; an assertion which, 1 trust, may be justified by the following Knpient and other Cases of Cholera, which have len under my own immediate observation :—: — CASE I. W. T., a young woman aged 21, was attacked about eight in the evening with violent cramps in her legs and stomach ; during that day, she had two evacuations in the bowels of a nature not very relaxed — she vomited once, and frequently retched — the surface was warm, countenance natural, pulse 80, and of fair strength, and tongue furred. Sixty drops of tincture of opium, at halfpast 13 eight, in brandy and water, and also an anodyne stimulating liniment, were directed by the professional attendant, at whose request I visited her soon after ten, when I advised the application of the paste to the rectum, which was afterwards twice repeated in the interval of two hours. The pain, however, continued most excruciating till twelve o'clock, when she was considerably relieved ; and soon afterwards fell into a comfortable sleep of some hours, and awoke greatly refreshed and free from pain ; but the succeeding day at halfpast three she was again tried with the recurrence of spasm, at which time, having had recourse to the paste, and repeating its application an hour afterwards, the pain soon yielded to the means. Nothing was taken during the complaint except tea and thin gruel, with which she was fully satisfied, and recommended to continue it a few days. Friction with the anodyne stimulating liniment, which was powerfully rubbed on the body, and the 60 drops of laudanum taken in brandy and water before 1 saw her, seemed to have afforded no relief, for so severe were the cramps in her stomach and legs, and so terrified was the patient that three individuals 14 were required to keep her in bed, till after the third application of the paste. CASE 11. E. A., a man, upwards of 50, and of a nervous temperament, after some indisposition and loathing of food, accompanied by slight pains in the loins, was attacked about the middle of the day with retching and vomiting, severe pains in the stomach and bowels, which were soon succeeded by three rapid and liquid evacuations from the bowels, great prostration of strength, and much thirst, deep anxiety of mind, violent pains in the back and legs, pulse small and intermitting, tongue slightly coated. I visited him in the evening about nine o'clock, and immediately directed the paste, together with friction ; the latter was soon discontinued, because it seemed to increase the pains. In two hours he experienced great mitigation of pain generally, and in the two successive hours he fell into a comfortable sleep, from which he awoke about five the following morning free from pain and in a tranquil state of mind ; he soon took a cup of tea, followed a short time afterwards by a little thin gruel, which he enjoyed. At eleven, nausea and vomiting returned in a small degree, and also in the evening, but 15 lised about eight; at nine I visited him, when ; pulse was steady at 80, and as he was c from all pain, the paste was not repeated ; j succeeding night he became rather restless, t in the morning he felt very comfortable, ending several times during the day a small t-cup full of weak mutton broth ; and the lowing day, with the exception of slight usea and vomiting, the patient appearing ite convalescent, I took my leave, directing several days a steady perseverance in gruel, 3th, and tea. It may not be unnecessary to observe here— 11. That it was in the case of this patient, as ill as in most others 1 have visited, that no acuation from the bowels took place for three ys after the introduction of the Paste, occaming, however, not the slightest inconvenience distension of the abdomen or otherwise. 111. That a gentle and warm perspiration ually accompanies the use of the Paste. CASE 111. IJ. H., a female, aged 17, was attacked about i in the morning with Cholera, the more pronent symptoms of which were severe purging, eat thirst, the surface of the body rather cold, 16 cramps in the stomach and thighs, a small irregular pulse, and a dread of dying. In the evening, when I first saw her, the anodyne paste was applied by her mother ; she was soon released from the purging and cramps, and in about three hours, having fallen into a comfortable sleep, which continued six hours, she awoke with feelings of convalescence ; in four days, having used the paste each successive night, she may be said to have recovered ; but in the intermediate time she occasionally ex- Irienced slight nausea and vomiting. No idicine was taken by the stomach, nor any pport beyond tea, thin gruel, and cold water, eviously to the attack of Cholera she was in 3d health. CASE IV 13, R., a female, aged 21, who was attacked h Cholera about four in the afternoon, was iviously in good health — vomiting and retch, and cramps in the stomach and bowels, I intense thirst, with a slight blueness of the 11, were the chief symptoms. With a view relieve the pain and sickness, the mother gave her, without the slightest mitigation of suffering, from a quarter to half a pint of pure 17 landy. Between nine and ten that night I vited her ; the paste was soon applied, which gave ;r almost immediate relief, and she had a comrtable night ; in four days she was quite well, c paste having been continued every night, edicine was not taken by the stomach, nor any ing besides tea, cold water, & weak mutton broth. case v. M. D., aged thirty-eight, a widow with a large family, who had lately suffered great mental anxiety from the death of her husband, and laboured under violent purging and vomiting for three days. At ten in the morning, she sent for medical assistance, when she was apparently in a sinking state, with general coldness on the surface of the body, the muscles of the neck and head considerably affected with spasms or cramp, the pulse scarcely perceptible, varying from 90 to 100 ; a slight blue cast on the countenance, with an expression of great anxiety ; voice extremely weak, tongue thickly furred, but not cold ; Id the stomach so irritable, that the least quanf of fluid could not be retained. Her prosional attendant directed the paste, with ! efficacy of which I had previously made n acquainted, and calling upon her again about an hour and half, he found an in- c 18 crease in the warmth of the body, and also in the force of the pulse ; the spasms in the head and neck had ceased, but had attacked the lower extremities. He ordered a repetition of the paste, and gave her also a pill, consisting of one grain and half of opium and three grains of soap, which was soon rejected by the stomach. At eight, the same evening, my assistance was requested in conjunction with her medical attendant, when, having found the heat of the body considerable, the perspiration general, & the severe spasms in the lower extremities much abated, tea and thin gruel alone were directed during the night ; in the course of which, slight vomiting having returned at intervals and several watery evacuations from the bowels having taken place, the paste was repeated. Visiting her again at seven in the evening, we found that she had slept several times, and was much refreshed by it ; that her bowels had not been moved, and that she had taken nearly a pint of gruel ; pulse still feeble, and the tongue much furred ; on the following morning she was free from pain, and her countenance considerably improved, although in the night the vomiting returned — pulse 76. In the evening she was comfortable. The next morning, about four o'clock, hiccup came on and continued till 19 In, when it ceased upon taking a little mutton oth, which she enjoyed at intervals during the ty. In the evening, found her in a tranquil ite, and the succeeding morning, at ten, aprently convalescent — pulse 66, and steady.— a few days, by the additional aid of a teaoonful of port wine every hour or two during 3 day, and occasionally during the night, her alth and appetite were much restored.* I Soon after the first edition of this little work is sent to the press, the following case was mmunicated to me by an intelligent medical end of mine, at some distance from hence : A ntleman, between 50 & 60 years of age, was sudnly seized with violent Cholera. "1 found n," says my friend, "at eight in the morning, an agony of pain confined to the lower region the Hypogastrium, in great anxiety of mind, stlessness, and general distress over the whole me — every alteration of position was followed increased suffering, especially if he attempted c erect posture — pulse full at 80. Copious llt may be noticed that in the above five cases nausea and liting after the first day of the disease occasionally attended each ent; but I have little doubt, that the patients would have i harassed with a great increase of beth these distressing jttoins, had medicine, wine, spirituous or other liquors, been in into the stomach. I may here add, that in the event of sea or vomiting continuing, however trifling, till the fourth day, ill be advisable to administer a clyster consisting of half a pint rariH water or thin gruel; repeating it, if necessary, either to ive nausea or vomiting, or to procure au evacuation from the bowels. 20 evacuations from the bowels had produced but transient relief, and he was laboring under severe cramp, nausea and rigor, and complained of extreme burning pain in the whole course of the alimentary canal. Soon after my arrival, I exhibited your paste into the rectum — at ten o'clock the spasms and pain continuing, though with some abatement, I repeated the application, which in less than two hours gave material relief and comfort to the whole system. A profuse perspiration was followed by quiet and refreshing sleep during the remainder of the night. At ten the following morning, vomiting returned, and two copious evacuations from the bowels were passed. The suppository was again administered as on the preceding evening with equal success ; in less than an hour, my patient became tranquil and comfortable, and I left him three hours afterwards free from all Cholera symptoms. Pgave him not a particle of medicine, and his port consisted of tea, thin rice gruel, and toast it is unnecessary for me to say whether I Id have ventured to predict effects so conit and potent from the administration of this odyne Paste before the experiment. I felt a frcient temptation and excuse for trying it in acknowledged defeat of oilier attempts, and 21 the deplorable consequences to the afflicted. That the malady originates in the morbid influence of a peculiar atmosphere, the effect of which is promoted or resisted by the state of health, or particular habits of individuals, is now, I presume, sufficiently evident — its sudden appearance, rapid progress, and terrifying symptoms, have perplexed the learned and experienced, and the early fatal termination of life has scarcely left time to vary expedients and remedies. My mind suggested the remedy I have pointed out, because, in the shape administered, it seemed to me to possess all the powers of the opiate, divested of some qualities which operate injuriously in any other shape. The result I now lay before the public, without any other feeling than that of deep gratification from anticipating the saving of human life, and the diminution of human suffering. I cannot refrain from adding, that the anxiety which I felt on the approach of Cholera, from the accounts in Medical and other Reports of the fatal and irresistible nature of its attacks, has so much subsided by witnessing the effects of the Anodyne Paste, that I enter the chamber of a Cholera patient with no apprehension or solicitude beyond that which accompanies me to the bed-side of individuals under fever usually denominated 22 That my confidence may be justified by the experience of my Medical Brethren is my animating hope, and will prove my encouragement. I should not omit to remark, that in the fervour of zeal on the chief subject of solicitude, attention to subordinate, though highly important considerations, must not be forgotten. The exclusion from the stomach of every description of medicine, and of all vinous, spirituous, and fermenting liquors, of sugar, and every species of animal food, except beef tea, plain chicken broth, or weak mutton or veal broth, is indispensable until a week after the removal of the complaint ; during which period, as well as during the existonce of the disease, the diet should consist only of tea, water, toast and water, barley or rice water, thin gruel, whey, or milk taken cold or warm, agreeably to the palate of the individual — to which simple articles may be added, if required, oranges and ripe fruit, chewed in the mouth at any time, but not swallowed. A great attention to cleanliness, quietude in the sick chamber, unbroken by any thing but the encouragement of hope — friction with the hand only, or with the aid of a small quantity of pomatum or pork lard, or of common treacle, on any part of the body affected by pain or spasms, are all of them valuable auxiliaries in soothing and subduing the malady. 23 PRACTICAL. CAUTIONS AND ADMONITIONS. I. No disease demands greater circumspection than Cholera, nor requires more prompt measures either to prevent or cure it. 11. Whether the attack be violent or not, the individual should instantly be put to bed, Id as soon as convenient there should be a lali fire in the chamber (if practicable) and nstantly kept up as a chief means of inainining a proper circulation of air, which is of eat value to the sick and the attendants — but en in the absence of a fire, the chimney board ould be taken down — the evacuations of every nd be immediately removed from the room, c bed-curtains kept open, and no carpet ould be suffered to cover the floor. I 111. Sprinkling the bed-room occasionally with Id water during the day and night is highly sirable, and refreshing both to the sick and tendants ; and after each evacuation from the miach or bowels, a piece of old linen cloth, of own paper, or of cork, being burnt in the amber or passage adjoining, is preferable to s use of vinegar, camphor, tobacco, or pastiles, 24 which not unfrequently occasion giddiness and lead-ache. In case of a desire to sprinkle the torn or bed-cloths with chloride of lime or >da, a mixture, consisting of a table-spoon full ther of liquid chloride of lime or soda, and a wine quart of cold water, may be employed. IV. However great the thirst or retching, a small quantity only of liquids should be taken at Ie time, not exceeding a wine-glass full, which, wever, may often be repeated. IV. Fear should be resisted as much as possi-2, being one of the principle causes of keep* up or aggravating the disease. I VI. In cases where head-ache shall occur after d vomiting and the action of the bowels have arly or altogether subsided, four or six leeches ould be applied to the temples — a safe and esitial remedy, which the more affluent will feel lied upon to have in readiness for their own b, and for their poorer neighbours, when juired. EE r 11. As a means of avoiding Cholera, tempere in all things should be steadily kept in view, violent exercise most carefully avoided. PUBLISHED BY THE SAME AUTHOR. 1. On the Ventilation of Army Hospitals, 1798, Bvo. 2. A concise Treatise on the Progress of Medicine, since the year 1573, being the Subject of a Latin Speech, delivered in the Chapel of Gonville and Caius College, Cambridge, Bvo. 1804. 3. Animadversions on certain Cases of Consumption and Dropsy, treated by the Foxglove, 1807, Bvo. 4. General Directions for the recovery of Persons apparently Dead from Drowning, &c. 1808, 12mo. 5. Pharmacopoeia Valetudinarii Gippovicensis, edendam, curaverunt W. H. Williams, M. D. et A. Bartlett, Chir : 1814, 12mo. 6. Observations on Dr. Wilson's Tincture, the Eau Medicinale, and other pretended Specifics for Gout, 1818, 4 to. 7. On the Discovery and Efficacy of the Seeds of the Colchicum Autumnale, in Rheumatism and other painful Disorders, published in the London Medical Repository, vols. XIV. XV. and XVI. 1820, 1821. 8. A concise View of the History, Literature, &c. of Gonville and Caius College, Cambridge, with a View of the College, on a royal sheet, 1823. 9. A Spiritual and Natural Thermometer, on a Board, 4th Series, for 1832.