ON ASIATIC CHOLERA. T. W. CHEVALIER, Surgeon, TO HIS PATIENTS AND ACQUAINTANCE. PRINTED FOR THE AUTHOR, BY HOWLETT AND BRIMMER, 10, FRITH STREET, SOHO. 1831. INDEX. Page The Preventives ;•• 3 Cholera Contagious 5 Chloride of Lime 5 Fear, Effects of 5 Indispensable Precaution 5 Symptoms 6 Treatment 7 Precaution in using No. 3 8 Faintness 8 First Dose Rejected 8 Portable Vapour Bath (Note) 8 Remedies.... 10 Doubtful Case (Note) 10 First Draught n Antispasmodic Embrocation, No. 3 8 and 11 Eau de Cologne 11 (Note), 12 Remedies to be kept ready at Home 12 Oil of Turpentine 7 and Note ; 12 Mustard Poultice 13 Clyster , 3 and 13 Table of Doses : Sudden Remedies 14 Continued Remedies 14 List of Medicines for the After Treatment , 15 ON ASIATIC CHOLERA. T, W. CHEVALIER TO HIS PATIENTS AND ACQUAINTANCE. 1831. THE PREVENTIVES. The most important preservatives against the Asiatic Cholera are, in the first place, Regularity of the bowels; which should be moved at the same hour daily, by persevering solicitation ; or, if necessary, by means of one or more of the following pills taken at bed-time> and succeeded in case of their insufficiency by a clister of a pint of warm water, to be administered half an hour before the accustomed period of relief. R: Quininae Sulphatis, gr. xxiv. Pilulae Gambogiae comp. gr. xxxvi. Aquae q. s. Misce, et divide in " Pil. Aperient." xij. Take of Sulphate of Quinine, 24 grains ; Compound Gamboge Pill, 36 grains ; Water sufficient: Mix, and divide into twelve " Aperient Pills." The next indispensable precaution is, Regularity in our hours of repose at night ; and thirdly, the most rigid and uniform Temperance in every indulgence, but especially in diet, with Equanimity of mind, and extreme Cleanliness of every part of the body, of the house, and even the neighbourhood in which we reside. 4 Go to bed at night, and rise in the morning, at the same hours— lo to 11, p. M. and (vto 8, A. M, at the latest. Abstain from every thing which may have heretofore been found to disagree with the stomach or general health. The past experience of every individual is his best guide: he can have none more intelligible, none more safe. As a medical practitioner acquainted with the sight of a death-bed, and in whom his readers have been accustomed to place confidence, I say that I have never seen real Equanimity in the irreligious : while every past year of my professional life has only confirmed my conviction in the fact, which my own personal experience has fully and undeniably proved, that plain true honesty of man's heart (be he who he may, or what he may), with prayer to God, in the name of his Son Jesus Christ, can never fail to procure it. Ordinary cleanliness is insufficient. I recommend the following Embrocation ; with which the whole body should be sponged at least once every day. It more than cleanses ; it accelerates the change of the cuticle, or outermost skin, for a new one; and it has an antiseptic or anti-contagious power, through the gradual evolution of its Chlorine Gas, from the dilution, and subsequent admixture of the two acids of which it is composed. I consider it a more eligible Embrocation than any solution of the Chlorides of Lime or Soda, and it may be used either cold or warm. R: Acidi Muriatici concentr. f. 3«iij. Aquae fontis f. sj. xx. Misce, et postea adde Acidi Nitrici concentr. f. 5. ij. Aquae Lavendulae opt. aut Aq. fontis f. iijfi. Fiat Embrocatio toto corpori applicanda quotidie, semel aut frequentius, salute durante. Take of Concentrated Muriatic Acid, 3 tea-spoonful 3; Water, 10 wine-glassfuls; Mix, and afterwards add Concentrated Nitric Acid, 2 tea-spoonfuls; Lavender Water, or Water, 2| wine-glassfuls : To compose an Embrocation, with which the whole body should be sponged once a day, or oftener, during health. 5 Having no shadow of doubt on my mind that the Asiatic Cholera is propagated chiefly from persons already suffering- under the disease, and by means of A contagion evolved from their bodies, which is capable of importation through the air, and especially in the confined air of clothes or packages; while I also suspect that it is a disease originating within the bowels of the earth, because it travels in the teeth of the hurricane and the tradewinds; I will not encourage any one in the idea that the precautions I have named, or any others, are an infallible barrier to its assault. When the disease has actually appeared, the saturated Solutions of Chloride of Lime or Soda, exposed in saucers about our houses, are, however, well ascertained to be the best means of disinfecting them : but these preparations are so nauseous that I do not recommend their use as a preventive before-hand. Again, in reference to the various opinions concerning the influence of Fear in predisposing the human constitution to take the disease, I would remark that it certainly has this effect; but on the other hand (and it is of all importance), I maintain that they know but little of the human heart, or of the natural history of pestilence, who have not observed that the very best way of parrying the terror of its approach is to describe it before-hand in all its horrors ; while there is yet time to recover from the first qualms which such descriptions produce, and to attain to that comparative resignation or apathy, one or other of which, according to the condition of every man's conscience, will infallibly succeed such qualms, and place him in a moral position the most remote from a Panic, and therefore the best calculated to resist infection. Indispensable Precaution. Above all things, it is indispensable to keep in continual and instant readiness the means of procuring a large fire in the bed-room of every individual. A fire well laid with plenty of wood may be instantaneously inflamed with a moderate quantity (half a wine-glassful) of the Oil of Turpentine (No. 5), and, if necessary, revived 6 by the same. Should the Asiatic Cholera arrive in London, I repeat that many lives will depend upon implicit obedience to this precaution. A supply of artificial heat is indispensable in the treatment. When a person is attacked with Asiatic Cholera, the first symptoms are as follow. They are all likely to be experienced in its onset ; but not always in the same order; for this terrible malady has in some instances produced nothing more than Languor, Retching, a Spasm, and then Death ; and there have been cases in which it has extinguished life instantaneously. " A notable prostration of the whole powers of life, says Sir Gilbert Blanc in his invaluable ' Warning to the British Public,' pervades every stage of this disease." THE SYMPTOMS. Awful Languor, Horror, and Prostration of strength throughout the whole body, most apparent between the paroxysms of spasm. The countenance as when "struck with death." The hands and feet alarmingly damp and cold ; altered sooner or later in their hue, towards a purple or livid complexion; and shrunk in outline, as from severe cold. Purging, more or less. Retching only, or with Hiccup. Vomiting (which if it be yellow and bitter, augurs favorably). Cramps, which generally begin in the extremities, and gradually extend themselves towards the heart. Feebleness and sinking of the Pulse. Vertigo, or Swimming of the head. These all becoming worse, with pain about the heart, and intolerable uneasiness, until the very near approach of death. I might add other symptoms, but it is best for my patients to have respect only to these as I have named them. Many may imagine themselves to be attacked with this Cholera, when they are not. None can mistake the disease when it has actually seized them : it is so new, imposing, deadly, overwhelming, and terrible. 7 I have been both surprised and grieved to see that the Directions for Treatment which have as yet fallen under my notice (with but one or two exceptions) are either pusillanimous ; or very ill adapted to the understanding, and therefore difficult of practice at the hands of unprofessional persons. Surely in such a disease our directions should be such that he who runs may read, and we ought to have recourse at once to the most powerful and infallible remedies that can possibly be devised, in the right kind, and with well approved safety. I have tried all the following upon my ovvn person. I have proved that no adult can suffer materially from any one of them (whether he have the Asiatic Cholera or not); and why may they not be taken upon its onset? or why have recourse to the milk-and-water medicines so generally recommended, when these are safe to use, and indisputably the most strenuous application of the principles of cure universally accredited amongst us 1 THE TREATMENT. It is right and truly important (where and when practicable) that the patient be placed as soon as possible in a warm bed, and plentifully supplied with artificial heat, such as hot clothes, bottles of hot water or bags of heated sand ; but all this takes time, and it is idle to prescribe it as the first means to be employed. The moment an adult is convinced that he is attacked with Asiatic Cholera, let him take the Pill and Draught, Nos. 1 and 2, and as soon as possible apply to his extremities (and to other parts,, or to the whole surface of his body, if these be also affected with that unnatural damp chill which is essential to the Disease) the Oil of Turpentine,* No. 5. This last remedy cannot be carried about the persons of those whose business is on foot; Nos. 1, 2, 3, and 4, should however be ALWAYS IN the pocket, or UNDER THE PILLOW OF EVERY INDIVIDUAL. For, * Care is requisite at night, lest the Oil of Turpentine get in- flamed by the candle being held too near the Patient. 8 No. 3 is a powerful Embrocation which is to be rubbed in the very first instance upon the right side of the chest, and over the pit of the stomach. It may not indeed be employed without attention to the following caution, but if only this caution be observed, it cannot possibly do harm, and it is the most efficacious remedy for the disease that the world knows of : it should therefore be constantly carried upon the person (as I have said with Nos. 1, 2, and 4), all properly labelled. Precaution in using No. 3. If, after applying this most powerful antispasmodic, No. 3, for some minutes, or for any time longer or shorter, the patient find his eyesight uncomfortable, or if a second person observe that his pupils are enlarged and fixed, it should be wiped off, and the skin washed with soap and hot water; and again, the application of No. 3 should in all cases be discontinued the instant that it begins decidedly to relieve the uneasiness, pain, or retching. On the other hand, in severer cases it may be applied with advantage not merely to the right side and pit of the stomach, but also to other parts if severely cramped. If upon the use of the above three or four remedies, the patient find himself (in the first place) growing faint, let him sip from his bottle of Eau de Cologne (No. 4), or of hot brandy and water, if this be within his reach, and the other not so. But (on the other hand) should the disease he advancing, let him be bold in the repeated use of the dark-coloured Embrocation, No. 3 ; and after a quarter of an hour (from the first taking them), let him have recourse to the pill and draught (Nos. 1 and 2) a second time. More especially if Nos. 1 and 2 should have been rejected the first time of swallowing them, let the Embrocation, No. 3, be next employed, and as soon as it affords any relief, repeat Nos. 1 and 2. t Meanwhile the Mustard Poultices (No. 6), and, if we have one in our possession, the Vapour Bath* will have • The cheapest Portable Vapour Baths are to be obtained for two or three guineas at Mr. Thomas Swift's, No. 125, Minories ; 9 been prepared for use; the fire will have burned up, the chamber warmed ; some strong broth, or other liquid nourishment got ready ; and by most persons the medical attendant will have been sent for. Without fail, LET EVERY EVACUATION, WHETHER BY STOOL, OR vomit, or urine (if the patient should be happy enough to pass any), be preserved for his inspection ! I therefore proceed to enumerate . those extemporaneous remedies with which every individual of adult age should be immediately provided in such quantities as 1 shall mark, and keep them, as far as possible, constantly at hand : or at all costs, let every house be provided against the sudden and simultaneous seizure of three persons ; for this would not be a singular instance in the history of the complaint. I subjoin two tables of the Doses proportionate to different aghs; namely, one which is applicable to all such medicines as are intended to produce a sudden effect, and not to be repeated without urgent necessity ; and another for such as are proper to be administered for a continuance.* These two tables apply to all medicines with the single exception of the preparations of Mercury, which are to be given to younger persons in double the doses therein indicated. (N. B. To exceed the limits prescribed in these tables, in the use of Opium, is very dangerous.) I shall conclude with a list of the drugs likely to be required for the later stages of the disease. the best and most commodious at Mr. Green's, No. 40, Great Marl- borough Street, for ten guineas. It is only requisite that the pa- tient be seated in a tent, which includes the whole body except the head, and supplied with abundance of steam (by means of a tube) from the spout of a boiling tea-kettle. * All and every one of the medicines named in this paper will keep for an unlimited period. 10 FOUR REMEDIES ALWAYS TO BE CARRIED ON THE PERSON. No. I.* ft: Hydrarg. Submur. gr. vj. Pulv. Opii levig. gr. 1?. Mucilag. Acacias q. s. Fiat Pilula primo assultu Choleric sumenda. Habeat vj. Take of Calomel, 6 grains ; Powdered Opium, | grain ; Mucilage of Gum Arabic, enough: To make the Pill which is to be taken in the first commencement of Cholera. — Ask for 6. No. 2 R: K.Opii,! m. xx. JEtheris Rectify TO. xxx Eau tie Cologne,^ f. 3. ij. AquSe fontis, f. 3. v. Misce. Fiat Haustus primo assultti Cholera Asiaticce sumendus. Habeat ij. * If any patient be in doubt whether he really have the Asiatic Cholera, let him content himself with taking this pill, and wait half an hour for more decisive symptoms, or for the arrival of his medical adviser. It is the best medicine for all such attacks as are likely to be mistaken for the pestilence in question. f Laudanum is a combination of Opium with Spirit of Wine. Opium is a natural compound of the purely caltnant or antispasmodic principle called Morphium, with several stimu- lants ; — precisely such a combination of stimulants with calmants lias now been proved by the experience of Asia and Europe the most efficacious remedial principle in the treatment of the Cholera. It is therefore better than the purely calmant Morphium, and never to be dispensed with in the exotic disease. Of preparations of Mor- phium, however, the best by far is the Liquor Morphia Alkalinus of the same strength as Laudanum, as invented and prepared by Morson, 19, Southampton Row, Bloomsbury ; and there maybe cases in which it shall pr,ove advisable to combine this valuable preparation with other stimulants than those with which it (the Morphium) is found combined in the poppy. 11 Take of Laudanum,! 20 drops; Rectified iEther,t half a tea-spoonful Eau de Cologne,^ 2 tea-spoonfuls; Spring Water, 5 tea-spoonfuls: Mix. To compose the Draught for the commencement of Asiatic Cholera. Procure two. No. 3. R: Liquoris Belladonnse* Battley, f. 3.J. Liquoris Ammoniac, f. 3. vij. Misce. Fiat Embrocatio primo assultu. Cholerse Asiaticee regionibus Epigastrico, et Hepatico infricienda donee nausea, et dolores aut spasroi membrorum mitigentur. Take of Battley's Liquor Belladonna* 1 tea-spoonful ; Liquor Ammonite, 7 tea-spoonfuls : Mix. To compose an Embrocation, which is to be rubbed upon the right side and pit of the stomach till the Retching or Heartburn and Cramp are mitigated — in the commencement of Asiatic Cholera. *y* See the Precaution, page 8. I JEther is not like Ammonia, neutralizable by the contents of the bowels. It much more certainly pervades and stimulates by its sudden influence the whole of the body, even to the fingers and toes ; and it is more readily retained on the stomach. § Eau de Cologne is often retained on the stomach (in cases of Nausea, Retching, Sea-sickness, &c.) when brandy and every other spirit is rejected. It is incomparably the best Alcoholic stimulant in our possession ; and it contains an abundance of the most fragrant and grateful of those empyrenmatic essential oils so much vaunted of (and not without good reason) in the treatment of Cholera. The genuine I believe is only to bo purchased in England of Messrs. Gattie and Peirce, No. 57, New Bond Street, at £1, I*. the box, or five shillings the bottle. The best sub- stitute is twice as much whiskey, gin, or brandy, with 15 drops of oil of peppermint. * Battley's new preparation of Belladonna is by far the best thing for our present purpose of arresting the spasms, and irrita- bility of the epigastric bowels. It is to be obtained at his shop in Fore Street, Cripplegate. The substitute for it is one drachm and a half of the common Extract of Belladonna to the seven of Liq. Ammoniac: or in any case, that quantity of extract mixed with so much water, and used warm. But if it cannot be obtained, then use Eau de Cologne, or pure Laudanum, likewise warmed in a table-spoon over the candle ; and let this last be rubbed over the whole of the belly.— N. B. I would strongly advise that 12 No. 4. 1 Habeat Eau de Cologne, f. £. j- Procure of Eau de Cologne, 1 fluid ounce. I prescribe this to be carried on the person in case of the sudden faintness, and inability to articulate a single sentence, which is sometimes one of the very first effects of Cholera. It should be diluted with water, if any be within reach. It is far more likely to remain on the stomach than any other spirit, and in case of faintness, or swimming of the head, it should be sipped every few minutes. See the Note, page 11. REMEDIES TO BE KEPT READY AT HOME. No. 5. Habeat Olei Terebinthinae Ilect. O. ij. Procure of Rectified Oil of Turpentine, 2 pints. This, which is the cheapest and best of external stimulants, I once, as an experiment, applied to the whole of my body during health, and constantly prescribe for burns, however extensive. It should be kept within arms-length of the bedside, or in the carriage. No. 6 R: Pulv. Sem. Sinapis; Setn. Lini pulv. aa. Tbfi. Aceti Calidi q. s. Misce. Ut fiat " Cataplasma Sinapis:'" Habeat Pulv. sing. ft)ij. Et Aceti, O. ij. the bottle containing this most effectual of our remedies (though indeed it is already distinguishable by its Ammoniacal Smell) should be covered with linen, and have Poison written upon it; that it may not by possibility be swallowed, even in the dark, instead of No. lor 2. Such a mistake would almost infallibly prove fatal. 13 Take of Common Mustard Powder, Linseed Meal, of each |it>, Hot Vinegar, sufficient. Mix. To make the M ustard Poultice : Procure of each Powder, 2f15. And of Vinegar, 2 pints. This is the severest remedy named in the present paper; and far from being the most important, since the turpentine, being more universally applied to the body, is more likely to restore its warmth and vigor, and to stimulate the kidneys to their secretion of urine. The Mustard Poultice should, however, be kept in readiness for extemporaneous mixture, if required by the medical attendant ; and when asked for, it should be made as stiff a paste as possible. No. 7. Habeat Extr. Colocynth. comp. 3. ij Procure of Compound Extract of Colocynth, 2 drachms. I prescribe two drachms of compound Extract of Colocynth, not merely as an invaluable purgative to keep in the house ; but more especially because one of the most efficacious Clysters is extemporaneously prepared by dissolving a scruple of it, or more, in a pint of warm water or thin gruel. If it be not at hand, use a strong ley of common yellow soap, upon occasion, for the same purpose. Every one should be provided with a bladder and clyster-pipe, or a pewter clystersyringe. 62, TORRINGTON SQUARE, LONDON, Nov. Uth, 1831. 14 I. TABLE OF DOSES Proportionate to different Ages, and applicable to SUDDEN REMEDIES. Age. Dose. Above 21 years 1 — 14 — i 9 * ¦ 3 i _____ i i 1 t At 2 months, and under . r V to -g ff N. B. At any age not exceeding nine years, it is desirable that the essential ingredients of internal medicines should be mixed up in due proportion with syrup instead of water ; and the whole draught not to exceed half a fluid ounce, or one table-spoonful. Of the external remedies prescribed in this paper, none need be diluted even for infants. II. TABLE OF DOSES Proportionate to different Ages, and applicable to MEDICINES FOR CONTINUED USE. Age. Dose. Frequency. Under 1 month .... 0 ... Every 4th hour* 3 months . . . . . . -\ 9 . . . . . . > Every 6th hour. •"¦' • • • • 6 • • 4 years . < . . \ . . j 9 £ . . V Every Bth hour. 14 £ . . > . 1 ( Every 12th hour * * (to every Bth. 15 111. LIST OF MEDICINES Probably desirable in the later stages of the disease Rectified iEther, \\ fluid ounces. Liquor Aramoniae, 1 fluid ounce. Laudanum, 2 fluid ounces. Calomel, two drachms. Antimonial Powder, one drachm. Tartar Emetic, ten grains. Powdered Ipecacuanah, half an ounce. Powdered Rhubarb, two ounces; or, Battley's Liquor Rhei, one fluid ounce. Powdered Senna, two ounces; or, Battley's Liquor Senna, one ounce. Castor Oil,, 8 fluid ounces. Sulphate of Quinine, half an ounce. Oxley's Essence of Ginger, 2 fluid ounces; or, Powdered Ginger, 4 ounces. Camphor, I ounce. Saturated Solution of Chloride of Lime, 2 pints. FINIS. Howlett and BiUMMEί,Printers, 10, Frith Street, Soko, London