PRACTICAL REMARKS ON THE PREDISPOSING CAUSES AND TREATMENT OP THE ASIATIC CHOLEHA; 

/ BY Fred. J. MOSBROVE, M.E.C.8., Eng. ASSIST. SVIKJIMI.N, lIOMHAY ARJIV. AUTHOR UK A PKACTICAL TREATISE ON CONGESTION AND INACTIVITY OF THE LIVER. 

My Father, if lha Prophet had bid theedo somo great tiling, wouldcst tliou not have clour it :¦ how much rather then, when ho snith to tiice. Wash, and be ¦ lean? Jftlftft^Uk . BOMBAY: ;,^ . , '?•.? •. - J AMERICAN MISSION PRESS.". T. GRAHAM, PRINTER! 



vJC>B 

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{ilmno- 1026g 

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Sir JAMSETJEE JEEJEEBHOV, Knight 

Sir, — Although but slightly acquainted with you, otherwise han as the munificent benefactor of the Native Inhabitants of his Presidency, I feel that no apology can be required for dedicating to the Founder of the Magnificent Hospital which bears rour name and which will be to the latest posterity a memorial of your deeds of Charity, a Worjt, in which it is attempted to hew, that a remedy for Cholera has been found which is at the oor of the meanest of those, to whose benefit your life has been evoted. 

I have the honor to be Sir, 

Your most obedient Servant, 

F. J. MOSGROVE, 

Assistant Surgeon. 





PREAFCE 

The publication of a few plain remarks on the nature and treatment of Cholera, and the precautionary and remedial measures to be adopted by those who may be exposed to the influence o this fearful malady, has long appeared a desidera turn. I have in consequence been induced to la; these pages before the public in the hope that the remarks which they contain-;— inasmuch as they are the result of actual practical experience and no nerely theoretical views — may be found in some degree useful to the community at large. 

P. J. MOSGROVE. 







THE ASIATIC CHOLERA. 

Many and various are the opinions entertainec as to the nature and cause of Spasmodic Cholera but it is not my intention in the following pages to endeavour to analyze the different theories that have )een adduced ; but as briefly and as clearly as pos sible, to state facts, and those in such a manne as will, I trust, be comprehended by almost every eader. 

The actual immediate exciting cause of Cholera is involved in so dense a cloud of mystery that it will be useless here, to offer any opinion on the subect; it must suffice us to know, that it is an impal>able influence producing the direst effects on the mman frame, but it is well perhaps that we should emain in this ignorance, for whatever may be this C»us influence, it is manifestly beyond the range man science, or skill, to remedy it. 





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desire more expecially to draw the attention of my readers ; as without that be present, the exciting cause will very generally be productive of but little mischief, this will be better understood when we consider that in any place where Cholera is raging with virulence, a small proportion only of the inhabitants are seized with the complaint; now it is manifest that all must alike in the several localities be subjected to the noxious influence, and the fact hat only a proportion are afflicted with the malady, evidences that some persons possess the power of resisting the exciting cause of the disease ; whilst again it is manifest that this power is not permanent, but is dependent on a certain healthy condition of the body, from the fact that rna'oy who have more than once escaped, whilst others around them have been stricken, at hist are obliged to succumb 

In order that I may be followed throughout, b) the non-professional reader, I will endeavour com prehensively to explain as much of (he principle by which the living body is governed, as is neces sary for the further elucidation of my subject; am here I cannot but express my regret that it so com monly happens that individuals possessing in every other respect high mental qualifications, should pos sess so little knowledge of the actions and median ism of the human frame. How constantly do we meet with persons of great acquirements and possessed of abilities which render them the adrairalion 



9 

of their circle, who yet possess so little knowledge of the living principle by which the human jody is governed, that they seem scarcely aware hey have a body and nervous system subject to naural laws, which cannot be systematically outraged vithout incurring severe penalties. In how strange a light does this present many of our learned mem erudite in thousands of things of but little use, but quite in the dark with regard to a few physiological facts on which the most important of secular inerests — that of health, — depends. 

It is an old saying that " before the age of forty a man must be either a fool or a physician;" that is' must (if w,ise at all,) have been forced, to acquire some knowledge of medicine; but unluckily the fact i 3 that many men the reverse of fools never become aware that they have a constitutional system liable to be deranged, till they are struck down by the consequences of their imprudence. The adage should be improved — it is not a knowledge of medicine which is wanted, but the conditions nepessary for preserving health^ a science involving lothing beyond a few slight rules for personal gov eminent. But when shall we see even this sligh knowledge universally communicated. Would tha ye could sec the day when the science of Physio ogy should form a part of the educational course of our youth. Certain lam that nothing would so far tend to annihilate empiricism and conduce to the happiness of our lives. In this country especialy, 



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where the exciting causes of disease arc so numerous, and where many are continually so placed as to be out of the reach of medical assistance, it )ehovcs every one to know, at least, the peculiariies of their own constitutions as well as the action of some of our most common medicines. It is in consequence of individuals not knowing themselves, hat very much of the sickness and disease may )e attributed, to which Europeans in this country are especially liable. 

The human frame, from the hour of its first enrance into the world until the period when the great enemy death asserts the victory, is in a coninued state of contest; it is surrounded by many exciting causes of disease, and were it not for a lealthy power of resistance possessed by the body, t is not possible we could remain in health a single lour. Predisposition to disease consists in a want or diminution of the necessary power of resistance, and an individual's constitution is said to be strong, or weak, according to the degree" in which this )ower is possessed. This power of resistance defends mainly on a balance being kept up between the mental and nervous energy, and the physical iower of the body. 

The brain and nervous system may be likened to a treasury on which the mental energy and physical frame arc entitled to draw equally, for whatever nervous support they may require to carry on the various functions in the animal economy. The 



11 

power of supplying the demand being limited, it necessarily occurs that, if from any cause, disorder of the brain be set up, or one function draws more largely on the treasury than it is fairly entitled to ; the supply given to the other must be diminished 5 hereby causing a loss of balance between the two brces. Thus is it, that so intimate a connexion exists between the mind and body. If the powers of the mind be exercised in excess, the functions of he bo"dy become impaired ; and if there be any deangement of the bodily organs, the vigour and energy of the mind become more or less diminshed. 

A healthy power of resistance to disease is thus manifested by a " mens sana in corpore sano," neither the mental or physical energies being in the ascendant but each so balanced as to be enabled accurately to carry on their respective functions. Any circumstance whatever, that may tend to disturb this balance by causing derangement of the body or by morbidly affecting the mind, immediately lowers the nervous energy or power of resisance to disease, and renders the individual exposed o any injurious influences with which he may come n contact. The liability to disease occurring, nanifestly depends on the degree in which the )o\ver of resistance is diminished as well as on the power and extent of the exciting cause. General or local weakness, or predisposition to disease, may be either hereditary or occasioned by adventitious 



12 

or accidental circumstances. Hereditary predisposition to disease is occasioned by the well known natural law, that disease or weakness of the system generally, or of any parts in particular, is more or less communicated from the parent to the offspring ; thus is it that we see in some families particular diseases handed down from generation to genera- 

The ordinary predisposing causes of this disease amongst the higher classes in this country are Mental or Bodily Fatigue, Fear, Anxiety of .mind, — and Intemperance in eating or drinking ; these, especially the three former, have invariably been bund the most powerful aids to the noxious niluenec, — whatever that may be, — which inluccs Cholera. My own Experience enables nc to rccal to mind, very many instances of hose who during the prevalence of the disease verc in a constant state of terror and dread, lest hey should be the next to suffer; in almost every nstance, their very cowardice occasioned the efect which they so much feared. Fatigue also has >een found a very fertile source of predisposition to Cholera; how frequently have I seen persons apmrently in the enjoyment of robust health, who lave been enabled for long to resist the active foe, until at last unmindful of all on which their safety epended or carried away by some temporary exilement in business, have passed a whole day in ctive mental and bodily labour, forgetful of food 



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mici rcstj nnci on returning iionic nave iounci incir up* petite for food gone, — prostrated in mind and body, they have retired to rest and become an easy prey to the destroyer. 

The fearful ravages made by the Cholera in H. \I. 86th Regiment at Kurracheein 1845, was, in my opinion very greatly owing to the fact of that fine legiment's having immediately previous arrived at hat station, after several weeks of tiring and harassng marches ; during the period of marching the contant excitement tends greatly to prevent disease, )ut it is on the arrival of the Regiment in quarters, when the excitement has ceased, and has been folowed by more or less depression, that the Military Surgeon knows so well that he must expect numerous applicants for admission into the Hospital. In addition to this predisposing cause, it is evident from he general virulence of the disease at that time, that he immediate exciting cause of Cholera was especially virulent. 

I would here remark on the distinction betwee he exciting and the predisposing causes of Cho era ; neither Fear — Fatigue — Intemperance, — o Anxiety of mmd — would of themselves occasion the disease, else instead of our occasionally only witnessing its ravages, it would unhappily be a prevalent as poverty and human frailty amongs us. Thus is it manifested that the disease immediately owes its origin to a specific exciting cause, what that be — as I have before remarked — has sur- 

2 



14 

passed the abilities of the most learned men to discover. 

But although we are not exactly acquainted vith this exciting cause, we know full well that its effects are immediately on the nervous system, occasioning prostration of the vital powers ; thus is it hat depression of the mind is a far more powerful >redisposing cause of the disease, than derangement of the body. 

It is very commonly the practice immediately on he alarm of Cholera being sounded, that many )ersons are especially careful as to their food, magining that as the symptoms of Cholera so cerainly manifest derangement of the stomach and >owels, that care only is to be taken regarding whatever immediately affects those parts, whereas I believe it would be far better for each one, to continue to follow his usual course of diet, provided only it be such as has evidently been conducive to lis health — rather than to be constantly reminded o«f the impending danger by the deprivation of some slight and perhaps harmless and accustomed enoyment. 

The immediate effect of the exciting cause of Cholera — as also of every other disease — depends on the state of the individual's constitutional powers at the period of the attack. In some cases, where the whole nervous and physical powers have previously been greatly depressed, the rapidity with which the disease advances is so great that the patient 



15 

.appears at once stricken by death. Other cases again are frequently met with during the prevalence of the disease, where the power of resistance is somewhat stronger; and here, although the malady marches with rapid strides, the attentive observer is nevertheless enabled to discover a line of demarcation between each of its stages. And again, in other cases, where the predisposition to disease has been but slight, the several stages, are clearly defined, and in each it can be seen how the healing power of nature is rallying her forces to shake off the attack. 

I have before mentioned that the first effect of the exciting cause of Cholera is a peculiar depression of the nervous system rendering the circulation of the blood languid, and thereby impairing the action of each organ of the body. The secreting organs especially sutler, as a proper supply of nervous energy, as well as a staled quantity of blood circulating through them, is indispensably necessary for the performance of their functions, and in proportion as either of these requisites be diminished, in such a degree will the functions of the parts become impaired. 

The skin or surface of the body appears more especially acted on by the Choleric influence, its blood vessels become contracted and thereby a large proportion of the circulating fluid is thrown back on the Heart, Liver, Kidneys, Stomach, Bowels, and 



16 

emedies be not adopted, this derangement rapidy increases, until the circulation in tho skin ap>arcntly ceases altogether, and the blood is thrown nto the centre of the body, which occasions the leart and large vessels to become so distended as obe almost incapable of acting. In this state do ye find the patient in the last stage of Cholera — that of collapse. 

I have before mentioned that there are under the generality of circumstances distinct stages in the advance of the disease on an individual, and it becomes now necessary to point out the symptoms which indicate these stages, and the remedies which have found most beneficial in the treatment of 

I In the Ist cv most insidious approach of the disase, I have noticed the following Symptoms : 

LA peculiar';/ s (range pricking and throbbing sensanin the hands and feet. Nausea, disinclination for food, and a sense of weight and uneasiness at the stomach. Slight diarrhoea, languor and head- 

The former of these symptoms, as far as I have )een able to ascertain, has never been noticed by any writer on the subject of Cholera, and yet in ;i cry large number of cases where I have had the opportunity of making enquiries subsequent to the recovery of persons from a severe attack of the disease, I have invariably ascertained, on drawing attention to the subject, that the tingling or (as it has 



17 

often been described to. me) creeping sensation in he extremities has invariably preceded the more ormidablc symptoms of the disease. If these indications are attended to and recourse had to the remedies which I shall particularize, the disease may, in almost every instance, speedily be put a 

Treatment. Abstraction of blood from the arm to the extent of six or eight ounces, is here eminently )eneficial; its effect is speedily manifested by a reief in all the symptoms. 

A stimulating aromatic mixture* should be taken at intervals of two hours, accompanied by a dose of Calomel* until the uneasiness in the stomach and bowels has subsided, when a mild aperient draught* should be administered for the purpose of removing any acrid secretions which may. have become collected in the Intestines. 

Amongst the native population these the first in ications of Cholera are scarcely ever attended to and consequently the Surgeon seldom sees a pa ient until the disease has advanced to the seconc tage, but I would earnestly entreat every one who may experience these symptoms immediately to eek medical aid, or if that be not procurable, to have ecourse to the remedies which I mention. If these le first symptoms be disregarded, as is too freuently the case, either from the individual not be- 

* See Appendix. 

2* 



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ng aware of their character, or from that peculiar neonsistency in our nature which induces many nen — even when in the midst of disease and death — o imagine that they will escape, and to shut -their eyes to the danger, until the disease has made such advances as to speak in too plain terms to allow any one to disregard it, — in either case the disease rapidly gains ground, and we sec nature endeavourng to relieve the congestion of the internal organs >y constant vomiting and copious and frequent evacuations from the bowels, These symptoms are usually considered as those only to be combated, and the remedies generally prescribed are intended chiefly to put a stop to these evacuations, as if they were the disease. Whereas they are merely the efect of the internal congestion, and plainly indicate hat nature is endeavouring to relieve the excessive "ullness of the blood vessels by allowing the more luid part of the blood to exude from their coats. It nust always be borne in mind that these dangerous evidences of the disease are only symptoms, and not he disease itself; in the same way that if any acrid substance be conveyed into the stomach and bowels, and vomiting and purging be occasioned, it would :>e manifestly absurd to endeavour to put a stop to he vomiting and purging whilst the acrid matter was permitted to remain. It has fallen to my lot to see several hundred cases of Asiatic Cholera, and [ am fully convinced that if remedies were employed, having for their object the removal of that state 



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of the system which is the cause of the vomiting and purging, much more success would attend the efforts of medical men. 

I have spoken of the healing power of nature, as manifested even in these formidable symptoms; this may appear strange to the non-professional reader, jut it is nevertheless true, and the same healing )ower is manifested under other circumstances, which at first sight seem equally strange ; for instance, what is the cause of the nausea or vomiting which follows the administration of any irritating natter into the stomach ? Nothing but an effort on he part of the stomach to reject the irritating mater, feeling it to be injurious. Again, if an irritating substance be conveyed into the bowels, increased mucous secretion and purging is occasioned, each symptom being indicative of the effort which nature s making to get rid of that which is injurious, each effort being in proportion to the degree and extent of the exciting cause. The effects of an emetic or >urgative dose is a simple illustration of this action. 

We will now proceed to advert to the second stage of Cholera. 

It is in this stage that the medical attendant most frequently first sees his patient. 

Symptoms. — Constant vomiting — frequent evacuations, of the characteristic rice-water-appearance, great prostration of strength, a sensation of extreme weight at the pit of the stomach, intense thirst, and occasionally cramp in the extremities, are the most 



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common indications of the' second stage of the disease. 

Treatment. — In considering the remedies to be adopted in this state of the malady, I must beg the calm attention of my readers. lam fully aware that I have much of prejudice to contend with, bu so fully satisfied am I of the success that has at tended, and that will result from, the adoption of my ilan, that I most earnestly exhort my professiona brethren not to condemn it because so totally op josed-to all previous modes of treatment, withou giving it a fair trial ; certain am I that one case will be, sufficient 1o convince any one, who is) will ng to be convinced — of the superiority of the treat nent which I recommend over any that has hithertt >een adopted in this country. The plan I have mrsued ha 3 been to gratify fully the patient's de sire for fluid, by giving unremittingly full draughts of water as cold as can be procured. 

I am fully aware that the generality of Surgeon n India are impressed with the idea that cok water increases the vomiting, and the answer ', lave received from several to whom I have men tioned my plan of treatment, has in purport beei the same. " I have often longed to gratify the pa ient's desire for water, but have been afraid to do so, as water appears to increase the vomiting." 

It is true such is apparently the case at first, as the stomach is in so irritable a state as to be unable 



21 

tion of the water be persisted in, a diametrically opposite effect is produced. The vomiting and purging cease, and the thirst and pains subside. In addition to 'the cold water, I have usually given to adults a full dose of Calomel (grs. 20), and to a child half that quantity, immediately the vomiting somewhat subsides. Three years have now elapsed since I first promulgated in India through f Bombay papers, the success which had attendthe administration of cold water in cases of Cholera, when that disease was prevalent in England ; since that period I have received sufficient testimony both from the result of my own practice, as well as from the experience of others, to convince me that if my plan be only generally tried, the most beneficial consequences will result. 

/ It has long been a matter of surprise to me, not merely that any should oppose the administration of cold water, but that it has not long ere this taken its place, as the first and most powerful remedial agent. It is the remedy which nature dictates, and which nature calls for. If any intelligent Physician were asked what would be his mode of treating a disease, the character and symptoms of whioh were new to him, the reply undoubtedly would be, (l to watch carefully what nature was doing to remove the disease, and to endeavour by remedial measures to assist her in the attainment of that object." But what does the history of Cholera to>-|/->li no ? TUiot in tJiio /Konoisa flia offVivfo ,-\f n o 1111 11 r« it.cmi us , .Liiai in 1114.S uiseaso mv eiiuris 01 iKuim. 



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mve been disregarded, she has called with a voice, one would have supposed loud enough to arouse the least observant practitioner, but without avail ; nstead of her dictates being followed, human reason has sat in judgment on the indication nature las given, and the constant and urgent cry for oater, water, has been disregarded^ 

One of the most talented Physicians of the present day, in a valuable work published a few years since,* has expressed himself so strongly on the advisability of being guided by the feelings of the jatient that I cannot refrain from copying so much is> bears on the present subject. 

"In the majority of instances of actual illness, irovided the real feeling's of the patient can be ascertained, his desires as to food and drink may safey be complied with. — Whatever be the physical •auses of the relation (and they are yet beyond our •csearch,) the stomach itself is the best expounder >f the general and more urgent wants of the system n this particular. But undoubtedly much care is leedful that we be not deceived as to the state )f the appetites, by what is merely habit or wrong mpression on the part of the patient, or the effect )f the solicitation of others. With such precau* tions, however, which every physician who can take -schooling from experience will employ, the stomach of the patient becomes a valuable guide, whether it dictates abstinence from, or a recurrence to, food, 

1 * Dr. Holland's Medical Notes and Reflections. 



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whether much or little in quantity — whether what s solid or liquid, whether much drink or little, whether things warm or cold, whether sweet, acid, or saline, whether bland or stimulating to the taste. t is a part of the provision for cure, which- we iiold in our hands ; and if not sufficiently regarded, .11 other remedies lose greatly of their 'value. lere, then, we are called on to maintain the cause >f the patient, (for such it truly is,) against the misaken importunities which surround him, and which t requires much firmness to put aside. 

"It is not wholly paradoxical to say that we are authorized to give greatest heed to the stomach, when it suggests some seeming extravagance of diet. It may be that this is a mere depravation of the sense of taste, but frequently it' expresses an actual need of the stomach, either in aid of its own functions, or indirectly under the mysterious law just referred to for the effecting of changes in th whole mass of blood. It is a good practical rule in such cases to withhold consent, till we find, after certain lapse of time, that the same desire continue or strongly recurs, in which case it may generall be taken as an index of the fitness of the thing de sired, for the actual state of the organs. — The feel ings of the patient are here rarely if ever that of thepry, although too often contradicted by what is merely such. 

" Dietetics musfbecome a much more exact branch of knowledge before we can be justified in oppos- 



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Eng its maxims to the natural and repeated suggesions of the stomach, in a state either of health or lisease." 

Who that has seen any cases of true Asiatic Choera, can fail to have been struck with the urgent lesire for cold fluid expressed by every sufferer ; )Ut none but the sufferer himself can tell what inense delight attends the gratification of that desire. X is evidently no depraved taste of the patient, it s widely different from the fanciful desires some* imes expressed by invalids, which are scarcely utered ere the wish has again departed, but it is a onstant and urgent calling of nature for assistance, he pointing out also the remedy required. This s not observed in merely a few cases of Cholera mt in all without exception, wherever any feeling whatever is expressed. Even in the last stage of le disease, when nature is all but overpowered, when all strength and almost all sense has departed rom the sufferer, the last feeble murmur is still, for water, water." Is it not then surprising that the emedy so manifestly pointed out, should have been ebarred the patient? Is there anything so uneasonable as would at first appear in the admintration of cold water ? 

The history, not of the Medical science merely but of the world in general, abounds with instances of the rejection by learned men of propositions, because they were so simple as to be deemed inadelicivc 



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since seen those very propositions, carried out to the welfare and advantage of our species. 

There is something discordant with our feelings something that tends to wound our self love in any )roposition which points to a simple cause as the origin of any formidable effect, at the time when we ourselves perhaps have been diving abstrusely into other circumstances, expecting to find the cause commensurate with the effect it has occasioned. We are too apt to forget that everything in nature s simple, and easy to be understood, if we but study nature aright ; we are too disposed to dig deepy into the rock in search of an explanation for nature's works, when if we would but open our eyes, we might see it written legibly on the surface. 

I In urgently recommending the free administra ion of cold water in Cholera, I beg again to pom iut that it is no theory of mine, it is an appeal ot 'chalf of nature — on behalf of those who may unhap rily become afflicted k with this malady. Howeve my one may in theory be opposed to my practice ! beg to remind such a one, that facts must be met >y facts ; I ask a fair and impartial trial, and if this ?e given, certain am I of the verdict which will be awarded. But here 1 would remark that half measures are useless ; it is necessary that the fluid, whether it be water or soda water, shall be unre- Eigly given whilst the thirst continues ; as soon c draught has been ejected another should be , the cup should be constantly at the patient's 

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Ips, bo that ho may drink whenever so inclined, n no disease is constant unremitting care and watching so necessary, as to the patient when prosrated by this fearful malady; fortunate is that sufcrcr who, when laid low and without energy or strength even to ask for what he needs, has a kind watchful friend at his side to mark the slightest desire as expressed by the eye, or by the feeble whis)erof his lips. 

But it must not be supposed that whilst advocating the gratification of the patient's desire for water, I oppose the use of all other remedies ; on the contrary, no means should be left untried which lave for their object the restoration of a free circuation in the blood ; the several remedies most apiropiate to elfecl this object I shall shortly proceed to notice. 

During the period when the Cholera raged to so frightful an extent in England in 1832 — 3, it fell to my lot to attend on several hundred cases of the disease in its most severe forms; the malady was then )ut little understood by medical men, and every remedy which could be suggested, was tried without success. Calomel, Opium, Cajeput Oil, Mustard, Alcalies, and various stimulants internally, and bleeding, the warm air bath, mustard poultices and hot turpentine externally, each of these remedies I saw administered, but apparently without avail ; the disease continued to advance and the mortality 



27 

vcrcd, and even when a patient survived the attack his constitution was so impaired that a perfect res toration to health scarcely ever took place ; medica men naturally became discouraged and gave up a patient as lost, immediately the collapsed stage se in ; it was at this period that I first employed cole water, and the case is in itself so interesting that will give the particulars as I entered them shortly afterwards in my note book. 

I was called at 3 a. m. to visit a child of poor parents, who was said to be attacked by the Cholera ; on reaching the house I found a little girl between 6 and 7 years of age in an advanced stage of colapse. Countenance sunk and discoloured, surface cold, pulse imperceptible, heart faintly beating, vocie almost entirely lost, constant purging, &c.&c. I was informed she had been in this state for fully Sialf an hour. 

I at once gave up all hope of her recovery, and— «• merely prescribing a little medicine as a satisfacion to the parents, — was about to leave the house, when I fancied I heard a constant hissing noise rom the lips of the little sufferer, and on placing ny ear near her mouth I heard the cry — (which lcrelofore I had so constantly disregarded) "water; vater" ; on mentioning this to the mother she •eplicd, "O yes Sir, she has been craving to drink water out of the pitcher all night, but we were araid to give it to her." 

Knowing that the gratification of this longing 



28 

desire could not increase the poor little sufferer's danger, I desired some water to be brought, and it was really painful to observe the avidity with which she drank at one draught a large mug full of water, jut the cup had not left her lips ere it was ejected. Again was the cry repeated. I became anxious to see what quantity of water, this child would take and certainly without any prospect of the adminisration being attended with benefit, I remained with ny patient constantly supplying her with fluid. She swallowed 13 full draughts, each, being rejected almost instantly ; after giving her the 14th I )erceived the water was retained fully one minute, >ut again ejected ; the next cupful was retained a onger period and to my great surprise I now observed a slight degree of animation in the little paient's eye, and on feeling at the wrist found a slight lickering throb was conveyed to my touch ; these appearances naturally increased my determination o persevere. 

During the short period the water was retained on the stomach the thirst disappeared, but immediately the fluid was vomited, the desire for drink again returned. Suffice it to say several fuither draughts of water were swallowed, each being retained longer than the preceding, reaction continued, encouraged by two or three doses of Sal Volatile which I administered, and within lialf an hour every symptom of collapse had disappeared ; indeed, the reaction continued so, perfectly that 3 



29 

hours after my first visit, the little patient was in a high state of fever; so much so, that I found it necessary to adopt antiphlogistic remedies, and to apply leeches to the head. In 3 days the child was perfectly recovered. 

A short time only after the occurrence of this case, I felt myself suffering from those first insidious symptoms of Cholera mentioned in page 16. I was immediately bled and adopted the remedies which I recommend*, and the disease was apparently removed, but, three days subsequently, although far from well, I was induced to walk out to see some fresh cases of the disease ;. of these two were of the most loathsome character ; I reached my home weary and sick,, and instantly retired to bed ; after 4 or 5 hours of restless sleep I awoke with violent cramp in the lower extremities, extreme sickness and purging, with much pain in the stomach, and intense thirst. The prostration of my nervous energy was so great that I was actually unable to walk to the opposite side of the room. I succeeded however in crawling to the wash-stand rom whence I took the ewer,and with it and atumber near me, lay on the ground drinking freely o he cold water. The relief this afforded me is indescribable, none but those who have experienced itj can at all appreciate the sensation conveyed to the 

* See Appendix. 

3» 



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patient ; I can safely affirm that no stimulating me dicines which could have been given to me, coulc lave roused my nervous energy more completely han did the cold water. After swallowing only a cw draughts, I felt the blood tingling through my extremities, and fresh life seemed to have been given me. I was now enabled to rouse up the re ative in whose house I was staying, who gave me a dose of Calomel, and I am thankful . to say I hac 10 further return of the malady. 

It is curious but no less true, that as the irritability of the stomach is diminished,, so does the cramp in the extremities decrease; thereby showing that the latter is chiefly dependent on the former, and thus that cold water is indirectly the meansof relieving that severe pain. 

I need scarcely say that, after experiencing these esults, I adopted the same means in every case which came under my observation, and, with but one exception, in upwards of one hundred and fifty nstances they were followed by the same beneficial results. In each case the water was retained on the stomach after a period of from 15 to 20 minutes, and then did reaction commence — the thirst subsided — ¦ vomiting and diarrhoea abated, and the circulation in the skin returned. One most remarkable fact I have almost invariably noticed; namely, that the thirst did not return, even when reaction had taken place to such on extent as to amount to fev£r. To avoid this latter result, I have been in 



31 

he habit of giving a full dose of Calomel (20 to 25 grains to an adult) immediately the water is retained on the stomach a perceptible period, for from hat time does re-action commence. The best mode of administering this medicine is to place it on the back of the patient's tongue, and then permit him to drink a draught of water.' 

I have delayed for upwards of three years to lay my views fully before the public, having been desirous of adding my experience in this country to that which I had gained in England. The testimony which I have received in India of the efficacy of my plan of treatment has been most striking; indeed, I have scarcely ever mentioned the subject in the presence of any persons who have witnessec much of the disease, but that it has recalled to some one's recollection one or more instances tending to shew the beneficial effects of cold water. 

The following cases were kindly forwarded to me by gentlemen, after perusing my letters insert ed in the Bombay Newspapers in May, 1846. The first circumstance is so extraordinary that I wil quote my correspondent's own words. 

" In the year 1835 in the month of May, Teheran the capital of Persia was visited by Cholera, and so rapid were the strides of death amongst the inhabitants, as also amongst the Shah's Army— (then encamped near the Goolistan, a favorite garden of H. M. close to the walls of the Town, ) that in 7 days upwards of 10,000 had died of the disease. 



32 

The Shah as well as his subjects were panic stricken and fled, the city was literally emptied. 

"Those persons who were led by chance or other wise towards the North, where beautiful water wa abundant, on being seized with the complaint, free ly indulged in the gratification of their desire fo drink, by laying down by the side of the stream drinking freely, and again vomiting, until thei thirst was quenched, and the other symptoms ha( subsided ; a very large proportion of these perspns recovered, whilst those who went towards the South where water was scarce, laid down by the way side and died by thousands, breathing a prayer for 3ome kind soul to give them a mouthful of water. 

"It was supposed at the time that where one o the former party had died, at least 200 of the latte ell victims to the disease. This communication you are at liberty to make any use of you please. . may mention that the British Legation, at the hea< of which was Sir J. Campbell and Col. Passmore as also the British detachment to which I had the lonor to belong, were on the spot." 

E?he following circumstance was related to me Officers in the 3rd Regiment M. N. I. who were witnesses of the occurrence. "In 1844 when hat Regiment was marching in the Concan, the Cholera made its appearance in Camp, and many sepoys daily fell victims to the disease. On one occasion as the Regiment was about to leave its encamping ground, the wife of one of the sepoys was 



33 

observed lying down by the side of a tank in an advanced stage of Cholera; her case was pronounced hopeless by the Surgeon of the Regiment, anc the woman was left without the slightest hope be ing entertained of her recovery ; but greatly to the surprise of all parties, she walked into Camp the next day, apparently as well as if nothing had oc curred. On enquiry it was ascertained that she ha( gratified her thirst by continued draughts of wate rom the tank, which had proved the means of he recovery. She stated that the vomiting and othe symptoms continued with great violence for a shor ime, but gradually subsided ; she then fell asleep and awoke finding all her malady had disappeared.' 

I coiffd mention numerous similar cases which lave been communicated to me by eye witnesses, mt shall content myself with giving the substance of a letter which I received from Col. G. of the Bombay Army. That Officer in company with a much amented Colonel in H. M. service, well known for lis advocacy of the Hydropathic treatment of dis sease, were travelling in the Upper Provinces when Cholera appeared amongst their palanquin bearers several had died in spite of every remedy that was administered, when on one occasion as they were encamped on the bank of a large tank, three men who were attacked with the disease in ils most viru ent form, crawled down to the water, and with ntense gratification continued to slake their raging hirst, until greatly to their surprise they found the 



34 

vomiting subside, and their pains cease. They continued to recover so rapidly that, as my correspondent informed me, they were able to resume their duties on the following day. 

I shall now proceed to give the experience of a Practitioner amongst the Native population in Bombay. 

At my request, when the Cholera was prevalent m Bombay in 1846 — he took cases alternately as they occurred, one he treated in the usual manner }y stimulants, opium, calomel, &c. and to the other le adopted the plan which I recommend of giving water unremittingly. The result in 22 cases treated thus, was, that of the 11 persons treated as I had recommended, 10 had perfectly recovered, whilst, of he others 9, had died. 

I was requested to sec a high caste Hindoo who was said to be attacked by Cholera; on visiting him n the company of two Gentlemen I found him in a complete state of collapse ; — no pulse could be elt at the wrist — surface cold, the countenance unk. The intense thirst was here very manifest ; ' directed the patient to be freely supplied with water, and, without prescribing any other remedies, eft the house to visit another invalid. On my reurn within half an hour, 1 found that my antieipaions had been fully realized. Re-action had^comnenced and the vomiting ceased. It is needless or me to enumerate cases, for in almost every one 



35 

Jays since the appearance of the disease in Bom jay, I have visited two cases of the disease in th company of my friend Dr. Reynolds, the Port Sur geon, who kindly permitted me to adopt my plan o reatment in their cases. It was, I am happy t say, attended with complete success. In one cas when, after the free administration of iced water he violent vomiting had ceased, much spasm of the stomach remained ; to relieve which, I was indue ed to recommend that the . patient should take )iece of ice in his mouth and constantly suck ieee water through a small tube ; this simple plan provec nost efficacious; both the gentlemen are now, I am jjlad to say, in a state of convalescence. 

I have but casually alluded to the third or las stage of the disease, that of Collapse. The symp toms are so well known that it is scarcely necessa ¦y to enumerate them. The sunken and disco oured countenance, cold surface, hissing voic significantly termed the Choleric whisper) — pulse in perceptible at the wrist, urgent thirst, constan vomiting and purging. All. these symptoms once seen, are not easily forgotton. 

The object of every plan of treatment employee in this state, should be to restore the circulation o the blood ; every means that are at hand for giving warmth to the surface of the body, should be a doptcd, and the patient's desire for water should be unceasingly "supplied. The various remedies wil lereafter be more fully and minutely explained 



36 

I will now endeavour to shew the manner in which cold water produces so favorable an effect on this disease. 

LI have before mentioned that the action which c Choleric influence has on the body, is to cause a large excess of blood to be thrown internally, on he heart and other important organs ; the storqach and intestines particularly suffer, as is evident >y the symptoms during life ; as is also manifestd by appearances after death. The blood also beomesmuch thickened (in consequence of the large jroportion of its serum (or fluid part) having passed away by the intestines), and is consequently rendered unfit for the purposes of the animal economy. The action of cold water on the stomach appears to be precisely similar to that of cold applications to congested and inflamed parts on the surface of the body. It is well known that the effect of such applications is to allay pain and irritability, as well as to stimulate the vessels of the part to contract, and thereby to expel any excess of blood which they may contain. 

Just such an action is, I believe, exercised over the stomach ; it is true that at first the nervous fibres of that organ are so irritable that they canno bear more than a momentary contact with the fluid but the continued administration of the cold water allays this irritability; it stimulates the congestec blood-vessels to contract, thereby giving an impetus to the general circulation of the blood. And here 



37 

ime not idle ; she strives earnestly to the last, to shake oft' the disease; this is seen in a very striking nanner by the exceeding rapidity with which he stomach (immediately its irritability is over come) absorbs the fluid, and causes it to be carried nto the circulation. 

I have constantly remarked that when the cold water has been retained on the stomach for a period of only three minutes, and the stomach has again with violence ejected its contents, that the quantity vomited has been scarcely three-fourths of the amount ast swallowed by the patient. Thus plainly maniesting that the simple remedy of cold water is camble of producing the two important effects for which the most powerful remedies have been emjloyed without success ; namely, relief of the congested circulation, and adding to the fluid parts of the blood. 

But I must again impress on the attention of my readers, the fact that vomiting and purging does not constitute Cholera; these are merely symptoms of the disease, and indicate that nature is endeavouring to. remove the Congestion of the blood vessels in the stomach and bowels. If an illustration of this fact be necessary I need but remark that during the prevalence of Cholera, cases are occasionally met with, where — in consequence' of a previous want of power of resistance — the patient ia at once prostrated by the malady, and nature is unable 

4 



38 

o cope with her foe ; here We have the disease itself, without any, or but slight manifestation of nature's efforts towards a cure ; the vomiting, purging and hirst are either of a very trifling character, or alogether absent. 

When the nervous energy of the patient is thus much overcome, the chances of recovery are indeed but slight ; nevertheless although nature is unable to expresί her need, the Physician (nature's assistant) should bear in mind what nature requires. The disease is the same although its usual characteristic symptoms are absent. 

The same remedies which should be employed n ordinary cases of Collapse ought here also to be lad recourse to. Water should be given continually, and the Various stimulants which are likely to arouse the nervous energy should be unceasingly employed. 

Having thus, as far as the limits of these pages Will permit, explained my views and mode of practicec, it remains for me merely to describe the various remedies that may be employed, with advantag — in addition to cold water — in the several stages of the disease. I have preferred giving these n a separate and succinct form, in order that they may at once be referred to on an emergency. 

II must again exhort my professional brethren and he public generally, to give a fair and important rial to the free use of cold water. 

It is surely something gained to know of a remedy 



39 

always al hand, which will in any way relieve the sufferings of those afflicted with this dreadful disease, but when it is, in addition, a valuable means of cure, and that too within the reach of the most destitute of our fellow creatures, it behoves every one who may have the opportunity, fairly to test its merits. I can only sincerely hope that it may prove as beneficial in the hands of others 





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APPENDIX 

JJIJitTMiUTUi CONCISE RULES FOH THJE TREATMENT Qf cholera. 

The importance of attending to the first stage of Cholera, cantot 

bo too strongly impressed on the attention of the public. The Diarrhoea or looseness of the bowels may bo entirely without pain, indeed it is most generally accompanied only by a scuation of weight at the pit of the stomach. This absence of pain las too often thrown the patient off his guard, who has thus negected the warning and allowed mucli valuable time to pass by. t may be safely asserted that during the prevalence of Cholera, Diarrhoea or looseness of the bowels which is free from pain, is nore dangerous — more likely to be the first stage of the disease han Diarrhoea accompanied with griping or pain. Let it then )e clearly understood that not a moment should be lost in puting a stop to the looseness of the bowels — recourse should be had mmediatcly to Medical Advice. When that is not procurable, 

the following may be taken with advantage. Take of Laudanum 15 (fifteen) drops. Brandy one 1 dessert spoonful. 

A Decoction of Spices or 

Warm water two (2) table spoonfula-r—r-i 

to be repeated every hour until the Diarrhoea has ceased, in addition to this, (5) five grains of Calomel with half a grain of Opium will prove beneficial, if the symptoms be not relieved 

after the first dose of the mixture. 

When the disease has gone beyond the first stage, my experience 

leads me to assert that Opium in 'every shape should be avoided, its action being injurious rather than beneficial; everj remedy that will stimulate the nervous energy, should be adopted. 



42 

When the disease has advanced to the second stage as indicated by vomiting, purging, cramps, and great prostration of strength, even if thirst be not present at first, the patient should always bo encouraged to drink continually of water as cold as can be procured, but when the thirst dictates it, let it be taken unceasingly. A full dose of Calomel (20 grains) should be given immediately, and half that quantity repeated every half lour to the extent of 4 (four) doses whilst the symptoms continue violent. If the patient's stomac 1 will permit of it, stimuants should be frequently given; by far the most eOicacious of hese remedies and one which is generally at hand, is Carbonate of Ammonia or Common Smelling Salts. It is difficult to name any specific quantity of this medicine to be given at a dose, as it varies so much in strength, but sufficient should be mixed with a wine glassful of water to render it moderately pungent, this may be given with advantage every quarter or half, hour according to the urgency of the symptoms. Ammonia whether it be in the form of common smelling salts, — spirits of Hartshorn — or Sal Volatile, is always a most valuable remedy. In the absence of this medicine a Decoction of Spices with Brandy may be given with benefit. The feet and legs of the )atient should be placed in water as hot as can be borne, to vhich add a handful of powdered mustard. Friction with warm flannels should be kept up over the body, and if much uneasiness bo felt at the pit of the stomach a mustard poultice nay be applied t » that region with advantage* 

In the state of Collapse, let the urgent thirst be unceasingly gratified, by the administration of cold water. Ammonia also, as previously mentioned, should be given occasionally whilst the collapse continues, or in the absence of this medicine, Brandy, or a mixture of pepper and spices is likely to be beneficial, if he stomach will retain it, but it is always better to allow the 

* The best and most simple method of preparing this remedy is, to make a hot poultice of flour, bread or liuseed meal and to spiiukle over it powdered mustard. 



43 

cold water to allay the irritability of the stomach before giving hese remedies, rather than to increase the irritability, by forcing hem on the patient when the stomach cannot retain them and vhen consequently they can produce little or no benefit. Caomcl should' bo given immediately cold water is retained on the stomach for a period of two or three minutes, 20 grains for the first dose and doses often grains each, every succeeding half lour to the extent of 4 doses.* Warmth should be kept up by every possible means over the surface of the body; to effect this,-lot bricks or*bags of sand, bottles of hot water, and friction with flannels, will be found the most efficacious remedies. Above all things, let those who are in attendance on the 6ick, avoid evilencing any symptom of alarm, for nothing is more injurious to the sufferer, whereas a cheerful and hopeful demeanour tends very considerably to assist the rallying powers of the patient to nake head against the depressing inlluencc of the disease. 

* I have mentioned throughout, the various doses for an adult ; to a child • Hitler 10 years of age, one-half, and to one under 4 years of age, one quarter of this quantity should be given.^^-