Transactions of Branches
BMJ (Clinical Research Edition)
She was a thin and delicate child, constantly taking coughs and colds, and very dyspeptic. On August 15th, she went to bed in her usual health, but in the middle of the night awoke intensely sick, cramped all over, and vomiting and purging dirty water, there being little difference between the liquid vomited and that purged. She was quite conscious, and complained of the cramps and pain in the stomach and bowels. I ordered a sinapism to the stomach, hot brandy and water, and a pill containing
... a pill containing two grains of calomel and half-a grain of opium, the pill to be repeated if the first was vomited; or if kept, and the patient unrelieved, in four hours. At 10 A.MI. on the 16th, she was completely prostrated, eyes sunk, pulse imperceptible, breathing almost imperceptible also, skin of a pale bluish colour, cold, and damp; had refused to take the pill or the brandy, but drank cold water, which was instantly rejected. The cramp had now left altogether; the eyes were half open, with a dark blue ring around them; she paid no attention when spoken to, but lay as if dead. No urine had been passed, and the suprapubic region was tympanitic. I ordered a complete hot mustard blanket bath with hot bottles around her to keep up the heat, enemata of strong warm beef-tea and brandy, with five minims of laudanum in the first, every two hours. It was with great difficulty that the parents could be got to adopt the above measures, nor would they have adopted them had I not procured a nurse, who energetically went about the performance of them, so hopeless did they think the case. Before noon, however, reaction was fairly established; she could speak, though still in a very hollow tone, and was persuaded to swallow one of the pills, and afterwards some ice and strong beef-tea. She made a good recovery. The other cases in this division were much less severe; they had obstinate vomiting and purging, some of dirty water, others of biliary matter; all with more or less collapse, and all followed by intense weakness. In all who applied during the beginning of the attack, calomel and opium were given with effervescing draughts, ice, and sinapisms to the chest, stomach, and bowels. None of them required a whole bath. Where the vomiting had disappeared or never been present to a great extent, fuming nitrous acid with tincture of opium were given, which in most cases effectually relieved the purging. The greater number had cramps more or less. The remaining 70 cases were all adults, the age varying from sixteen to sixty, but in only four cases was the collapse so alarming as to call for the application of the whole bath. In them, however, the effect was striking and most gratifying. In a few minutes the cramps disappeared, the skin became warm and red, the vomiting became less urgent, and a tendency to sleep induced. All four recovered. Two of the cases were above fifty years of age, and both were very severe cases and made slow recoveries. With regard to the other treatment of these adult cases, the combination of calomel and opium was found to answer admirably, both in relieving the sickness and vomiting, and the pain and purging. We soon found that one grain of opium was of little use given as a single dose to an adult; but that a grain and a-half, when combined with three grains of calomel, and administered on the cessation of a wave of sickness (for it was always observed to come as if in waves), almost invariably remained on the stomach, relieving all the symptoms. Effervescing draughts were given for the intense thirst. When the calomel and opium failed to stay on the stomach, ice swallowed in small pieces invariably afforded relief. The remainder of the adult cases varied very much in severity, from what in the absence of an epidemic would be called severe bilious attacks, to what is usually denominated British cholera. The calomel and opium, ice and sinapism treatment was adopted in all, with all the success that could be desired. When diarrhcea persisted after the attack was over, nothing did so well as the fuming nitrous acid with laudanum every four hours. In one case, drachm-doses of carbonate of soda were given, with the effect of aggravating all the symptoms; it was therefore in that case discontinued, and not again tried. So satisfied were Dr. Manson (a member of the British Medical Association) and myself of the admirable effects of the mustard bath in this class of cases (and he was equally pleased with it in the cases in which he ordered it), that we determined, if unfortunately at any time we should be visited with an epidemic of real Asiatic cholera, to give the treatment a fair trial in it also. It was with much pleasure, and great interest, therefore, that I read Dr. Bullar's paper in the JOURNAL recommending the same line of treatment, and I hope others will give it a fair trial too. As regards the form of the bath, I think the blanket bath should be preferred, as being in most cases more readily and more quickly available, and also more easily applied in very bad cases.