Southern Planter

Cholera.—Dr. Samuel B. Smith, Assistant Surgeon in the United States Army, has addressed a letter to Captain Wilson, dated Fort Armstrong, September 23, 1832, from which we make the following extracts:

I give you some hasty reflections upon the Asiatic Cholera, as it appeared in our army recently at this place. These illustrations, although imperfect, will hold good in every part of the United States, and the treatment will probably be the same. Should any exceptions prevail, they result from some accidental causes, the chief of which is intemperance. For reasons presently to be assigned. I am assured that a collapsed state in this disease is absolutely incurable: hence it is imperative upon all interested, to apply with promptitude for curative means, the instant the premonitory symptom, Diarrhoea, occurs. Happily this warning is universal, and for the most part of such duration, as to afford ample time to escape the danger. The great majority of cases that occurred after the 29th and 30th of August, were preventable from a knowledge that this insidious looseness of the bowels was the prelude to destruction; and for the sake of those who so miserably perished in the onset, it is to be lamented that it had not been earlier known. About the 20th of August it was apparent to any observer that diarrhoea very generally prevailed among the troops, and gave to the atmosphere a very peculiar odour. I observed it to the late Doctor Coleman, who admitted it, and attributed it to a change in the habits of the men.

On the nights of the 20th and 29th of August, there was a severe storm of cold rain, which inundated the tents. Before dawn, more than twenty were brought in from the camp, of whom eight died before 10 o'clock in the morning. A strict investigation of those, and some of the preceding cases, proved that rice water Diarrhoea had prevailed universally. Measures were now promptly adopted to alarm those afflicted with purging, and from 145 such persons were under medical treatment, very few of whom went into collapse. By particular attention to every complaint, the disease lost its ferocity; and at the end of fifteen days from its first appearance it ceased among the troops.

This form of disease is exceedingly similar to the Typhoid state of malignant bilious fever, and should be treated much in the same manner. Moderate bleeding, general or topical: blue pill, or small doses of Calomel; blisters, Dover's Powders, &c.

The cramps, I believe to proceed from a deficiency of secretion of the brain, and is consequently an effect. Whatever may be the cause of them, they are exceedingly painful, and engross the whole attention of the patient. One only remedy was found for them, viz: Friction: and experience taught that this by the naked hand was the most effectual. All medical applications were hazardous, because they interfered with the heat imparted by the warm, healthy hand. It is altogether vain to hope that any stimulus, however powerful, will produce any effect upon the surface of one from whom all apparent heat has departed. I have seen the most violent spasms of the muscles, in a moment controlled by the judicious treatment of a warm hand; and I can truly declare, that the same results were not so soon obtained by any of the common stimuli, such as essence of Peppermint, Camphor, Spt. Turpentine, Mustard, &c.

Collapsed Cholera is, justly speaking, that approximation to death, from which there is no apparent chance of escape. Reliance must exclusively depend upon the timely use of medicines when Diarrhoea declares an altered state in the secretions. This precursor is universal, and is the more dangerous as it is unattended by pain. At first the discharges are natural in color; they next change into a white clay colored paste, and very soon after into a flocculous rice water appearance. As this advances, alarming debility comes on, accompanied by distressing vomiting and racking spasms of the limbs. This form of Diarrhoea I believe to be the blood broken down, consequently the hopeless hour of collapse is near at hand. It must be instantly arrested by an injection composed of half pint of warm water and half an ounce of laudanum, at the same time rubbing the belly with equal parts of hot brandy and laudanum. You cannot be in time a position as in an earlier stage of the purging, but it is the best that can now be done. In the early form of the disease, the great first principle is to rouse the liver to an active secretion in which the Cholera is entirely suppressed. If this can be accomplished, little danger is to be apprehended: Many practitioners recommend large quantities of Calomel, hastily given to reach the torpid biliary; but after much experience I would recommend smaller doses steadily exhibited at short intervals. The following form will generally supersede every other, and the deep salivations consequent upon larger amounts avoided. Calomel five grains, Aloes two grains, Opium half grain, Rhubarb five grains, repeated every hour, suppressing the Opium as you advance in numbers. There should be no cessation until the proper proportion is attained. In a few hours after the bile is restored to its natural quality and quantity, convalescence is almost immediate. During the prevalence of the Cholera, thirst is generally tormenting, but much fluid of any description should be withheld and especially cold water. The fermenting Soda Powders are exceedingly grateful, and soda in every form is a valuable remedy.

Weakness of bowels more or less remain after the attack, and the slightest intemperance, either in food or drink, will cause a troublesome purging and sometimes active inflammation. For the first, half an ounce of the subjoined julep, repeated pro re nata will generally answer: Rhubarb half oz. Spirit of Mint half drachm: water 16 ounces: and for inflammation moderate blood letting from the arm will insure safety. There is a secondary form of Cholera which may be termed Typhoid or Congestive, and is exceedingly dangerous.