Section Ii.--Remedies, Recipes, Etc.

Considering the general principle of treatment, and the nature of the remedy so clearly suggested by the pathology of the disease to be fully established, it now remains for us to point out some of those curative agents which may be employed to advantage. It may be here observed, that among the few that can be confidently recommended, there is no single remedy yet discovered which seems to possess all the properties necessary to meet the complex condition presented in a malignant case of cholera. Yet it is believed we have simple remedies, which, when properly combined, will prove successful. Among the number that seem best adapted to meet and fulfill the indications, may be named chloroform, as the leading remedy on which we may reasonably hope for success. This may be united with spirits of camphor, the tincture of xanthoxyli fraxinifolii bacca, the compound fluid extract of rhubarb and potassa,[XVII.] and the oil of monarda punctata, and a very valuable and reliable remedy obtained. The following formula exhibits the mode of combination, which may be varied and adapted to suit any emergency:

Rx. Chloroform, (sq.,) dram ij. Spirits Camph., dram j. Ol. Monarda, gtts. x. M. et adde-- Tinc. Xanthox. Frax. Bac., ounce ij. Fluid Ext. Rhei et Potas., ounce iv.

M.--S.--From dram j. to ounce ss. every half-hour, hour or two hours, according to the urgency of the symptoms and the stage of the disease. As soon as relief is obtained, it should be given in minimum doses and less frequently. This is admirably adapted to the cold stage, and will give prompt relief in a great majority of cases.

In the premonitory stage, it can be administered to good advantage in small and less frequent doses. In some instances, an additional astringent may be necessary. The deceptive and painless diarrhoea should receive prompt attention, and be regarded and treated as the incipient form of the disease. According to the best authorities, the diarrhoea commences with the first chemical change or alteration of the blood, and proceeds gradually, in most cases, for some hours, and even in some instances, though rarely, for days. It is not sufficient to check the diarrhoea merely; the cause must be removed, which is essentially of miasmatic origin. When the cholera is prevailing, and the diarrhoea is essentially choleraic, or the result of a depressing miasmatic influence, it should be treated with chloroform, aided, if required, by appropriate astringents.

In the fully developed stage, and even in the stage of collapse, perhaps no combination is better adapted to meet promptly all the necessities and wants of the system, and suspend the action of the cholera-poison, than the one named above. It is a simple, prompt and diffusive stimulant, approximating the principle indicated. This peculiar remedy is essentially required, and should be continued through all the stages of the disease till relief be obtained, varying its administration according to the urgency of the symptoms. When the stomach is too irritable to retain medicine, it should be given by the bowel. Take of the above mixture, one-half ounce, of the tincture of prickly-ash berries one-half ounce, of the tincture of opium ten drops, of warm water one ounce and a half--mix and inject. This may be repeated after every evacuation three or four times, unless relief be obtained earlier. Thus, it should be administered perseveringly by stomach and by bowel, aided by due employment of all necessary external means for furnishing warmth and giving relief. Opium, however, should be omitted after two or three injections. Its continued use to check the movement of the bowels is decidedly injurious.

The vomiting and irritability of the stomach may often be allayed by a strong decoction of spearmint and horse-peppermint (monarda punctata), equal parts, alternated with camphor water in small repeated doses every five minutes. This will often succeed when all other means fail.

The compound cajeput mixture[XVIII.] is a very excellent and prompt stimulant, and may be alternated with other remedies with good effect. It is particularly useful in allaying violent cramps, and restoring warmth to the body, and may be given in doses of one tea-spoonful every ten or twenty minutes in mucilage, simple syrup, or, better still, in hot brandy-and-water sweetened.

The aromatic tincture of guaiac[XIX.] will be found very useful in some cases, and may be united with chloroform according to the following:

Rx. Chloroform, (sq.) dram ij. Spirits Camphor, dram j. Ol. Monarda, gts. v. M. et adde-- Tinc. Guaiac. Arom., ounce iv. M.

S.--From one-half to one tea-spoonful every half hour, or, if necessary, in violent cases every twenty minutes, in a little sweetened water. This may be alternated with some other remedy to great advantage.

Chloric ether has been with some a very favorite remedy, and, in combination with other diffusive stimulants, may serve a good purpose. So, too, the spirits of turpentine, and the rectified oil of turpentine, have proved very beneficial, the former in combination, the latter administered alone. These agents, however, can be rendered more prompt and effective by combination. It is the promptness, the instantaneous or electric action like that of oxygen, ozone, and caloric that gives value to the combination, and renders it peculiarly efficacious when it possesses the other peculiar properties required.

In the early stage, sulphuric acid, in the form of elixir vitriol, has given very prompt relief, and is very highly recommended as a curative agent in the treatment of this disease. The following formula presents the mode of its exhibition:

Rx. Elixir Vitriol, ounce j. Tinc. Xanthox. Frax. Bac. ounce ij. Ess. Lemon, dram j.

M.--S.--Tea-spoonful in a gill of sweetened cold water every two or three hours.

This recipe was used in the incipient stage quite extensively in the epidemic of 1849, with decided advantage. It generally removed the symptoms speedily, without any other treatment. In the more advanced stage it was thought not so reliable as other means named above.

Dr. Fuller, of this city, advocates the use of sulphuric acid as a prompt and efficient remedy, and affirms that according to his experience, a great majority of cases may be cured by this mode of treatment.

Dr. Cox, of England, has also spoken in its favor, and recommended its use as an infallible remedy. The eclectic physicians are entitled to the credit of its first introduction as a curative agent in the treatment of the Asiatic cholera, combined with the tincture of prickly-ash berries and the essence of lemon, as noticed above. In our estimation it may be rendered more effective, combined according to the following:

Rx. Elixir Vitriol, } Chloric Ether, } [=a][=a]., ounce j. Tinc. Xanthox. Frax. Bac. ounce ij. Ess. Lemon, dram j. M.

S.--A tea-spoonful in a gill of sweetened cold water every two or three hours. Thus combined, it forms a very prompt and diffusive stimulant, and is well adapted to meet the indications in the earlier stage of the disease. In the last stage perhaps no remedy will be found so prompt and decided in its action as the injection named above, with the internal use of chloroform as combined in the recipe on page 189.

In cases of excessive irritability of the stomach, the following combination was administered with good effect, and was especially beneficial in cases attended with stupor from the commencement of the disease:

Rx. Common Salt, dram j. Black Pepper, dram j. Vinegar, f. dram v. Hot Water, f. ounce iv. M.

Of this, when settled, or strained, a table-spoonful may be given every ten or twenty minutes. It seldom failed to quiet the stomach and check the motion of the bowels. In this condition the injection should be also administered, and repeated as occasion may require.

Some advocate the use of the spirits of ammonia and tincture of capsicum, properly combined with other diffusive stimulants, as a very efficient and successful remedy. The following is, perhaps, the most desirable formula:

Rx. Chloroform, (sq.) } Spts. Camph., } [=a][=a]., dram iij. Spts. Ammonia Aromat., } Tinc. Capsicum, } Elix. Opii (McMunn's), dram ss. Syr. Zingiberis, ounce ij.

M.--S.--Tea-spoonful in water every thirty minutes till relieved. Then less frequently, according to circumstances. This is said to give very prompt relief in the earlier stage of the disease. With some practitioners the following has been quite a favorite remedy:

Rx. Æther Chloric., ounce j. Tinc. Cardamom., ounce ij. Spts. Camph., ounce ss. Elix. Opii (McMunn's), dram ss. Syr. Zingib., ounce ij. M.

S.--Two tea-spoonsful in water every 10 or 30 minutes till relieved, then continued less frequently and in less doses every one, two, three, or four hours, according to circumstances.

For the purpose of promoting reaction in cholera and diarrhoea, the following formula has been extensively used and most universally approved. It is, indeed, so highly valued in England and in India, that it is ordered to be always in store and in readiness in the Medical Field Companion of the army when on the march:

Rx. Ol. Anisi, } Ol. Cajeput, } [=a][=a]., dram ss. Ol. Juniper, } Æther Chloric, ounce ss. Liquor Acid. Haleri,[XX.] dram ss. Tinc. Cinnamon, ounce ij. M.

S.--Ten drops every fifteen minutes, in a table-spoonful of water. An opiate may be given with the first and second dose, but should not be continued.

Another recipe which has been used with some success in private practice, illustrative of the use of chloroform as a diffusive stimulant and sedative, is the following:

Rx. Chloroform (sq.) } Spts. Camph., } Tinc. Capsicum, } [=a][=a]., dram ij. Tinc. Zingib., } Tinc. Cardamom., } Syr. Simplex, ounce ij. M.

S.--Tea-spoonful in a little water every half hour, hour, or two hours, according to circumstances. An opiate may be given with the first and second dose, but should not be continued. Should the first dose be ejected, give another immediately after the vomiting.

In collapse, which is simply a more advanced stage of the disease, indicating the gradual failing of all the powers of life, our main reliance is on enemata, as noticed above, often repeated, and continued as occasion may require.

Rev. Dr. Hamlin, of Constantinople, observes, "It is difficult to say when a cure has become hopeless. The blue color, the cold extremities, the deeply sunken eye, the vanishing pulse, are no signs that the case is hopeless. Scores of such cases in the recent epidemic have recovered."

Here it may be proper to add, that a cure, even with the most efficient remedies, cannot be easily effected without placing the patient at the commencement in a recumbent position. This appears indispensable. The patient should be placed in bed and kept there in the horizontal position, comfortably covered with blankets, and with warm applications to the feet. Every necessary convenience should be at once provided to prevent, if possible, the patient from rising to, or standing upon, his feet, for the erect posture, before relief is fully obtained, will inevitably hasten the unfavorable termination of the disease. On this direction, therefore, the physician must insist if he would save his patient. Says an eminent physician, perfectly familiar with the disease, "This direction faithfully observed, and good nursing, will save very many patients even without medicine."

Of the auxiliary aids, consisting of various external applications, we cannot speak in very flattering terms. To the mind of the practitioner the more important are readily suggested, and are promptly employed by nurses in the earlier stages of the disease. It is impossible for any person to attend on a case of true cholera without being instinctively moved to apply heat friction, and warm stimulants to the surface for the relief of the suffering patient. Any attempt to prevent these kind offices and apparently beneficial appliances would be unwise, and most certainly, in private practice, unavailing. It becomes, therefore, necessary to direct the use of those which are most agreeable to the patient and tend to preserve and sustain the recuperative power; those which tend to weaken and depress the system are the most objectionable. Among the number that seem to do good, we may mention bottles of hot water to the feet and calves of the legs, hot bricks dipped in water and wrapped in flannel and applied to different parts of the body; blankets wet in water as hot as can be borne, and wrung out so as not to drip, and applied to the whole surface, and changed at short intervals, so as to keep up a steady and permanent temperature of the surface; flannels moistened with spirits of turpentine, or other stimulant embrocation, and laid over the stomach and bowels, may be employed, as these all, in some instances, seemed to be beneficial. Their necessity and use, however, must be governed by circumstances. As we have before said, our main reliance is on a prompt and diffusive stimulant internally; other means, at best, are very uncertain.

Such are some of the remedies evidently suggested by the pathology and phenomena of the disease, and adapted to meet and remove the more urgent, essential symptoms. They are not entirely new. They have been employed to some extent in former epidemics of cholera, and have sustained a good reputation as useful and curative agents in the treatment of this disease. The combinations here suggested are the result of observation and experience, and are intended to present the form in which these remedies can be exhibited to the best advantage. They are simple, prompt, and reliable, such as will leave the system, when the disease is subdued, in its ordinary condition, without any injury whatever to prevent its immediate return to its normal state of health. Let them be employed, and their utility thoroughly tested. They will bear the strictest scrutiny, and sustain their reputation untarnished under the most trying circumstances. Should the cholera appear again in our midst in its epidemic form, and these remedies be generally employed and properly administered, we venture to predict their efficacy will be abundantly proved in the successful result of saving more than nine-tenths of those attacked.