Section Iii.--Prophylaxis--or Means of Prevention.

In presenting a course of preventive treatment consistent with the origin and general character of the disease, we are necessarily limited to the means of sustaining the normal action of the system, and suppressing the operation of those causes which, by reducing the general health, tend to generate, foster, and develop the cholera. Of the former so much has been written and published, inculcating the general principles of hygiene, that it seems quite unnecessary to dwell on a subject so familiar to the great mass of community; yet, there are occasions when the most familiar truths have to be impressed upon the mind, by constant repetition, to prevent threatened dangers, and obviate the most serious consequences. In no instance is this more important than in time of prevailing epidemics; for it is an undeniable fact, that multitudes will neglect the most obvious principles of hygiene, and tolerate, with utter indifference, the most offensive nuisance, in and around their dwellings, and if attacked by disease, will often wonder why they, more than others, should be visited by a malignant disease, or become the victims of a prevailing epidemic. Hence the necessity of urging the observance of some of the most obvious principles of hygiene, in the preventive treatment of Asiatic cholera.

Pure air, pure water, and a frugal nutritious diet are Nature's great preventives for the thousand ills of life. These are the great essentials in sustaining the healthful and normal condition of the system, always of primary importance in preserving its tone and energy, and rendering it impervious to any miasmatic or epidemic influences. Therefore, the tone of the system should, more especially when epidemics are prevailing, be kept fully up to its normal standard. This cannot be accomplished without pure air,--whether our dwellings be located in the city or in the country; free ventilation of all apartments is of the first importance. Kitchens, sitting-rooms, dressing-rooms, and especially sleeping-rooms, should be kept constantly and thoroughly ventilated; cellars and vaults, too, should receive attention, and be kept free from a deteriorated or foul atmosphere. Everything within and without our dwellings, tending to impregnate the atmosphere with noxious effluvia, should be removed, and the foul air promptly purified by the use of appropriate disinfectants.

Pure water for drinking and culinary purposes is another preventive remedy, whose employment cannot be safely omitted. It is a well-known fact that, in various localities, wells only a few feet deep, which are mainly supplied by drainage or surface water, have proved a fruitful source, and in some instances a direct and efficient cause of epidemic cholera.

The water from rivers flowing past large cities and villages is often so impure as to render its use decidedly deleterious, if not an actual source of disease. In some cases they have been literally so filled with portions of fish, and other animal matter, that all city supplies were made endurable only by long-continued filtration. The waters of many of our Southern and Western rivers are rendered impure from the lime and surface drainage with which they are so highly impregnated that they often become a direct source of diarrhoea and cholera. Pure water, free from the impregnation of vegetable, animal and mineral substances, should be sought and obtained for domestic use.

A good nutritious diet is an indispensable requisite in the prevention of disease. The system in comparative health requires, and should regularly receive, its proper aliment. Its daily recurring demands should be judiciously met with pure and wholesome food, in such quantity as can be readily digested, assimilated and duly appropriated for the supply of its wants. Due regard, however, must be had to the existing and peculiar condition of the digestive organs, on which mainly depends the process of supporting and perpetuating the general health.

It is not the profuse variety and the incongruous mass composed of baked, roasted, boiled and fried meats, fish and fowl, oyster, lobster, frog and turtle, with puddings, tarts, jellies, cakes and creams from the pastry room--fruits and salads, native and foreign, rich and rare--alcoholic stimulants, and cooling ices, but the simple, plain and frugal diet, properly cooked and particularly nutritious, that conduces to the most vigorous health.

Regular, temperate habits in all things, are especially commended; excesses of all kinds are reprehensible. Great and sudden changes in the habits of living are always deleterious, and must be particularly so, when an appalling and fatal epidemic is prevailing. Temperance, sobriety and cheerfulness, regular hours for meals, for rest and for business, repeated ablutions and perfect cleanliness, moderate exercise and avoidance of irregularities, persevering self-government and duly subjected passions, all contribute to health, to happiness, and the prevention of disease.

Exposure to the extremes of heat and cold should be avoided, and the clothing properly adapted to the climate--to the season and its variable temperature. Constant vigilance is necessary to guard against the numberless causes tending to produce an abnormal condition, resulting in the derangement of the stomach and bowels, or in depressing the nervous power, thus enfeebling and prostrating the general health. The neglect of these hygienic principles and essential preventives of cholera may induce the condition which temptingly invites the disease. Some are vastly more susceptible than others, and may not be able, with all their watchfulness and care, to avoid an attack, should the disease extensively prevail among us.

The premonitory symptoms requiring special attention, when the epidemic cholera is prevailing, are definitely presented in Chap. II., Sec. 2, page 56, to which special reference is made. Whenever any of these do occur, though generally supposed to present no particular characteristic of the cholera, they should, however, receive prompt attention. The loss of animation, the depression of nerve-power, the pain in the forehead and slight vertigo, the nervous agitation and oppression at the chest, with slight nausea, may in most instances be promptly removed. They should be at once patiently and perseveringly treated by the use of camphor water, prepared as follows: Take spirits of camphor, one tea-spoonful, and put it into a half-pint of cold water, and give of the mixture two tea-spoonfuls every half-hour, hour, or two hours, according to the severity of the symptoms. A strong decoction, or tea of horsemint (monarda punctata), is an excellent remedy even in this early stage. The essence of monarda, or horsemint, in doses of eight or ten drops in a little water, and repeated every hour or two, will often give prompt relief. Where the horsemint cannot be obtained, the spearmint, and the peppermint also, may prove serviceable.

Keith's concentrated Tincture of Veratrum Viride is also an excellent remedy in these premonitory symptoms. Put three or four drops into a tumblerful of cold water, and give of the mixture a tea-spoonful every hour or two hours, as occasion may require. This may be alternated with the essence, or tea of horsemint.

But another more general symptom, which may be properly termed the incipient stage of the disease, is the slight diarrhoea, usually termed painless, though it is by no means always so, but frequently the very reverse, severe and painful. This at first may be slight, but gradually increasing, soon becomes obstinate, painful, and exceedingly difficult to control. It therefore should receive attention at its very commencement, for it is in reality the stealthy invasion of the citadel--it is the cholera. The loss of life becomes imminent; treatment becomes indispensable; send at once for your physician. And, in the meantime, continue the camphor mixture, the horsemint tea, and give of the fluid extract of rhubarb and potassa, prepared according to the formula in the American Dispensatory, one or two tea-spoonfuls every hour, and, if necessary, add four or five drops of laudanum, or its equivalent in paregoric, to each dose, till relieved. In this early stage, opium in small doses may be given four or five times, but should not be continued. These remedies, properly administered, will control the great majority of cases.

If, however, the diarrhoea be uncontrolled and vomiting ensue, the recipe on page 189 will be found very efficient, and should be perseveringly administered till relief is obtained. It is prepared as follows: Chloroform, two drachms; spirits of camphor, one drachm; essence of monarda (or horsemint), three drachms; tincture of prickly-ash berries, two ounces; fluid extract of rhubarb and potassa, four ounces--mix. Give from one-half to one table-spoonful every half-hour, hour, or two hours, according to the urgency of the symptoms and the stage of the disease. This remedy is well adapted to every stage, and may be used in collapse as an injection, combined as follows: Take of the above mixture two table-spoonfuls, and add to it tincture of prickly-ash berries, two table-spoonfuls; laudanum ten drops; warm water, six table-spoonfuls--mix, and inject up the bowel. This injection should be repeated as often as required. In some desperate cases it has been repeated many times and the patients saved.

Wherever the disease prevails, all discharges from cholera patients should be promptly disinfected and disposed of. Bedding, linen, water-closets, cesspools, etc., should be thoroughly disinfected and renovated, so that no germ may remain to propagate the disease.

FORMULÆ

FOR SOME OF THE PREPARATIONS USED IN THE ABOVE RECIPES.

GREENHOW'S AROMATIC TINCTURE OF GUAIACUM.--Take of guaiacum, cloves and cinnamon, each, in powder, one ounce; best brandy, two pints. Macerate for fourteen days and filter.

Dose.--From a tea-spoonful to a table-spoonful, in sweetened water, every fifteen or twenty minutes.--Am. Dis.

COMPOUND CAJEPUT MIXTURE--HUNN'S DROPS.--Take of oils of cajeput, cloves, peppermint, and anise, each, one fluid ounce; rectified alcohol, four ounces. Dissolve the oils in the alcohol.

The ordinary dose is from ten drops to half a tea-spoonful; to be given in simple syrup, mucilage of slippery-elm, or in hot brandy and water sweetened.--Am. Dis.

FLUID EXTRACT OF RHUBARB AND POTASSA.--Take of the root of the best India rhubarb, in powder, and bicarbonate of potassa, of each, one ounce; cassia or cinnamon, and golden seal, in powder, of each, half an ounce; boiling water, one-half pint. Macerate the roots and seeds for an hour; strain and dissolve the potassa in the strained liquor when nearly cold, and add one gill best brandy; essence of peppermint, one tea-spoonful, and refined sugar, two ounces.

Dose.--From one to two tea-spoonfuls as often as necessary.--Am. Dis.

TINC. XANTHOXYLI, or Tincture of Prickly-ash Berries.--Take of prickly-ash berries eight ounces; diluted alcohol, two pints. Form into a tincture by maceration, or displacement, and make two pints of tincture.

The ordinary dose is twenty or thirty drops. In cholera, from a tea-spoonful to one or two table-spoonfuls, according to circumstances.--Am. Dis.

TINCTURE OF OIL OF MONARDA--Essence of Monarda, or Horsemint.--Take of oil of horsemint one fluid ounce; alcohol, nine fluid ounces, Imp. Meas. Mix with agitation.

Dose.--From ten to twenty drops on sugar, or in sweetened water.--Am. Dis.

ELIXIR OF OPIUM, prepared on the base of Dupuy's formula is less objectionable as an ingredient in recipes for an advanced stage of cholera than other preparations of that drug.

FOOTNOTES:

Transcriber's Notes:

Passages in italics are indicated by underscore.

The tables have been equalized as good as possible.

Rx. is used for Prescription.

There are diacritical marks in the text, they are marked as [=a] which represents a marcron (straight line) above the a.

Fractions are displayed as follows: 1/4 correlates with one-fourth, 1/2 correlates with on-half, 1-1/2 correlates with one and a half....

The following words have been retained in both versions:

formula (pages 73, 136, 157, 189, 194, 196, 198, 211 and 214), formulas (pages 76 and 87) and formulæ (pages 8, 138, 142 and 213)

ether (pages 123, 138, 193 and 195) and æther (pages 73, 139, 197 and 199)

spoonful and spoonsful (various occurrences in the text)

Other than the corrections listed below, printer's inconsistencies in spelling, punctuation, hyphenation, and ligature usage have been retained.

The following misprints have been corrected:

changed "December, 805; making a total in" into "December, 805"; making a total in" (page 9)

changed "principle of a specific disease--poison." into "principle of a specific disease-poison." (page 13)

changed "violent and fatal whereever it appeared." into "violent and fatal wherever it appeared." (page 27)

changed "cholera in 1832, at Cataria; in Palermo, 40,000." into "cholera in 1832, at Catania; in Palermo, 40,000." (page 32)

changed "In Bassorah and Bagdad, situate in low, unhealthy" into "In Bassorah and Bagdad, situated in low, unhealthy" (page 32)

changed "In the Province of Caucassus, out of" into "In the Province of Caucassus, out of" (page 32)

changed "phenomena, for numorous cases of" into "phenomena, for numerous cases of" (page 47)

changed "The slight, painless diarrhoeea, depression of" into "The slight, painless diarrhoea, depression of" (page 57)

changed "be withheld. This pecnliar icy coldness" into "be withheld. This peculiar icy coldness" (page 59)

changed "urinary secretion and micturation entirely" into "urinary secretion and micturition entirely" (page 60)

changed "the second or febrile stage. The former is" into "the second or febrile stage." The former is" (page 61)

changed "spent in the gradual introducion of the" into "spent in the gradual introduction of the" (page 69)

changed "Other methods of restoring warmth were had" into ""Other methods of restoring warmth were had" (page 71)

changed "when on the march:"" into "when on the march:" (page 73)

changed "philosophy of such eminent surgeon, as" into "philosophy of such eminent surgeons, as" (page 88)

changed "Medical Bureau in the departmnet of India, whose" into "Medical Bureau in the department of India, whose" (page 89)

changed "opium, accompanied with sinipisms, and hot, stimulating" into "opium, accompanied with sinapisms, and hot, stimulating" (page 110)

changed "if it remainun subdued by" into "if it remain unsubdued by" (page 112)

changed "PATHOLOGICAL TREATMENT--First Stage: This consisted" into "PATHOLOGICAL TREATMENT--First Stage.--This consisted" (page 132)

changed "the medicines which I would prefer:" into "the medicines which I would prefer:"" (page 138)

changed "Aromatic Spirits Amomnia," into "Aromatic Spirits Ammonia," (page 139)

changed "It was a sudden and severe, case and" into "It was a sudden and severe case and" (page 143)

changed "are camphor, cuprum metalicum, and veratrum." into "are camphor, cuprum metallicum, and veratrum." (page 152)

changed "may be given. This is prepared" into "may be given." This is prepared" (page 161)

changed "administered in tea-spoonful does in hot, sweetened" into "administered in tea-spoonful doses in hot, sweetened" (page 161)

changed "unfold the process of d seased action, and, as" into "unfold the process of diseased action, and, as" (page 167)

changed "in that of Mishni Novogorod," into "in that of Nizhni Novgorod," (page 172)

changed "in Moscow and Kasan," into "in Moscow and Kazan," (page 172)

changed "During the prevalence of the cholora in 1832, the physician" into "During the prevalence of the cholera in 1832, the physician" (page 182)

changed "Rx Chloroform, (sq.,)" into "Rx. Chloroform, (sq.,)" (page 189)

changed "M. S.--From dram j. to ounce ss. every half-hour," into "M.--S.--From dram j. to ounce ss. every half-hour," (page 189)