^LIBRARY OF CONGRESS.! 
 
 [FORCE COLLECTION.] 
 
 f UNITED STATES OF AMERICA. { 
 
 m 
 

THE 
 
 PATHOLOGY AND TREATMENT 
 
 OF 
 
 CHOLERA: 
 
 WITH AN 
 
 CONTAINING HIS LATEST INSTRUCTIONS 
 
 TO PLANTERS AND HEADS OF FAMILIES, 
 
 (remote from medical advice) 
 
 IN regard to its 
 
 PREVENTION AND CURE, 
 
 BY SAM'L A. CARTWRIGHT, M, D. 
 
 NEW ORLEANS: 
 
 PRINTED AT SPENCER & MIDDLETON'S " MAGIC PRESS" OFFICE. 
 No. 89 Magazine street. 
 
 1849. 
 
u 
 
 ^ 
 
 
PREFACE. 
 
 The demand from physicians, medical students, planters and 
 other persons, upon the Author for his views on Cholera, has been, 
 and is yet, so great, that the present publication is forced upon 
 him, it being impracticable to answer all the inquiries in any other 
 way than through the press. It was intended for publication in 
 the New Orleans Medical and Surgical Journal, but from some 
 inadvertency was passed over in making up the July number. To 
 wait for its appearance until September, would be too late, as the 
 remedies, recommended by the author, are at the present time in 
 very extensive use in the south and west; and hence many errors 
 and fatal mistakes may be avoided by an immediate publication of 
 the necessary directions and an exposition of the principles which 
 should govern the treatment. An explanation of the modu* 
 operandi of the remedies advised, and the pathology of the 
 complaint they are intended to cure, will not only lessen the evils 
 to be apprehended from their empirical employment, but do some 
 good in preventing the indiscriminate use of other medicinal agents 
 likewise. The present paper is intended for medical men-not 
 for sophomores or pretenders, but for intelligent and well read 
 members of the profession. But as Cholera is a disease in which 
 the most skilful physicians need help, in the initiatory treatment, 
 until their personal attendance can be procured, just so much pub- 
 lic information is given in the present paper, and particularly m 
 the Appendix.aswas thought necessary to guard against panic and 
 to instruct the patient to give the required help ; by taking the 
 medicine first and sending for the doctor afterwards. In eommu- 
 
4 PREFACE. 
 
 micating enough of medical information to enable non-professional 
 persons, in the absence of a physician, to begin the treatment in 
 Cholera, the Author expects to incur the censure of those, whom the 
 vanity of a little medical reading has led into the error of supposing 
 that their skill can compensate for the time lost in procuring their 
 advice. The present publication is due to the students of the Lou- 
 isiana Medical College, who repeatedly requested the Author for 
 his views on the subject : It is also due to upwards of six hundred 
 medical students of the Schools in St. Louis, Louisville and Cin- 
 cinnatti, who expressed to him personally, in a recent visit to those 
 cities, a desire to see his views in extenso on the pathology and 
 treatment of the disease, and handed in their names and address: 
 It is due to a great number of physicians, students and other per- 
 sons, scattered throughout the Union, who, since the publication of 
 Secretary Walker's letter, giving an account of the great success 
 of the Author's treatment of the Cholera in 1833, have written to 
 him for further information : But more than all it is due to the 
 medical public, that a plan of treatment, which, in the hands of a 
 number of other persons besides the Author's, has succeeded in 
 curing about ninety-nine in a hundred, when putin practice prior to 
 the failure of the pulse from h e cholera action, should be made 
 known and no longer criticised, subro$d,by those who cannot rea •"*, 
 their diplomas, but go forth to the profession at large, while the dis- 
 ease is prevailing so extensively in different parts of the Union, to be 
 tried on its merits, without waiting for it to disappear before the 
 Author's method of treatment is vindicated from the charge of 
 empiricism and its rationale explained. 
 
 New Oreeans, July 9th, 1849. 
 
THE PATHOLOGY AND TREATMENT 
 
 OF 
 
 CHOLERA. 
 
 » 
 
 hJitltl V uT' Mke GVery thin « e!se ""Perfectly known, 
 
 las Si ? CtS ' S °° n ^ ks & PP earance * ** <%' 
 
 las _ wmter, the wnter left Natchez and repaired hither to meet it 
 on th e out . postg; wherehe hag ^^ ^^ ^ _» ^ ^ ^ 
 
 mer experience m regard to its nature and treatment, both by con- 
 ternng with his medical brethren, by observing and treating it in 
 fbrT 6 P r C ^, e ' by eMmini »W ^e disease and the remedies used 
 of nl!" the f Charity Hos P itaI ' ^d h witnessing a great number 
 ZITL n eXaminati0DS * c holera subjects, made by the 
 
 cTof f ? anatomists » a " J Penologists of the city. A multipli- 
 c.ty effects in re-rd to it has thus been ascertained; bat much 
 of what has been brought to light is inconsistent or irrecon ikbTe 
 
 ash m f better systematized and their harmony discov- 
 ered. It is too common m Medicine, as in other sciences for ob 
 
 =:; ° as? a wh ser r ions which ~" 
 
 — ce, in ^ .£S&SS^*5£ 
 
 ZZZn ag tr n ° ther; -'—ng block is thust'Zwn ^ 
 the path of knowledge, causing great numbers to fall into u m J t t 
 
 •« - • lhe & reat mas s of the votari^ nf 
 
 -ence, m trymg to reconcile contradictory truths by idle l put a 
 fons or mgemous logic, stumble on the very borLs f TeS 
 
C TIIF. PATHOLOGY AND TREATMENT OF OHOl.ERA. 
 
 knowledge, 'and never become profitable laborers in any «"«P^ 
 ed field of science. A s there are a great many irreconcilable facts 
 -irreconcilable to oar intelligence, In every science-chanty be 
 highest virtue in morals, is the highest wisdom in »«»™£ ? £ 
 th ; hey to unlock the door to pracica, knowle^e **-* 
 the inquirer after truth cannot ent or, b ^f^ re . Our 
 wilderness of controversy, where no go»d fruits matur 
 knowledge at first, is confined to isoUted facts each o fwto* 
 should sfand on its own evidence, wither it can be i"°-££<£ 
 other facts or not. To harmonize or discover the relaUa as be 
 tween apparently contradictory things, is often —naWe after 
 the greatest minds have devoted a lifetime to the subject. Whereas 
 the evidence on which eachalledged fact rests is open to all, and 
 requires V* little time to ascertain whether it be a fact or not. 1 
 should not therefore be rejected because it clashes with any ot her 
 known fact, as v Ws would be tantamount to rejecting he exper 
 ence of others, because it does not tally with our own, but should 
 be received or rejected wording to its own mtr inst f^ 
 Many important facts connecW with the subject of Cholera have 
 been uncharitably rejected, without hearing or an e— m 
 f the evidence on which they are p*** merely *««£** 
 nt V.e reconciled with other facts already known, bucn a pro 
 cannot be "**>™*? after truth> by rejecting truth 
 
 £lt£££TS£. 1 further progress in knowledge, 
 
 Ind eadl to unprofitable disputations. Every physinan therefore, 
 
 d2ous of advancing the interests of his profess.on and profit.ng 
 
 bXxperience of his medical brethren, should practice sufficient 
 
 cLd v towards them to give their experience a fair hearmg and 
 
 an Z^ examination, whether it comports with h,s own ex- 
 
 ' an mp t rharitv is a virtue whose cultivat.on not only 
 
 penence or not. Charity is a v cultivated, 
 
 »l^ the heart better, but the head wiser. If moi e culm ateo, 
 
 make, the ^ hear, b , pro f e ssio„, and its progress in 
 
 there would be less d,seor p ^ ^ ^^ 
 
 S^SSJSS^-*- true science; the ,atter 
 I dilate wUhoIt the former, and is ^^a^ 
 gross ; improvements being arrested at every step by Inckenn, 
 
THE PATHOLOGr AND TREATMENT OF CHOLERA. 7 
 
 and contentions. The profession not only suffers from the un- 
 charitableness of its members towards one another, but also from 
 the uncharitableness of the public towards the profession. A great 
 many remedies, apparently the most opposite in their properties, 
 have been recommended as curative agents in Cholera. A large 
 portion of the public, taking a narrow view of the subject, errone- 
 ously conclude that t'ne whole science is a humbug or the most pre- 
 carious and uncertain in the world, or the regular physicians would 
 not pursue such opposite courses of treatment for the same disease. 
 Their faith being shaken in the regular science by their incorrect 
 reasoning, they are too apt to fly to quacks for relief, forgetting 
 that if Medicine proper, be a humbug, quackery must be a great- 
 er ; because the remedies it proposes for the cure of disease are 
 more multifarious than those of the regular physicians. The great 
 truth, that Nature has provided more ways than one, to arrive at 
 the same end, the restoration of health, is not considered or under- 
 stood by many of those, who, accustomed to «b an end reached 
 only in one way, unphilosophically concise, that all those, who 
 assert that the same end has and «*n be reached by other ways, 
 are deceivers or the advocates of false doctrines. They 
 cannot reconcile other methods of treatment with their own, 
 and reject them without further examination, on the ground of ir- 
 reconcilibility with the truths taught by their own experience ; the 
 apparent contradictory experience of others being rejected without 
 a hearing or an examination of the evidence on which it is founded. 
 The error lies in limiting the science of Medicine to one remedy 
 or particular class of remedies for the same disease. If proof be 
 brought, that it is not so poor in its resources as to have but one 
 remedy for a disease, they reject it altogether, sooner than give up 
 the contracted view they took of it. They cannot see the truth 
 because it stands m opposition to erring reason, and tells of cures 
 by opposite means, which their contracted theory cannot explain 
 It is as unwise to lose faith in Medicine because it affords various 
 and apparently opposite remedies for the treatment of Cholera as 
 it would be to reject it because it affords various, and to all ap- 
 pearances, directly opposite remedies for the cure of burns and 
 
A 
 
 THE PATHOLOGY ANt) TREATMENT OF eHOLESA, 
 
 scalds, Those, who have only witnessed the good effects of cool- 
 ing, soothing and emolient applications in burns, would be apt to 
 deny the fact that the application of such a heating, exciting and 
 inflammatory a substance as spirits of turpentine to surfaces, raw 
 and inflamed by fire, could ever produce any good effect, or be en- 
 titled to the consideration of a curative ao*ent. The admission of 
 such a fact would be tantamount to an acknowledgment of 
 ignorance, the very last thing for th<5 ignorant to acknow- 
 ledge. If it be humiliating to professional pride to admit 
 that there are so many curative agents for burns and scalds, 
 the Cholera and numerous other diseases, whose apparently 
 contradictory characters, actions and properties cannot be 
 scientifically explained, it should elevate, instead of lower, that 
 noble science in public estimation, that has so many opposite 
 and various resources for the relief and cure of the infirmities in- 
 cident to humanity. Yet because the resources of the science of 
 Medicine, for the cure of Cholera and many other diseases, cover 
 a larger field than the trj e of reason can scan, there are many who 
 distrust it on account of this very perfection, and view the regular 
 medical profession with suspicion, forego its advantages, and are 
 brought to untimely graves with curable diseases, in the triumph- 
 ant car of empiricism, gilded with their own gold. 
 
 They are the victims of a false philosophy, founded upon their 
 own limited views of things, their own experience, or the pretend- 
 ed experience of a few designing men, in opposition to the enlarged 
 experience of the civilized world. Every newspaper they open, 
 inculcates this false philosophy in the shape of captivating quack 
 advertisements. They have not charity enough for the regular 
 medical science to examine the evidence on which it stands. They 
 perceive that different doctors prescribe different remedies for the 
 same complaint, and often call it by different names, and they re- 
 ject the whole, because they cannot understand why this should be 
 so. They do not consider which is the most likely to be right, the 
 accumulated experience of ages, concentrated in the regular medi- 
 cal profession, or the ephemeral and limited experience of quacks 
 and impostors ? The quack publishes remedies for nearly all dis- 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 9 
 
 <eases, professing to rest on his own experience or that of a few- 
 others ; they enrich the quack by purchasing his remedies, and 
 forego all the advantage the world's experience could afford them. 
 
 More quack medicine is consumed in the Mississippi Valley than 
 all the medicine prescribed by physicians. Medical statistics prove 
 that increased mortality and quackery go hand in hand together. 
 Besides the individual quacks, each of whom sets up his experience 
 in opposition to the experience of the world, there are of late years, 
 many associations of persons calling themselves doctors, who set 
 up the experience of the association in opposition to all that of all 
 the world before them. 
 
 Of this class are those associations of individuals, who profess 
 to cure all diseases by steam, by cold water, or by infinitismal 
 doses. They all unite in bringing prominently forward the appa- 
 rent discrepancies and contrariety of remedies of the regular medi- 
 cal profession, as an argument in favor of their professed simpler 
 and more certain method ; alarming the public by telling of the 
 failures of the regular physicians, but saying nothing about their 
 more numerous cures. All of which has a tendency to confuse and 
 unsettle the public mind on the subject of Medicine, particularly 
 when the fears of the people, from the presence of the Cholera or 
 other epidemic, get the better of their judgment. It is this distrust 
 and want of confidence in Medicine as a science, that quackery of 
 all kinds takes so much pains in disseminating by the press and 
 every other available means among the people, at every visitation 
 of Cholera or other epidemic malady, that opens a market for the 
 sale of nostrums and pretended specifics ; and if physicians refuse 
 to publish methods of cure, they are denounced as being selfish, or 
 having no knowledge to communicate, or no love for the people. 
 The unhinging of public confidence in the medical profession in 
 times of alarm from an epidemic, when its services are the most 
 needed, is attended with much worse consequences than that of 
 creating a harvest for quacks, as it deprives a large portion of the 
 public entirely from the benefits to be derived from past experience, 
 concentrated in the medical profession; or if they avail themselves 
 of that experience, it is often too late, having lost much precious 
 
I 
 
 10 THE PATHOLOGY AND TREATMENT OF CHOLERA. 
 
 time, in the first instance, in trying experiments with nostrums, 
 coming recommended to their notice — not in the massive tomes of 
 a science as old as civilization — but with no higher recommenda- 
 tion than that of newspaper puffs and advertisements, published at 
 the instauce and at the expense of the empirics themselves. 
 
 What is the main ground upholding quackery ? It is no other, 
 than because a science, as old as civilization, and which had arri- 
 ved at great perfection long anterior to the Christian era, and cul- 
 tivated and improved in every country where civilized man has 
 dwelt, has more than one way of curing diseases. 
 
 The abundant resources of the medical science, instead of being 
 arguments in its favor, are brought forward to prove its imperfec- 
 tions and to shake public confidence in it. Some of their principal 
 remedies denounced as poisons in almost every newspaper, and 
 even the Science itself distrusted of doing more harm than good, 
 or of being something no better than antiquated nonsense, physi- 
 cians work to great disadvantage during the prevalence of any 
 wide spread epidemic. Their advice is either not followed, or 
 followed with hesitation and reluctance. Often it is not asked for 
 at all except in desperate cases. They get no credit for success, 
 if they cure, and all the blame if the patient dies ; and if two or 
 more physicians effect cures by different or apparently opposite 
 means, so far from getting credit for it, these very cures are ad- 
 duced in proof that there is nothing really true or useful in the 
 science, or that the cures were not effected by the means used, 
 because the means were opposite or different in the same disease. 
 There are not wanting many medical men, who are led gradually, 
 by such false reasoning, to doubt the healing powers of the science 
 they profess, and to disbelieve the evidence of their own senses, 
 because they cannot explain or see the reason why opposite reme- 
 dies should produce similar results. They sooner believe that they 
 produce no effect at all or no good effect, rather than give up some 
 cherished theory. Thus, those physicians, who have seen much 
 good by the application of molasses or some other emollient and 
 soothing application to burns, and having conceived a narrow the- 
 ory, that every thing else, applied to such affections, except emol- 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. II 
 
 lient and soothing applications, would be useless or pernicious, 
 sooner disbelieve in the good they have seen done, than in the cu- 
 rative virtues of spirits of turpentine, as such a belief would militate 
 against a cherished, but short sighted theory. Again, those, who 
 have witnessed the good effects of ice, bleeding, and the cold 
 water treatment in cholera, and have become wedded to a theory, 
 that it depends on an inflammation of the stomach, (making every 
 thing inadmissible, but cooling and soothing things,) are not pre- 
 pared to believe in the virtue of large doses of such a heating 
 thing as capsicum or red pepper, as one of the best remedies in 
 that disease. They will not believe in the facts of its curative 
 virtues, because the facts are in opposition to their theories, or 
 rather to their prejudices. All prejudices are nothing more than 
 short sighted, narrow, contracted theories, built upon a few facts, 
 without taking in the whole. The theory or prejudice, of medical 
 men against the pepper family of plants, in acute diseases, is 
 of modern origin, not two centuries old, and has been derived 
 from the north of Europe — a cold region, where the diseases are 
 inflammatory, and the heating spices injurious. On the other 
 hand, the facts in favor of their medicinal virtues, are spread over 
 an extent of country ten times as large, and extend through a 
 period of 2000 years. 
 
 From Hippocrates to the time when the Edinburg school was 
 founded, is upwards of 2000 years, yet the virtue of pepper during 
 all that time, was admitted. It entered largely into the compo- 
 sition of all the celebrated compounds for the cure of plague, 
 and conjestive diseases of southern latitudes. Even after the 
 revival of learning, no less than twenty medical works were writ- 
 ten, by as many different authors, on the virtues of a compound, 
 which forms the basis of my prescription for cholera. That com- 
 pound contained no less than three different kinds of pepper, 
 the white, the black and the red. In 1571, Josephus, Valdanius 
 of Brescia, wrote a work on its virtues in pestilential fevers. — 
 De Onis, of Venice, in 1576 ; Stelliola, of Naples, in 1577 ; 
 Eugubino, of Ferrara, in 1597; Fontaine, of Avignon, south of 
 France, 1601 : Gasparis, of Rome, 1640; and many others too 
 
12 THE PATHOLOGY AND TREATMENT OF CHOLERA. 
 
 tedious to mention. The composition, besides the peppers, con- 
 tained many antispasmodics, which might be well represented by- 
 gum champhor. For the purgative ingredient, the white agaric, 
 a slow but sure cholagogue, calomel is an excellent substitute. 
 
 The white agaric and red pepper have been found to be the best 
 remedies for a disease, very much like cholera, prevalent in the 
 Alps, and supposed to be caused by swallowing leeches. The 
 white agaric may be said to be the calomel of the Alps, as it is 
 used on almost all occasions, as we use calomel or blue mass. 
 
 The composition above referred to, also contained some opium, 
 and a number of plants, which have been lately analyzed in Paris, 
 and erected into a natural family, under the generic name of 
 cinch oniacioe, from the fact of their yielding a substance like 
 quinine. Yet that celebrated composition, which formed one of 
 the principal staple commodities of the great city in the Adriatic, 
 was expunged from the Edinburg Dispensatory, less than a cen- 
 tury ago, because it contained ingredients too heating for that 
 high latitude ; but worse than all, the Edinburg theorizers could 
 not explain its action on the human system, and rejected it on 
 that score. But they have not yet explained all the difficulties 
 and mysteries hanging over a single blade of grass. Until they 
 do so, we, of the South, should be cautious in sanctioning the re- 
 jection of medicinal agents, which the experience of twenty cen- 
 turies, in a climate similar to ours, has proved to be valuable in 
 the treatment of many diseases incident to southern latitudes. 
 
 I claim not to be an experimenter or innovator in Medicine, but 
 only the reviver of a practice, having the highest medical author- 
 ity to sustain it — the authority of twenty centuries — the practice 
 of combining pungent aromatic stimulants with antispasmodics 
 and purgatives. In setting forth this practice to the consideration 
 of the profession, it is not my i^ention to call in question the 
 practice of others differing from mine. There is more than one 
 way of reaching the same end. Among the various plans of 
 treating cholera, some may be good, others better, or best. But 
 good, better and best, are only relative — what is best for one case 
 may not be best for another. Much, therefore, must be left to the 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 13 
 
 judgment of the practitioner in adapting the most suitable plan 
 to each case, as it occurs. No one plan can he best in all cases ; 
 because the constitution of the patient and the circumstances sur- 
 rounding him, are not the same in all cases. With these remarks 
 I pass on to give an expose of the general plan of treatment in 
 cholera, which my experience has proved to be the most successful, 
 together with its rationale, and the pathology of the disease. In 
 justice to others, who pursue a different method, I must state that 
 I have not tried all the plans of treatment that have been pro- 
 posed, nor the half of them ; consequently I do not know whether 
 my method is the best of all or not. It is only the best among 
 those I have tried. I am satisfied with it however, believing that 
 if it be not the best, it is a very good one ; and all I ask is an im- 
 partial and unprejudiced hearing. 
 
 Like fire, the cholera is easy to subdue in the spark, but soon 
 becomes uncontrolable and destructive, if let alone or improperly 
 tampered with. No skill in physic can be depended upon to repair 
 the damage caused by delay. Anything to smother and keep it 
 in check, is better than nothing, until the personal attendance of 
 a physician can be procured, even if the treatment be not the best 
 the case admits of. The cholera, like a wild horse, should be put 
 in strong harness from the first. Inefficient doses cannot be re- 
 lied on. More deaths have occurred from trifling with the 
 diarrhoea, by inefficient doses and quack nostrums, than from any 
 other cause. I treat both the cholera, and what are improperly 
 called its premonitory symptoms, in the same manner. By one 
 or more efficient doses of medicine, given as soon as possible, 
 viz : 20 grains capsicum or Cayenne pepper, 20 grains calomel, 
 or hydrargyria cum creta, 10 grains gum camphor, 15 
 gum Arabic and the same of calcined charcoal mixed together, 
 and given at one dose. Two table spoons full of cold water, being 
 the best vehicle. The end of a towel or napkin, wet in cold 
 water, and inserted into the mouth, immediately after swallowing 
 the medicine, will remove the burning, pungent seasation in the 
 mouth, and also prevent vomiting. Much water, drank after 
 taking the medicine, is apt to cause vomiting, and is less effectual 
 
14 THE PATHOLOGY AND TREATMENT OF CHOLERA, 
 
 in allaying the burning sensation, felt in the mouth and fauces, 
 than the wet napkin. If the above composition be vomited, 
 another should be given, or half doses, if only a part be, 
 until at least one full dose is retained on the stomach. Then 
 little sips of some aromatic teas, as chamomile, mint, cinnamon, 
 &c, to determine to the surface. If the skin be cold, or the feet 
 and hands, besides mustard externally hot salt in bags or hot 
 bricks, or bottles filled with hot water, applied around the patient, 
 will assist in starting a perspiration. As soon as the skin gets 
 warm and moist, the drinks should be given more freely, and 
 the hot applications removed entirely. Fresh, cool air to be ad- 
 mitted in the room from the commencement. As soon as the 
 patient begins to sweat freely, warm drinks to be given freely, 
 or cold drinks if the patient prefers them. It is not necessary 
 then, that the drinks should be stimulating or pungent : warm 
 water itself, will not vomit when a revulsion is made to the sur- 
 face by the sudorific powder just mentioned, and a perspiration 
 induced. 
 
 The hungry absorbents take up instantaneously any bland liquid 
 and carry it into the circulation to replenish the loss of the serous 
 or watery parts of the blood, occasioned by the disease. 4 The wa- 
 tery fluids, taken into the stomach and carried into the circulation, 
 will be a sufficient stimulant. It is unnecessary then, that the fluids, 
 drank after the perspiration begins to flow, should be impregnated 
 with aromatics or stimulants, as brandy, pepper, &c, except to give 
 them an agreeable taste. Bland drinks — as gruel, chicken water, 
 beef tea, fyc, are better. The perspiration to be kept up from six 
 to twelve hours. This sweating process does not exhaust, but 
 strengthens, if the patient be freely supplied with diluent drinks. — 
 The discharge from the external surface, makes the absorbents 
 opening on the internal surface, greedy of all drinks taken into the 
 prima via — and thus the blood vessels are refilled and the neces- 
 sary fluidity to the blood restored. 
 
 Formerly I was in the habit of giving some purgative to work off 
 the above mentioned medicine. Subsequent experience has pro- 
 ved it to be unnecessary, as the medicine works itself off the next 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 15 
 
 day ; if retained longer than twenty-four hours, and the blood has 
 regained its aqueous constituents, some simple purgative or enema 
 might be necessary to prevent the calomel from salivating, by re- 
 maining too long in the system. I found it not often neces- 
 sary to give opium, laudanum or morphine. The combination of 
 pepper, calomel, camphor, charcoal and gum arabic, has the same 
 power in arresting a rice-water vomiting, or purging, that calomel 
 and opium have in arresting a bilious vomiting and purging. 
 
 For all thin large evacuations from the bowels of a light color, 
 or destitute of bile, whether the disease be cholera, or congestive 
 fever, or any other complaint, the above combination is the most 
 effectual medicine that can be used. This I regard as an axiom 
 in Medicine of great practical importance. 
 
 No consecutive fever follows the above treatment. If opium, 
 in any form, be used, consecutive fever is very apt to occur. It is 
 almost sure to do so if some medicine to restore the abdominal 
 circulation through the liver, be not used. But I use opium or 
 morphine, very freely in those cases, where the above mentioned 
 combination cannot be retained on the stomach. Instead of re- 
 peating the powders, when the stomach is too irritable to retain 
 them, the morphine or opium should be substituted for them — For 
 instance, half a grain of sulphate of morphine, dissolved in two 
 tea spoons full of camphor water, and given after every spell of 
 vomiting, or every operation on the bowels, will be found an ex- 
 cellent remedy in such cases. If opium or morphine be given at 
 all in cholera, it should be in decided doses, three or four-fold 
 the ordinary dose. As much as a grain of morphine, or 4 or 5 
 grains of the best opium have been given at a dose without nar- 
 cotizing the system. A little strong coffee should follow the use 
 of opium — also, calomel or hydrargyrus cum creta, or blue mass, 
 to act on the liver. Large opiates do not lock up the liver like 
 smaller doses of that drug. It is very important not to purge too 
 soon — a sufficient time should elapse for the watery parts of the 
 blood to be restored before the bowels be operated on, otherwise 
 there is danger of prostration. 
 
 The method I have adopted in treating cholera does not differ 
 
16 THF PATHOLOGY AND TREATMENT OF CHOLERA. 
 
 materially from that which Sydenham found to be the most success- 
 ful in the plague of London, in 1666. Nor does Sydenham's 
 prescription for the plague differ much from that which the ex- 
 perience of the preceding 2000 years, proved to be the most effi- 
 cacious in the cold, congestive diseases, (under the name of 
 plague and epidemics,) that have, from time to time, afflicted 
 mankind. The remedy, proved by experience to be the most 
 successful in all such affections, consisted of a combination of aro- 
 matic, pungent stimulants, with antispasmodics and a slow 
 purgative. 
 
 The peppers, both red and black, invariably entered into the 
 composition of every one of them. The white agaric, a slow 
 drastic cholagogue, performed the same office in the theriacas, 
 alexipharmics, and the various compositions for treating poison 
 and pestilence, that the calomel or chalk mercury does in the com- 
 bination which experience has proved to be so successful in cholera. 
 
 The camphor in the cholera powders, does the same that the 
 various balsams and antispasmodics of the old prescriptions for 
 plague were intended to do. Such prescriptions were necessarily 
 complex, because the irritating, drastic cholagogues then in use, 
 required the addition of opium to correct their action, and there- 
 fore a number of other articles were thrown in to correct the 
 effects of the opium ; for instance, its tendency to check the renal 
 secretion required the addition of diuretics to counteract that 
 effect. 
 
 In cholera the kidnies cease to a:t from a deficiency of arterial 
 blood. The venous system is phis, and the arterial system minus, 
 as far as the systemic circulation is concerned. In the lungs, the 
 reverse Is the case. The arteries plus and the pulmonary veins 
 minus ; because, in the pulmonary circulation the veins circulate 
 the red, and the arteries the black blood. I will not refer to the 
 post-mortem examinations I have made in cholera on its former 
 visitation, or to those made by physicians out of the city of New 
 Orleans, because it is not worth while to go abroad for facts, 
 when we have all the facts much clearer made out at home. — 
 Instead of the physicians of New Orleans looking to those of 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 17 
 
 other cities and countries, to learn the pathology of the disease, 
 it is time for them to say to their medical brethren elsewhere, 
 " Follow us," and to assert the right of the Crescent City to 
 take the same high rank in Medicine, she already has in commerce. 
 She has all the elements to become as great in that as she is in 
 this. Hence it is unnecessary to quote books to prove, from the 
 post-mortem examinations made in other cities, what the scalpels 
 of our own anatomists have demonstrated every day, for months 
 in succession, and which so many physicians of this city either 
 made or witnessed, to whom, I beg leave to refer as authority for 
 the following facts, revealed by dissections in their presence : The 
 great venous trunks were found turgid with a thick black blood, 
 and the pulmonary arteries filled with the same grumous fluid. The 
 pulmonary veins going to the left side of the heart, comparatively 
 empty, as also that side of the heart and the whole arterial sys- 
 tem every where, except the pulmonary arteries. In every*cavity, 
 a fluid like rice water, was discovered — in the kidnies, in the blad- 
 der, in the uterus, and even in the fallopian tubes. The spinal 
 column and cranium contained a great excess of serum. The 
 exhalent arteries of all the membranous surfaces had parted with 
 the serous portion of the arterial blood contained in them, in the 
 shape of a rice water exudation, bedewing the surface of the 
 membranes to which they are distributed. 
 
 The fluid parts of the blood having escaped, the fibrine and 
 red globules remaining, gave to the membranes that peculiar 
 leaden or stone color, so conspicuous in the mucous coat of the 
 intestines, and invariably present in all the numerous post-mortem 
 examinations. But in the bowels, another source of rice w T ater 
 was detected, besides that derived from the capillary arteries. — 
 The thoracic duct was found empty, the great trunk of all the 
 absorbents, and the bowels contained a substance bearing the 
 chemical characteristics of blood in every particular, except color. 
 Where did this white blood come from? The empty thoracic duct 
 is in proof that it had poured back its contents by a retrograde 
 action into the alimentary canal, that the absorbents had actually 
 vomited back the constituents of the blood into the prima via, 
 
13 THE PATHOLOGY AND TREATMENT OF CHOLERA. 
 
 instead of carrying the same to the right side of the heart. It could 
 not get to the heart, because the heart was full, and the vena cava 
 and subsclavian in a state of utmost destention from the conges- 
 tion of venous blood therein, which could not move through the 
 lungs. Deprived of the stimulus of the chyle, the blood in the 
 heart underwent decomposition, and the febrine separated from 
 the mass in the shape of oyster-like polypous substances, which 
 the scalpel revealed to the eye and touch. The knife revealed 
 the fact that the circulation in the liver had been suspended 
 from the same cause. The blood from that organ could not be 
 poured into the cava and heart, already full ; the right side of 
 the heart could not empty itself, because the pulmonary arteries 
 were full, and the pulmonary veins contained no red blood. 
 
 What they did contain was carbonaceous, like venous blood. 
 The scalpel in the hands of such men as Stone, McCormick, 
 Dowler, Wederstrandt, Smith and others, has shewn us all that 
 post-mortem examinations can probably teach. Many of the 
 New Orleans physicians have witnessed Dr. Dowler's experi- 
 ments on the living subject afflicted with cholera — the same indi- 
 vidual who has immortalized his name by the discovery of an un- 
 known law of contractibility by which the power of muscular motion 
 can be restored for a time to the dead subj ect. The thermometer on 
 the tongue applied by the learned doctor indicated a diminution of 
 animal heat, below the healthy standard, from fifteen to twenty de- 
 grees. This diminution of vital heat is evidently owing to the 
 morbid cause of cholera, whatever it may be, enervating the 
 brain and nerves, as poison does, diminishing the combustion in 
 the lungs, causing a deficient arterialization of the blood, and a 
 diminution of animal heat as a consequence. It is the caloric given 
 out by the combustion in the lungs, which impels the blood through 
 the pulmonary veins to the left side of the heart. True, there is 
 not much difference in the sensible temperature of the black and 
 red blood, yet the red blood contains much more caloric in a latent 
 or insensible state — its capacity for caloric being increased by its 
 diminished density and less specific gravity, when compared to 
 black blood. Ether and oil have different capacities for heat. — 
 
THE PATHQLMY AND TREATMENT OF CHOLERA. VJ 
 
 Ether, in a tube, is rapidly propelled forward before its sensible 
 heat is much increased. The same happens to the red blood in 
 the pulmonary veins. The caloric, it receives from the combus- 
 tion in the lungs, propels it rapidly forward towards the left side 
 of the heart in those valveless tubes, called the pulmonary veins, 
 without its sensible temperature being much increased. The cal- 
 oric, given out by the combustion in the lungs, passing into the insen- 
 sible state, from the increased capacity of the red blood for heat, 
 is the reason why the sensible temperature of the lungs is 
 not more exalted, by the great quantity evolved in the met- 
 amorphosis of the thick, carbonaceous blood into a light florid 
 fluid by the process of respiration. It is this latent heat that moves 
 the arterial or red blood through the pulmonary veins to the left side 
 of the heart. This important fact is not yet in our system of phys- 
 iology. It is a newly developed truth, but can be easily demon- 
 strated. When the heat diminishes as in cholera, the motive power 
 of the red blood through the pulmonary veins is diminished also ; 
 at length the pulse ceases to be felt at the wrist, because the blood 
 from the lungs has lost the motive power that impels it into the 
 left side of the heart, and consequently accumulates in the pulmo- 
 nary arteries, stagnating in the right side of the heart, and causing 
 a congestion in the venous system. The absorbent vessels and all 
 the hollow organs fall into a spasmodic or irregular action, as a 
 natural effect of the loss of nervous power, the carbonaceous state 
 of the blood, the deficiency of animal heat and the stimulus of 
 destention, caused by the venous plethora. The venous conges- 
 tion is so great, that the exhalent arteries cannot pour their contents 
 into the distended venous system, and all the albuminous and 
 watery parts escape in the shape of rice water, by a kind of 
 filtering, which the loss of tone greatly favors. 
 
 This being the pathological condition of the system, dif- 
 fusable stimulants are indicated to arouse the failing ner- 
 vous energy, dry heat, externally, is indicated to elicit a flow 
 of blood to the surface, and to promote perspiration. Fric- 
 tions are of use to assist the motion of the blood in the con- 
 gested veins. The use of cold water, as in fainting, is a powerful 
 adjuvant of internal stimulants. By throwing water in drops in- 
 to the face, causes the patient to take fuller respirations and pro* 
 
20 THE PATHOLOGY AND TREATMENT OF ©HOLERA* 
 
 motes the circulation of the blood through the lungs. If Ether 
 or Chloroform be added to the water, the effect is increased. A 
 cool, fresh, circulating atmosphere, for the patient to breathe, is 
 of the highest importance. Such an atmosphere feeds and fans 
 the pulmonary combustion, by supplying a greater amount of oxy- 
 gen in a given bulk of air, thereby promoting the transformation 
 of the black into red blood, and the consequent development of 
 more heat, — the propelling power of the blood from the lungs to 
 the left side of the heart. If the vital power be not too much 
 impaired, blood letting is indicated to remove the plethora of the 
 venous system, and to accelerate its motions through the lungs. 
 The asthmatic, anxious breathing in cholera, as in measles, is 
 often relieved by the lancet, which by taking off a part of the ex- 
 cess, enables the balance to circulate more readily by diminishing 
 the plethora in the system of vessels circulating black blood, and 
 thereby removes the difficulty of promoting a healthy perspira- 
 tion. That plethora diminished, the absorbing vessels are enabled 
 to empty their contents into the veins. As soon as the circulation 
 in the absorbents is restored, the rice water discharges cease en- 
 tirely, which no astringents and opiates could check effectually. 
 A revulsion to the cutaneous surface, in the shape of a gentle dia- 
 phoresis, is the most speedy and certain method of arresting the 
 cholera action. If drinks be given, while the blood is flowing, 
 the enervating effects of the loss of blood will be but little 
 felt, if felt at all. Indeed blood letting to a moderate extent, the 
 patient drinking freely of diluents while the blood is flowing, is 
 in fact a powerful stimulus. But it is not a stimulant unless the 
 absorbents are in a condition to take up a portion of the fluids 
 drank. The loss of blood, however, by removing the venous 
 plethora, gives activity to the absorbent vessels and makes them 
 thirsty for fluids. Purgatives, to unlock the portal circle and to 
 make the liver aid in restoring the equilibrium between the two 
 systems of vessels circulating black and red blood, are important ; 
 but should be slow in their action, as all purgation is injurious un- 
 til the lost serum of the blood is replenished, by exciting into ac- 
 tivity the absorbent vessels of the alimentary canal through the 
 
THE PATHOLOGY AND TREATMENT OF GHOLERA. 21 
 
 medium of a moist cutaneous surface. After the blood has been 
 watered, so to speak, by the absorption of liquids taken into the 
 stomach, through the instrumentality of the activity, which per- 
 spiration gives to the absorbent vessels, purgatives act kindly and 
 do not prostrate. While the fluids are inspisated they cannot act 
 on the liver. Spasms also prevent their acting kindly. All the 
 hollow organs are apt to fall into a spasmodic condition, as well 
 as the muscular system, in consequence of the inspisated condi- 
 tion of the blood and the nervous irritation. Even in a common 
 colic there is great difficulty in bringing the liver into action be- 
 fore the spasms are relaxed. Besides the spasms, the venous 
 plethora and torpor of the stomach, the natural course of the ab- 
 dominal circulation is reversed. The constituents of the blood 
 are running back into the alimentary canal, and the exhalent ar- 
 teries are filtering out the remnant in the arterial and capillary 
 system, by a kind of passive hemorrhage of its watery parts. To 
 trust alone to calomel would be unsafe, because in the violent 
 cases, if it acts at all, it cannot act in time. Combined with opium 
 it promises more. Opium relaxes spasm, and increases the energy 
 of the brain and nerves; so far so good; but it suspends all secre- 
 tions, except those of the skin, and its use in cholera, if long con- 
 tinued, is apt to be followed by a secondary fever or cerebral ex-? 
 citement, often more dangerous than the disease. Quinine is 
 liable to great objections. It is a new remedy and its use in 
 cholera is experimental. It has been given in this city in doses 
 as high as 30 grains, with 2 grains of opium. The success of the 
 quinine practice has not made it popular with the faculty or the 
 public. The sulphur and charcoal practice, about which so much 
 has been said, is evidently a humbug — at least in the small doses 
 advised, uncombined with other things. In scorbutic habits, and 
 in persons who cannot use mercury in any form, without being 
 salivated, or who, like the French, have inveterate prejudices 
 against calomel, I have substituted a teaspoonful of sulphur for 
 the mercurial part of my cholera powder — some ten or twenty 
 grains of Turkey rhubarb have also been substituted for the mer- 
 curial medicine in the prescription, but owing to the difficulty of 
 
22 THE PATHOLOGY AIND TREATMENT OF CHOLERA. 
 
 procuring good rhubarb, the lac sulphuris or sulphate of potash 
 is preferred. Camphor in large doses is equally as effectual 
 in relieving spasm as opium, and has none of the objections 
 appertaining to that article. Opium and its preparations, tan- 
 nin and all astringents of that class, have more or less power 
 in restraining the watery purging. The capsicum, however, 
 is equally, if not more effectual in arresting the purging, not 
 only by stimulating the nervous system generally, but by its 
 direct, pungent, stimulating effects upon the mouths of the ab- 
 sorbent vessels, which are pouring back their contents into the 
 alimentary canal, by a retrograde action. But the main virtue 
 of the pepper lies in the fact, that in combination with the other 
 articles of the prescription, it is one of the most certain, safe and 
 powerful sudoriflcs of the Materia Medica. The revulsion to 
 the cutaneous surface made by the sudorific powder, is much more 
 effectual in arresting the purging, than any astringents or opiates 
 possibly could be. The spasm being allayed by the camphor, the 
 retrogade action of the absorbents, checked by the revulsion to the 
 surface, and the nervous system aroused by the stimulating pro- 
 perties of the ingredients in the sudorific or non-purgative pow- 
 der, the natural course of the greater or systemic circulation is re- 
 stored, and nothing more is necessary than to give agreeably fla- 
 vored diluents to support the sweat and to restore the lost serum 
 in the blood, until the purgative medicine in the composition, has 
 time to empty the distended gall bladder, and restore the natural 
 course of the circulation through the liver. In a cold climate where 
 the liver plays a very subordinate part in the animal economy, in 
 comparison to what it has to perform in a southern one, the dis- 
 ease might be treated successfully without cholagogues. But in 
 the south, where the lungs do so little and the liver so much, it is 
 evidently unsafe to dispense with chalk mercury, calomel, rhubarb, 
 sulphur, or some other slow purgative, to facilitate the circulation 
 of the blood through the liver by exciting that organ into action, 
 thereby removing viceral congestions, that might otherwise ter- 
 minate in inflammation or a dangerous consecutive fever. A very 
 common error is to over stimulate. Stimulants, of some kind 
 or other, are all important in the -commencement of the dis- 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 23 
 
 ease to arrest its downward progress. That indication being 
 fulfilled, they are injurious or useless in the subsequent treat- 
 ment. They are of use until perspiration occurs, and the 
 rice water Diirmns: is arrested : afterwards tesans, gruel, chicken 
 water, and such kinds of diluents, are the best stimulants. Chick- 
 en water alone will cure the disease, if there be sufficient ac- 
 tivity in the absorbents to carry it out of the prima via into 
 the circulation. Perspiration will impart to the absorbents the 
 necessary activity. Then all that will be necessary to effect 
 a cure will be to make the ingesta exceed the excreta. If the 
 fluids gain by absorption more than is lost by the diarrhoea, the 
 patients strength will increase instead of diminish. The error in- 
 to which Prof. Cook led a portion of the medical profession in the 
 south and west, of treating congestive diseases by large doses of 
 calomel, as if patients were all liver, has caused many of the pro- 
 fession to run into the opposite extreme, and to treat cholera as 
 if the patient had no liver at all. Extremes of all kinds are bet- 
 ter avoided. Due consideration ought to be given to the influence 
 of climate and surrounding circumstances. From not attaching 
 sufficient importance to the change of treatment, which difference 
 of climate makes necessary, many of our physicians are less suc- 
 cessful than they would be. 
 
 The half starved, crowded population of Europe, particularly 
 when huddled together in close damp apartments, loaded with the 
 malaria of typhus fever, will not bear blood letting in any dis- 
 ease. But that is no reason why our full fed, free, and happy peo- 
 ple should be deprived of the benefits to be derived from the lan- 
 cet. This will be the case, if we imitate too closely the practice of 
 the north of Europe, and fall into the error of treating our people, 
 like the paupers of foreign hospitals, as if they had neither 
 blood nor bile. Purgatives and the lancet have certainly been 
 used to excess in many parts of our country, but the abuses of 
 those powerful agents, ought not to lead us to forego the advan- 
 tages to be derived from their judicious employment in the proper 
 kind of cases. 
 
 A large portion of the public may be said to have rebelled 
 
24 THF PATHOLOGY AND TREATMENT OF CHOLERA. 
 
 against the regular physicians, and enrolled themselves under the 
 banner of qaackery, because they see the medical faculty using 
 such opposite modes of treatment, and also often condemning 
 each other's practice. Dr. Rush, a host in himself in the open field 
 against empiricism, was shorn of more than half his usefulness, 
 and lost the greater part of his practice from the efforts, prompted 
 by the jealousies of cotemporary practitioners, to detract from his 
 merits and to throw his brilliant medical attainments in the shade. 
 If professional men will not see their own interest, and will con- 
 tinue to work against one another, especially against those, who 
 have deservedly gained some reputation in their profession, they can- 
 not wonder that quackery should grow like an evil weed, when 
 they themselves have cleared the field for it. Every stone, which 
 jealousy or envy may prompt one physician to throw against an- 
 other, is a §tone thrown against the house that Hippocrates built. 
 If physicians everywhere were to cease throwing stones, the in- 
 terest of all and each, would be greatly promoted. While medi- 
 cal men operate against one another they injure themselves and 
 play into the hands of quackery. When any one member of the 
 profession brings his brother into disrepute with the public, and he 
 the other, both are injured and only the quack is benefitted. If 
 the public were to see more harmony in the profession, and each 
 member of it following his own plan of treatment, no matter how 
 different it might be from others, and all going smoothly on doing 
 good and curing diseases, though walking in different paths of 
 practice, the effect would be the same on the popular mind, as 
 when the various religious denominations move harmoniously to- 
 gether, each working in its own way against moral evil. The phy- 
 sicians of the different schools extricating man from physical, and 
 the clergy of the different persuasions from moral evil, each guid- 
 ing him by his own lights through the labarynths of pain and er- 
 ror, all making progress out @f evil into good, is a spectacle worthy 
 of both professions. Stopping by the way to quarrel about the 
 different shades of the respective lights that each is guided by, is 
 unworthy of both and does much mischief to both, as it leads to 
 the belief that they are all wrong and to the rejection of their aid 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 25 
 
 as guides. The difficulty of making the public understand why- 
 medical men should have different methods of treating the same 
 disease, (as they, no more than the clergy, can agree on any one 
 fixed system or formula,) has lead a large portion of the faculty 
 to be adverse to any public prescription, or advice in regard to the 
 treatment of cholera, as calculated to do more harm than good. 
 If each school of physicians were to publish its method, the several 
 methods might appear so irreconcilable to one another, that not 
 understanding why the same end can be reached by different 
 means, the public w ould be led into the error of believing that 
 there was no truth in any. If every person had a physician at 
 his elbow, or if cholera was a disease to wait until one could be 
 procured, there would be no necessity for any popular treatise on 
 it. But when the people's fears are awakened, they will have ad- 
 vice of some kind or other. If physicians will not give their ad- 
 vice, they will take that of quacks, and are too apt to fall into the 
 error of supposing that some interested motive may have influ- 
 enced the former in withholding their council. From these and 
 other considerations, there are not wanting many eminent names 
 in the profession, favorable to putting the treatment, (or at least 
 the initiatory treatment) of all rapidly fatal epidemics in the hands 
 of the people ; among the number, that of the illustrious Rush 
 stands conspicuous. Some good, as well as evil, attaches either to 
 giving or withholding advice. In 1833, 1 published my method of 
 treating cholera. That publication, like the present, was forced 
 upon me from the fact that it was physically impossible to answer 
 all the calls for advice in regard to the disease, without availing 
 myself of the assistance of the printing press. That it did much 
 good, there are many most convincing proofs. That it has done 
 some harm is very probable. A knife or a gun in the hands of 
 those who do not know how to use it, may do hurt, but in times of 
 pressing danger, when not a moiety of the people can command 
 the services of a physician in time to protect them against an 
 enemy, walking in darkness, and destroying its victims before as- 
 sistance could be rendered, it seems to be all right and proper, that 
 a weapon should be put into their hands to protect themselves n* 
 
 
26 THE PATHOLOGY AND TREATMENT OP CHOLERA. 
 
 they best could. If not told what to do, they would have fallen 
 into the hands of quacks, and taken council from them, instead of 
 the regular profession, as a large portion of the people every 
 where, both in town and country, are now doing. Although mine, 
 then, as now, may not be the best council that can be given, it is 
 better than that. The publication made by me, in regard to the 
 Cholera in 1833, had a good effect in putting down quackery, for 
 the time being, in Natchez and its vicinity, and kept the practice 
 in the hands of the regular physicians, for the very reason that the 
 people chose to follow my professional advice rather than quack 
 advice. 
 
 It had another good effect, it inspired confidence, and confi- 
 dence made the disease more curable. It removed unnecessary 
 alarm and panic, and during the cholera epidemic, the commer- 
 cial and other interests of Natchez were nat prostrated, as they 
 would have been, if the field had been given up to quacks to 
 excite by their publications unnecessary alarm, to sell nostrums. 
 
 Alarm and terror, in opening a market for quack medicines, 
 prostrates all the great and vital interests of every town and city 
 where it is created- — the merchants suffer more from quackery 
 than the physicians. The commercial and other great inter- 
 ests of New Orleans have suffered much more than there 
 was any necessity for. 
 
 The hue and cry, that quackery raises about the cholera, 
 causes unnecessary alarm, and the many errors under its man- 
 agement, sw Us the mortality and increases the alarm. Terror 
 itself will often kill. The truth is the best policy, or as Wash- 
 ington expresses it, " Honesty is always the best policy, both in 
 public and private affairs." Those, who try to hide the fact of the 
 presence of cholera, do more harm to the interests of any city or 
 place it may visit, than those who over-estimate its prevalence^ 
 When the people, at a distance, find that they have been deceived, 
 and told that there is no disease of that character when there is, 
 they are ready to fly to the opposite extreme and believe the most 
 exaggerated and unfounded reports. They are also apt to get 
 frightened, and to adopt a system of diet and drinks calculated to 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 27 
 
 produce it, if there was none in existence. I have often been 
 called to cases produced by the very means adapted to prevent it 
 — too much stimulation and too little vegetable food. Those persons, 
 the best acquainted with it, see cause for prudence and watch- 
 fulness, but none for terror or alarm : believing that the science of 
 Medicine has sufficient resources to protect them, if timely in- 
 voked. During the great excitement in December and Jauuary 
 last, in this city, the risk from cholera, was considered so small, 
 that nearly all the most intelligent portion of the community re- 
 mained in town. Nearly all the wealthy classes, who had ample 
 means to fly to the ends of the earth, remained unmoved, and 
 fewer have died with cholera, and all other diseases put together, 
 (if I am correctly informed,) than an equal number in other sea- 
 sons reputed healthy. These are the facts on one hand ; on the 
 other, the ignorant, who became frightened, and changed their 
 accustomed manner of living, running into extravagant intem- 
 perance to prevent the disease, and after it came, instead of calling 
 in medical aid, lost much precious time in waiting to see whether 
 it was cholera or not, or in trying experiments with quack nos- 
 trums, died in great numbers. The useless waste of life, thus 
 brought about, by swelling the bills of mortality, caused the people 
 abroad to over-estimate the danger. Whether any thing can be 
 done to prevent the reenactment of a similar tragedy, in other 
 towns and cities, destroying many valuable lives and prostrating 
 all business, is a question worthy of the serious consideration of 
 the profession. A question which I would answer, by saying, 
 " Give the people light" It is not expected that they can be 
 taught to treat the cholera as well as regular physicians. But 
 they could be taught enough of its symptoms and its insidious 
 movements, to prevent them falling victims to the deceptive enemy, 
 through a careless inactivity, trying senseless experiments with 
 quack nostrums or trusting to inefficient, temporising means. — 
 They could be taught to avoid making themselves more obnoxious 
 to the cholera influence, and more liable to the disease in its worst 
 form, by disturbing their digestive functions with alcoholic drinks^ 
 hy a change of diet and habits, or by taking nostrums as preven- 
 
28 THE PATHOLOGY AND TREATMENT OF CHOLERA. 
 
 tives. They could be taught that the best preventive is the regu-* 
 lar play of all those functions, constituting what is called health ; 
 and that anything, which disturbs the system, whether by making' 
 the blood scorbutic, as an exclusive animal diet is apt to do ; or 
 robs it of its energies, as fear and the depressing passions, or 
 breathing a contaminated atmosphere, or the unnatural excite- 
 ment of artificial stimulation, increases the liability to an attack. 
 They could be taught that fresh air is the natural food of the 
 lungs — of vitality itself — and the purer the air the better the food ; 
 and thus see the necessity of cleanliness in their persons, their 
 houses and the localities in which they reside. They could be 
 taught, that remedies the most opposite, in the hands of the pro- 
 fession, who know how to use them, can often be made to pro- 
 duce the same effect ; and thus see the folly of mistaking for sound 
 reasoning the cavilling of empiricism, which condemns scientific 
 physicians as impostors, because they often treat the same disease 
 by medicines of opposite properties ; unless indeed, they are pre- 
 pared to condemn navigators of the ocean as impostors, for 
 making agents, so opposite in their nature, as the cold, free winds 
 over their heads, and the pent up, fiery steam beneath their feet, 
 produce the same effect ; lastly, but not least, they could be taught 
 the necessity of keeping a few doses of cholera medicine in their 
 houses, ready for use at a moment's warning, and how to use the 
 same, until the services of a physician could be procured; and 
 thus be able to deprive the disease of its terrors by guarding 
 against panic and empiricism on the one hand, and a careless in- 
 difference on the other. 
 
 Unless the people have light, so stealthy and insidious is cholera, 
 that they will most assuredly continue, as heretofore, to be the 
 victims of a surprise by it; often falling into collapse or a dying 
 state, before they are aware that the complaint is upon them. — 
 Because physicians cannot cure the dying, the uninformed, panic- 
 struck multitude, fly into the arms of every species of humbuggery 
 and quackery, proclaiming that the doctors and their remedies 
 have been tried and failed, whereas they themselves, have failed to 
 give the proper remedies, or to call in medical aid in time to be of 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 29 
 
 any use, having let the eomplainl steal a march upon them from 
 ignorance of its nature and character — mistaking the diarrhoea as 
 nothing more, at most, than a premonitory symptom — not knowing 
 that it is the veritable and dreaded Asiatic Cholera itself. With 
 the proper light on the subject, so many valuable lives would not be 
 trusted to a little paregoric, a fewgrains of sulphate and charcoal or 
 some other inefficient remedy of doubtful utility in the mild cases 
 and wholly inadequate to the cure of severe ones ; but the pro- 
 priety would be apparent, of taking some medicine of sufficient 
 potency to make sure work, by causing a revulsion to the surface. 
 
 The evil of being taken by surprise is not buried with the dead, 
 as it too often causes the living to throw aside, as useless or pei- 
 nicious, the only remedies which can be relied on, as curative, 
 in the severe cases, from having seen them fail to cure the dying. 
 
 Unfortunately for the combination, to which I am most partial, 
 that of the camphor, pepper, chalk mercury, &c, being regarded 
 as a strong medicine, is seldom resorted to, except in the severer 
 forms of the disease, and after the failure of other remedies. — 
 Even in such cases, it has gained a popularity, equal if not supe- 
 rior, to any other combination in use in the Mississippi valley. 
 But it is best adapted to the early stages of the disease, before 
 the diarrhoea has robbed the blood of its serum. It then acts as 
 a sudorific, with much greater facility and certainty, than when 
 given in the more advanced stages of the complaint. The cure is 
 rapid and effectual, free from relapses or secondary fever, and 
 leaves the system in a better and healthier condition than pre- 
 vious to the attack — so far from being a harsh or dangerous 
 remedy, only admissible in strong, robust patients, it is particu- 
 larly adapted to weakly constitutions, as it cures by a revulsion of 
 the fluids to the surface — a plan of cure, which gives strength to 
 the system, instead of taking it away — provided the perspiration 
 induced be supported by nourishing beverages — as chicken water, 
 &c. But as example is sometimes better than precept, a lady 
 at the St. Louis Hotel, probably one of the most delicate, weakly 
 and nervous woman in New Orleans, and who had long labored 
 under spinal irritation, was violently attacked with cholera in the 
 
30 THE PATHOLOGY AND TREATMENT OF CHOLERA. 
 
 shape of cramps, and rice water evacuations. Her husband in- 
 formed me that a single grain of mercurial medicine had always 
 prostrated her. Seeing the necessity of an immediate arrest of 
 the diarrhoea by a revulsion to the surface, I instantly gave her 
 rather more than a full dose of my cholera powder, and in five 
 minutes had a good perspiration established, which was supported 
 by chicken water. It was three days before the medicine opera- 
 ted, and then only twice. In another case of a very delicate lady, 
 who had been afflicted with a remittent bilious fever for nine days, 
 the cholera came in place of the expected crisis — violent vomiting, 
 and copious operations in quick succession — a full dose of the cholera 
 powder was instantly given and effected a cure. Another lady 
 of very frail, feeble frame, with copious rice water diarrhoea, took 
 three powders before sweat was induced, and the diarrhoea arrest- 
 ed. So great was the paresis of the nervous system produced by 
 the disease, that she scarcely tasted the powders, although each 
 contained 20 grains of the strongest Cayenne pepper. In another 
 case the powder caused perspiration, but owing to some local irri- 
 tation in the bowels, the diarrhoea continued notwithstanding. — 
 The patient had great determination of blood to the head, con- 
 tracted pupils, and a state incompatible to the opiate or astrigent 
 treatment — Taking advantage of the activity, which the powder 
 communicated to the absorbents, by inducing perspiration, I gave 
 this patient, for several days, nothing but chicken water, beef tea, 
 soda water, and such things. The strength daily increased, not- 
 withstanding the diarrhoea, until perfect recovery. Other cases, 
 in addition to the powder, had to be cupped over the stomach — 
 some had to be bled from the arm, and a few had to be washed all 
 over with cold water and to have cooling drinks, before perspiration 
 was induced, and the disease cured. In some patients whose 
 blood was scorbutic, I gave the powders and lemonade, vinegar 
 and nitre to correct the scorbutive tendency — in others I omitted 
 the mercury and substituted sulphur. In the great mass of cases, 
 however, hot applications to the stomach and extremities had to 
 be used, together with hot teas to assist the powder in causing 
 sweat. Many cases were met with, where the powder could not 
 
THE PATHOLOGY AND TREATMENT OF CHOLERA. 31 
 
 be retained on the stomach, and some in which it appeared to act 
 as an emetic ; throwing off a great quantity of a tough phlegm, 
 which could be drawn out into long threads like spider web. In 
 all these cases, the morphine and camphor, followed by coffee, had 
 a happy effect, and produced no unpleasant action upon the head 
 and nervous system — which may be attributed to the removal, by 
 the powder, of the tough phlegm adhering to the stomach, that 
 formed a kind of artificial coat, making it insensible to every thing 
 in the shape of medicine, not of the most pungent, penetrating 
 kind. In all the apoplectic cases of cholera, where the patient 
 falls down insensible, I have invariably found the stomach, fauces 
 and trachia thickly coated with a tough, stringy, croupy substance. 
 In such cases, the cholera powder mixed in water, or salt and 
 mustard, are the only things that the patient can be forced to 
 swallow. The pungency, of these articles with the strangling sen- 
 sation produced by them, disembarrasses the throat, fauces and 
 asophagus of their artificial coat of phlegm and facilitates deglu- 
 tition. It also removes the stertorous breathing by relieving the 
 trachia of the same substance, and restores the almost suspended 
 respiratory function. 
 
 My general plan of treatment in cholera, may be summed up in 
 a few words. It is the sweating plan, which past experience has 
 found to be so successful in most of the malignant and congestive 
 epidemics of former ages. The powder, I recommend, will gen- 
 erally start a sweat in ten minutes, if timely given; and in ten 
 minutes actually begins the cure of the disease by making a re- 
 vulsion to the surface. That revulsion to the surface has only to* 
 be supported by diluent drinks. No stimulants, astringents or 
 opiates are necessary, if a healty sweat can be brought about. 
 They do harm if they interrupt the sweat, by heating the system 
 too much. But until perspiration takes place, stimulants are all 
 important. Bleeding or cupping, or the application of cold water, 
 is as necessary in some cases to bring the system down to the 
 sweating point, as hot applications, mustard plasters and frictions, 
 are in the cold and torpid cases. In those instances, where the 
 powder will not lie on the stomach, I give morphine in half grain 
 
32 TMF PATHOLOGY AND TREATMENT OF CHOLERA* 
 
 doses, dissolved in 2 or 3 teaspoonsful of camphor water, to arrest 
 vomiting and purging — the subsequent treatment has to be varied 
 according to the symptoms of each particular case. Whenever 
 the cholera is very fatal, there is something wrong in the treat- 
 ment, or in the locality of the place in which it occurs ; or in the 
 diet or drink of the inhabitants ; or the cause of the malignancy 
 lies in some vice of the constitution, as worms, scurvy, scrofula, 
 &,c. In most of the post mortem examinations of its subjects 
 made in this city, an enlargement of the mesenteric glands, or 
 some chronic visceral derangement, from former disease or intem- 
 perate habits, was discovered. On many of the plantations, where 
 the complaint has been very fatal, the negroes were scorbutic or 
 afflicted with worms — some were panic stricken. But the most 
 prolific cause of malignancy can be directly traced to unwholesome 
 provisions, as damaged pork, or bread made of weavel eaten corn, 
 and the breathing of an atmosphere vitiated by some local nui- 
 sance. In the latter case, a removal out of the contaminated at- 
 mosphere, has always deprived the disease of its terrors. Apart 
 from the circumstances enumerated, the cholera is not a fatal com- 
 plaint, and can be cured with as much facility and certainty, if 
 taken in time, as a common ague and fever. 
 
APPENDIX. 
 
 Containing the authofs latest instructions to planters and heads of 
 families, (remote from medical advice,) in regard to the preven- 
 tion and cure of cholera. 
 
 Wherever cholera has been very fatal on plantations among the 
 negroes, or in private families, or in particular localities, its ma- 
 lignancy may be generally traced to some one or more of the fol- 
 lowing causes, viz : improper or inefficient treatment, or misman- 
 agement, panic, unwholesome diet or drinks, an unhealthy state of 
 the individuals themselves from worms, scurvy, intemperate habits, 
 excessive fatigue and exposure, the depressing passions, or from 
 some local contamination of the atmosphere. When from the latter 
 cause, an immediate removal of the sick and well on the same day 
 into the open field, to sheds erected after the removal has been made, 
 has been tried in many hundred instances on plantations, with al- 
 most uniform success, in arresting its progress among negroes. 
 The cholera poison, like a mad dog, follows some determined course 
 along a road, a river, a hedge or a ditch, and has a propensity to 
 rest in houses, whether inhabited or not. Hence in making a re- 
 moval, old houses should be avoided and the middle of a field se- 
 lected for the camp. A few hundred yards will be sufficient. 
 The sick recover quicker and fresh attacks are prevented. The 
 quarters should be thrown open and entirely abandoned for some 
 three or four weeks. The depressing passions, and every thing 
 which has a tendency to create panic, should be particularly 
 guarded against. Amusements, mirthful plays, and recreations, 
 music, funny stories, &c, should be pressed into service, and made 
 to dispel the depressing influences of grief and despondency. The 
 encouragements to be derived from hope should not be lost sight 
 of. Great attention should be paid to the subject of food and 
 drinks, to see that they are good and wholesome. Bread made 
 out of weevil eaten corn, or that which has undergone a sweat 
 from exposure to the weather, is a prolific cause of malignancy in 
 disease. In travelling through Illinois the winter before last, I 
 saw many cribs of corn entirely without covers, and for many 
 months had remained exposed to the weather. The purchasers of 
 such unsound grain cannot expect that the bread made from it 
 
34 APPENDIX. 
 
 would deserve the appellation of the staff of life. I detected an- 
 other cause of disease in the practice prevalent in Ohio, of killing 
 hogs a long time before they are salted up, and then using more or 
 less Liverpool or Kanhawa salt in making pork. It has been 
 found cheaper or more convenient to kill hogs, and send them to 
 the Cincinnati market on railroads, canals and steamboats, than 
 to drive them as formerly. The pork, made out of meat which 
 has remained so long without salt, as to have entered into the first 
 stage of putrefaction, is a wide spread and fruitful cause of the 
 malignant character of cholera among its consumers, whether in 
 Cincinnati itself, among the negroes on the cotton and sugar plan- 
 tations, the emigrants on the Rio Grande, or the distant plains 
 of the west. The use of artificially made salt, which contains 
 slack and bittern, causes the pork, prepared with it, to undergo a 
 change in hot weather, rendering it a very unwholesome kind of 
 diet. One year, the trade in solar salt being interrupted, the Irish 
 pork was prepared with Liverpool or artificially made salt. The 
 consequence was so much sickness in the East India fleet and 
 army, supplied with this kind of pork, that it had to be thrown 
 overboard. When cholera appears in any family, or on any plan- 
 tation among the negroes, if any suspicion can rightfully be at- 
 tached to the wholesomeness of the meat, bread or drinks, a 
 change should be made of these articles for others more wholesome. 
 The particular kind of food is of much less consequence than 
 its entire soundness and freedom from any putrescent taint. — 
 Fresh meat or pickled beef is much to be preferred to bad pork, 
 and bread made by rasping green corn, to that made from old 
 damaged corn. These are matters, which each planter can better 
 judge of, than the physician in his hurried visits to the sick. The 
 planter likewise, by observing his negroes, can tell better probably, 
 than any one else, whether they have their usual healthy appear- 
 ance, glossy skins, and cheerful, joyous countenances, indicating 
 good health and spirits, contentment and satisfaction, or are de- 
 jected, dissatisfied, uncleanly in their persons and houses, — scor- 
 butic teeth and gums, with skins of a husky, dirty, ashy appear- 
 ance. In the latter case, medicine is unavailing without fresh 
 vegetables, the more acescent the better; fresh meats, highly sea- 
 soned with spices; rice, pepper and mustard, with molasses, or 
 metheglin. In addition to this, ablution with warm water and 
 soap, followed by frictions over the whole body, of equal parts of 
 bear's oil or sweet oil and lime juice, or the fresh juice of lemons, 
 to which may be added, with much advantage, a drachm of qui- 
 nine, and a drachm of oil of origanum to each half gallon of the 
 oil and lime juice mixture. If this liniment be not only rubbed 
 
APPENDIX. 35 
 
 on, but slapped in with the hands on the naked skin, the effect will 
 be better in arousing into healthy activity the lymphatic circula- 
 tion. The cholera is a disease more particularly of the lymphatics 
 (or the vessels circulating white fluids,) which are more liable to 
 obstructions in the black and yellow races, than in the white. — 
 Indeed all the yellow races of Asia and the Sandwich Islands, 
 from time immemorial have used oiling, frictions, slapping, knead- 
 ing, shampooing, (called in French ptassage,~\ as preventives of 
 epidemic maladies of almost every kind. The Russians use, for 
 the same purpose, warm bathing, followed immediately by the 
 cold, with gentle, yet agreeable flagellations over the whole body. 
 But what is to be done for the malignant cholera which kills in 
 an hour or two, and has been so destructive on a great number 
 of plantations — running its course to a fatal termination in defi- 
 ance of all remedies, mine among the rest ? This is a very im- 
 portant question. I have labored long and faithfully to answer it 
 understandingly. Much time has been required to collect the ne- 
 cessary facts, to form principles of practice therefrom— to try the 
 principles by the test of experience, and to ascertain the results. 
 Although the cholera, when timely treated by the remedies I have 
 advised, is according to my exp 'Hence, almost invariably found to 
 be a curable disease : yet I am bound to believe from the expe- 
 rience of others, that in some instances, neither my remedies, nor 
 any others, no matter how early administered, will have any effect 
 at all in arresting the downward progress of the complaint. On 
 some plantations the negroes have died in an hour or two without 
 warning or premonitory symptoms, as they are called, and without 
 any vomiting or purging, except probably at the moment of disso- 
 lution. This malignant species of cholera, called by overseers, 
 " the thunder and lightning cholera" to distinguish it from the 
 less malignant grades, in resisting ail manner of remedies, spreads 
 panic and terror wherever it has appeared. It is more important 
 to bring this species under the power of the healing art than any 
 other, because the terror it inspires, and the panic it creates, have 
 the eifect of making the milder forms of the disease put on its own 
 malignant livery. Dr. Williams, of Thibedaux, informed me that 
 he saw a woman, with a very mild attack, fall into collapse from see- 
 ing a person on her right hand and another on her left, in the hospi- 
 tal, die suddenly with the malignant form of the disease. Wherever 
 it occurs among negroes, like a wolf among sheep, it will continue 
 to strike down its victims until it has thinned out the flock, unless 
 something be done to arrest it. Whenever this form of cholera 
 occurs, I recommend that every negro on the plantation, young and 
 old, have a full dose of my cholera medicine, ik proportion to their 
 
36 APPENDIX. 
 
 ages, given to them in their respective houses, without waiting fo? 
 them to get sick. They should take the medicine in their sev- 
 eral houses and go to bed, and keep their beds for one day and 
 night. A beef or mutton should be killed, and soup made for the 
 whole of them. It should be well seasoned with pepper, and they 
 should drink freely of it through the day, keeping up a gentle per- 
 spiration. They should keep within doors until the medicine, as- 
 sisted next day by gruel with salt in it, acts once or twice on the 
 bowels — which will be black and bilious. If it continues to act 
 more, or if the operations get thin, frequent, and light 
 colored, another dose should be given : or a dose of mor- 
 phine, dissolved in camphor water, if there be excessive bil- 
 ious operations. The plan of giving a good dose of medi- 
 cine in advance, -as a preventive, has been tried in so many 
 instances, with complete success, that I do not hesitate to 
 recommend it. The practice of crowding the sick together 
 in a hospital, is very pernicious and has added greatly to 
 the mortality of cholera on plantations. Each patient should 
 remain in his own house, on his own bed, and one of the members 
 of his own individual family, should be detailed to wait upon him, 
 besides being under the general supervision of the regular nurses. 
 As little exertion as possible on the part of the patient should be 
 permitted. When attacked with the disease in the field, the pa- 
 tient should lie down and take the medicine on the spot, and should 
 be carried home in a cart, or on a litter — though ever so able to 
 walk, no unnecessary exertion should be permitted — not even rising 
 to have an operation. Should the negroes be afflicted with worms, 
 whether any malignant cholera has appeared or not, a better medi- 
 cine could not be given to expel them, than the above mentioned 
 cholera powder. In that case the calomel is better than the chalk 
 mercury, and a little oil and turpentine, next day, to carry it off is 
 advisable. The objection to the cholera powder, with calomel in 
 it, is its liability to salivate — owing to the impurity of the article 
 generally sold for calomel. This may be obviated by washing it in 
 a large quantity of pure water, and drying in the shade. Calomel, 
 as well as camphor, is known to possess vermifuge properties. 
 But it is not so generally known that pepper is a better vermifuge 
 than either, and has been used for that purpose long anterior to 
 the Christian era. After Medicine as a science, began to be chiefly 
 taught in the north of Europe, the pepper family of plants fell into 
 disrepute with the medical profession, owing to their being too 
 heating and exciting for the diseases of high latitudes. Hence the 
 prejudices and ignorance of those medical men in regard to the pep- 
 pers ; who look only to the north of Europe for medical authority, 
 
APPENDIX. 37 
 
 and are under a species of colonial vassalage to Great Britain and 
 France; scarcely ever aspiring, even in Philadelphia, New York, or 
 Boston, to any higher aims in Medicine, than that of republishing 
 some English or French medical book. It is necessary to allude to 
 the prejudices of physicians against the peppers, and the cause 
 of it, in order that the objections, made by many of them to that 
 class of remedies, may not have more weight than they deserve. 
 Those medical writers and lecturers in the cities just mentioned, 
 who have stigmatized my practice in cholera as empirical, suppos- 
 ing that I derived it from the steam doctors, are better acquainted 
 with the writing's of modern charlatans than with the standard 
 
 S3 
 
 medical authorities of all antiquity, and the experience of all 
 southern nations, or they would have perceived that I had the 
 highest authority, for the use of the pepper family of plants, in 
 acute congestive diseases, of any known to the science of Medicine. 
 It would be out of place to notice a theoretical prejudice against 
 pepper, derived from an exclusive northern medical education, if 
 it did not often lead to an omission of one of the most efficient ar- 
 ticles in the treatment of the disease under consideration. 
 
 In the treatment of the milder forms of cholera, physicians often 
 fail in effecting cures, owing to the fact that many negroes, through 
 carelessness or the fears of taking medicine, will not report them- 
 selves as sick, until the diarrhoea has nearly drained their blood 
 of ail the serum it contains. The proper way to remedy this evil 
 is to physic the whole of them, in advance, as recommended for 
 the more malignant grades of the disease. This I consider a most 
 important and valuable truth, calculated to save many lives. 
 
 AN ANSWER to the question: " What is the best course of treat- 
 ment for a non-professional person to pursue, in a case of cholera, 
 where medical advise is not at hand? 
 
 Give the patient instantly 20 grains Hydrargyria cum creta, 20 
 grains best cayenne pepper, 10 grains gum camphor, 15 grains 
 calcined charcoal, 15 grains gum Arabic, mixed together in two 
 tablespoonsful of cold water, and put a wet towel in the mouth 
 to take away the burning taste and to prevent vomiting. The pa- 
 tient should swallow the above dose quickly, and the whole of it 
 without stopping to taste it. He should lie down an! cover up 
 and keep down. The doors and windows should be opened to 
 give fresh air to fan and feed the combustion in the lungs, which 
 burns slowly in cholera, i. e.; the change from black to red blood 
 
lib APPENDIX 
 
 does not go on as in health, and the temperature falls. A jacket 
 or a flannel shirt wrung out of scalding water, and rolled into a 
 ball as large as a child's head, until it will not drip, should be 
 wrapped in a dry cloth and applied over the stomach and bowels, 
 as hot as it can be borne. Bottles filled with hot water should be 
 applied to the extremities. Five minutes having elapsed from the 
 taking of the powder, a spoonful of hot sage, balm, mint or cham- 
 omile tea, to be given to the patient from time to time, with a ta- 
 blespoonful of cold water, or a teaspoonful of pounded ice, alter- 
 nated with the hot tea. Now look out for a perspiration. From 
 10 to 15 minutes after the powder is taken, perspiration is gener- 
 ally established. If so the patient is safe. Nothing more is* 
 needed but to give warm teas, or any warm fluid the patient likes 
 best, in sufficient quantities to allay therfhirst, and support the 
 sweat. The sweat should be kept up 6 or 8 hours — then gruel to 
 assist the Hydrargyria cum creta to empty the gall bladder. Then 
 the circulation will go on through the liver. The revulsion to the 
 surface will cause the absorbents to suck up the fluids taken into 
 the stomach, and the pouring back action will be arrested. This 
 sucking up action, caused by the sweat, will restore the natural 
 fluidity of the blood. When the sweat is established, stimulants 
 are unnecessary or hurtful, as they may stop it. To put back the 
 lost water in the blood, is the best mode of stimulating. I have 
 thus described a case cured by one dose of medicine — a part of 
 that dose might have been sufficient, it may be supposed. A 
 smaller portion might have fallen in with the disease and operated 
 on the bowels. A large dose is a non-purgative, because it is su- 
 dorific, , revulses to the surface, starts a centrifugal action of 
 the fluids, and arrests the centrioetal action of the disease. — 
 But if one dose does not sweat, give another, or half a dose ; if 
 that does not do, bleed from the arm, or cup freely over the epi- 
 gastrium, and give warm stimulating drinks to force a sweat, and 
 apply hot applications externally. Suppose the skin gets too hot 
 under this high stimulation, outside and inside; wash the patient 
 all over with cold water to bring the system down to the sweating 
 point, if the pulse will not bear bleeding. Suppose the extremi- 
 ties are too cold to be compatible with healthy perspiration; warm 
 them by hot applications and friction. Suppose the patient vomits 
 the medicine; give a cup of chamomile tea, let him vomit that, 
 and then repeat the medicine. Suppose he still vomits; then give 
 two tea spoons full of the " drops for vomiting and purging," and 
 repeat after each stool or spell of vomiting, that is, about half a 
 grain of morphine dissolved in camphor water. As soon as the 
 stomach is settled, throw in some 20 grains of chalk mercury or 
 
APPENDIX. 39 
 
 calomel. Give coffee if the morphine be used. The doses may- 
 be thought large, but if opiates be used at all in the complaint, 
 the doses should be two, three or four fold. Small doses do more 
 harm than good. I give nothing to work the medicine off before 
 the next day or the day after. A purgative before the aqueous 
 parts of the blood are restored is a dangerous thing. The medi- 
 cine generally works itself off. Under this plan no secondary fever 
 follows. But if stimulants be used after the patient begins to 
 sweat, secondary fever is sure to occur. Stimulants, until the 
 sweat begins, are all important — none are too strong. Fire itself 
 is scarcely too strong. But when a sweat is established, all stim- 
 ulants, internally and externally, should be suspended. The dilu- 
 ent drinks to thin the blood are the best of all stimulants. I often 
 give mineral water, soda water, and even lemonade, for that pur- 
 pose — any diluent or watery fluid that agrees best with the stom- 
 ach. The patient cannot purge and sweat at the same time. The 
 rice water in the bowels may run out after the perspiration is es- 
 tablished, but more cannot be poured into the bowels while the 
 perspiration goes on, indeed the perspiration generally causes the 
 rice water in the bowels to be absorbed, carried into the circula- 
 tion, and made aid in the cure. In Dr. H.'s case and some others, 
 great assistance in the cure, was derived from the rice water in the 
 bowels. As soon as the powder caused perspiration, the rice 
 water was retained in the bowels, by compression, and soon ab- 
 sorbed, as proved by the abdominal destension disappearing, and 
 the pulse rising — nothing afterwards ever being seen of the rice 
 water, which at the time the compression was made, was running 
 in a constant stream from him. 
 
4U 
 
 FORMULAE. 
 
 FORMULAE, to be handed 
 of the principal medicines 
 being enough of three kinds 
 
 LABEL. 
 
 Cholera powder, dose for an 
 adult, 80 grains or 1 drachm 
 and 1 scruple, in two table - 
 spoonsful of cold wa:er. 
 40 grains for 7 years. 
 20 grains for 3^ years. 
 15 grains for 2 years. 
 8 grains for 1 year. 
 3 to 6 grains for less than 
 
 a year. 
 
 LABEL. 
 
 Cholera powder for scorbu- 
 tic persons, or those witb bad 
 teeth and easily salivated — 
 Dose 2 drachms, or 120 grains 
 for an adult, to be mixed in 
 water. 
 
 LABEL. 
 
 Camphorated Morphine 
 Drops, for vomiting or purging, 
 to be used in those cases where 
 the cholera powder will not 
 remain on the stomach. Dose 
 2 teaspoonsful, after every spell 
 of vomiting, or every opera- 
 tion. 
 
 to the apothecary, for the preparation- 
 necessary in the treatment of cholera, 
 for the cure of some eight or ten cases. 
 
 fr. Hydrargyri Cum creta. 
 
 Best Cayenne pepper, a a §fs 
 
 Pulv. gum camphor, . 3ij 
 
 (which has not been exposed tojhe air.) 
 
 Pulv. gum Arab. 
 
 Calcined Charcoal, a a 3iij 
 
 (finely powdered, and which *has not 
 been exposed to the air,) M and rub- 
 bed well together and tightly stopped. 
 
 $. 
 
 ifs, 
 
 ;, Lac Sulphuris 
 
 or 12 drachms. 
 Best Cayenne pepper, 
 
 or 4 drachms. 
 Pulv. gum^camphor, 
 
 or 2 drachms. 
 Pulv. gum Arab. 
 
 Pulv. calcined charcoal, a a 3iij 
 
 or 3 drachms, mixed and well rubbed 
 together, and securely stopped io a vial. 
 
 fs. 
 
 3ij, 
 
 r£. Aqua camphor 
 
 Sulphate morphine, (M) 
 
 grs. 
 
 Xij 
 
 Copy Right secured to Messrs. Harper & Brothers, Cliff st., N. Y,