A 575180 * C ** R ARTES LIBRARY 1837 [#YURA VERITAS IHTIBIIIIII UNIVERSITY OF MICHIGAN E PLURIBUS UNUM SCIENTIA HBCUETUVOJA VIA OF THE SQUAERIS PENINSULAM AMOENAME CIRCUMSPICE GUSALUTATAVU AJANJA HOM (101 METTITAKA #61693 J85 (1) саруг HOMEOPATHIC TREATMENT - EPIDEMIC CHOLERA, BY B 111 111 senf OF Bau klin F JOSLIN, M.D., L.L.D., FELLOW OF THE ALBANY MEDICAL COLLEGE; FELLOW AND CORRESPONDING MEMBER OF THE HOMEOPATHIC MEDICAL COLLEGE OF PENNSYL- - VANIA, &C., &c. THIRD EDITION, WITH ADDITIONS. NEW-YORK: PUBLISHED BY WILLIAM RADDE, No. 322 BROADWAY. PHILADELPHIA: RADEMACHER & SHEEK-BOSTON: OTIS CLAPP.- LONDON: J. EPPS, 112 GREAT RUSSELL-ST., BLOOMSBURY.- MANCHESTER: HENRY TURNER, 41 PICCADILLY. 1854. Entered according to Act of Congress, in the year 1854, BY WILLIAM RADDE, In the Clerk's Office of the District Court of the Southern District of New-York. HENRY LUDWIG, Printer, 45 Vesey-street. *. LA 1216 CONTENTS. PREFACE AND INTRODUCTION, CHAP. I.-NATURE and PATHOLOGY of Cholera. Characteristics of the discase,.. Physiology of Respiration, . • Application to the Pathology of Cholera,. Preliminary ætiological remarks, Atmospheric heat, Becoming chilled by cold air, or bathing, CHAP. II.—ÆTIOLOGY, especially of the Predisposing or occasion- al Causes. The Night season, Depressing passions, fatigue, fasting, and alcohol,. Abstinence from animal food,. · Ungeneralized facts,. Recapitulation, • · Oppression of the digestive organs with food, Crowded or insufficiently Ventilated Rooms,. Neglect of personal Cleanliness, .. • • · CHAP. III-DOCTRINE OF INFECTION. : Error of the prevalent doctrine,. Indefiniteness of the problem, Influence of Dilution,. Influence of Dose,. Influence of susceptibility, Routes and modes in which the Cholera travels, • • • • Page 7 • 13 16 18 30 32 35 37 38 40 43 44 45 46 48 50 52 53 55 58 60 243 ! 4 1 CHAP. IV.-HYGIENE and PROPHYLAXIS. Articles hurtful to persons taking medicines,. Rules of Regimen,. Prophylactics,. ▼ (C CONTENTS. CHAP. V.-HISTORY OF TREATMENT, Or Statistical proofs of the success of Homœopathy in Cholera, Preliminary Remarks, • • The Cholera Epidemic of 1831–32, 1848-49, 66 (C in 1854,... ** CHAP. VI.-EARLY TREATMENT, Including that of the Premonitory Symptoms, and of the dis- ease at its onset, with rules for the general management, Treatment of Premonitory Symptoms, &c., ،، at the Commencement of Cholera, Rules for the management of a Cholera patient, • CHOLERA. • • Law of cure, and repetition and magnitude of doses,. Symptoms of the 1st variety, Diarrhoeic Cholera, Treatment of Diarrhoeic Cholera, Symptoms of the 2d variety, Gastric Cholera, Treatment of Gastric Cholera, . + • Symptoms of the 4th variety, Dry Cholera, Treatment of Dry Cholera,. CHAP. VII.-SYMPTOMS and TREATMENT of the VARIETIES of Symptoms of the 3d variety, Spasmodic Cholera, Treatment of Spasmodic Cholera, ། # • Symptoms of the 5th variety, Acute Cholera, Treatment of Acute Cholera, • · • O • • • • . Symptoms of the 6th variety, Gastro-Enteric Cholera, Treatment of Gastro-Enteric Cholera,. Page .. 61 62 65 67 67 70 76 97 100 100 102 108 109 113 115 116 117 117 118 119 120 120 121 122 123 CONTENTS. сл Symptoms of the 7th variety, Dysenteric Cholera, Treatment of Dysenteric Cholera,. Symptoms of the 8th variety, Febrile Cholera, Treatment of Febrile Cholera, First Stage, stage of Invasion,.. Second Stage, stage of full Development, Third Stage, stage of Collapse, Fourth Stage, stage of Reaction, CHAP. VIII.-SYMPTOMS and TREATMENT of the STAGES of CHOLERA. Preliminary Remarks, Cases of Choleroid Disease,. Cases of Diarrhoeic Cholera,. Cases of Gastric Cholera, Cases of Spasmodic Cholera Case of Dry Cholera,... Cases of Acute Cholera, Case of Gastro-enteric Cholera,. Cases of Dysenteric Cholera,. Case of Febrile Cholera,. Case of Acute Choleroid,.. • • • • • CHAP. IX.-CASES OF CHOLERA AND CHOLEROID, WITH THEIR TREATMENT. • • D • • • • Explanation of the use of the Repertory. Mental Symptoms, Remedies for,.. Head, remedies for symptoms relating to the,. Eyes, remedies for symptoms relating to the, Face, remedies for symptoms relating to the, Tongue, remedies for symptoms relating to the,. • Page 123 • 125 126 126 128 129 130 131 CHAP. X.-CHOLERA REPERTORY for SYMPTOMS AND GROups, with the values of the medicines distinguished. 134 138 144 160 162 168 170 176 176 179 180 181 183 184 184 185 186 6 1 Nausea and Thirst, remedies for, Vomiting, remedies for,.... Pains at the Stomach, remedies for,.. Abdomen, remedies for symptoms relating to the,. Diarrhoea, remedies for...... Urine, remedies for symptoms relating to the,. Voice, remedies for symptoms relating to the,. Chest, remedies for symptoms relating to the,. Superior Extremities, remedies, &c.. Inferior Extremities, remedies, &c... Skin, remedies for symptoms relating to the, Perspiration and pulse, remedies relating to, General and miscellaneous symptoms, remedies for,. Explanation of the use of the Repertory,. VOMITING in general, Character of the vomiting,. Its causes or conditions,. Its Concomitants,. CONTENTS. CHAP. XI.—AUXILIARY CHOLERA REPERTORY, also adapted to Vomiting, Diarrhea, Cholera Infantum and Dysentery. Sensations (pains, &c.) at the Stomach and Epigastrium,. . DIARRHEA in General, Color of the Fæces,. Odor of the Fæces,.. Their Composition and Consistence,. Causes of Diarrhoea,. Dysentery,. Appendix I.,.. Appendix II.,. . Index, • · Concomitants of Diarrhoea,.. Groups of Diarrhoeic Symptoms, Cholera Infantum, • • • · • . • ► • • Page 187 187 188 189 190 192 193 193 194 194 195 197 198 199 200 200 202 203 204 206 206 207 207 208 209 210 212 212 215 239 245 PREFACE AND INTRODUCTION. THE favorable reception which the former editions of this book have met with, has encouraged the author in the labor of improving it, by such modifications and additions as were sug- gested by much experience in the epidemic of 1849. A great amount of practical matter has been added, including a chapter of illustrative cases, in 1849 and subsequent years, to the present month. The book has been used as a guide in the treatment of cho- lera, not only by the profession, but by many intelligent lay- men. In this rapid disease, for which our system affords the only effectual remedies, many families in localities where no homœopathic physician can be soon procured, will find it ne- cessary at last to commence the treatment; and some mem- bers of the profession who had been previously allopathic will be induced to prescribe homoeopathically for cholera. In consideration of the wants of these two classes, the more im- portant rules of treatment are given in a more particular and elementary form, than would be necessary for an experienced homœopathic practitioner. The plain rules for prevention, preliminary treatment and nursing, may either be consulted directly by families, or employed by their physician as a safe and convenient basis for his instructions. The plan offers the advantage of a threefold arrangement of the principal medicines; viz., with reference, 1st, to the varie- CO INTRODUCTION. ties of cholera; 2d, to its stages; and 3d, to its symptoms as arranged in repertories. These last will give the work a permanent value, in treating the more frequent complaints of summer. The author has aimed to prepare for the use of practitioners a portable treatise, so full and systematic as to enable them to find with facility the remedy for every curable case of this disease. When we fail in our attempts at homœopathic treatment, in any malady which is curable in the present state of the Mate- ria Medica, the fault is not in the law, but in its administra- tion. It is unjust in any one, to impute to Homœopathy the disastrous consequences of his own ignorance, indolence or haste, and unwise to attempt by allopathic patches to strength- en his practice already sufficiently spurious, and conse- quently feeble. Such expedients emasculate his Homœopathy. None will learn to swim who depend upon bladders under the arms. Eclecticism will be less resorted to, in proportion as the character of the profession shall become more elevated in intellect, industry and attainments, and physicians shall not consider a minute study of the case and of the Materia Medica too onerous, when human life depends on the correctness of the prescription. With Hahnemann's eulogium of the profession, he has connected a requirement and an injunction. “To the physician, whose province it is to vanquish the disease that brings its victim to the very borders of corporeal dissolution, and to produce as it were a second creation of life—a greater work than almost all the other much-vaunted performances of mankind—to him Nature in all her wide expanse, with all her sources and productions must lie open. Let all hold aloof from this most pious, this noblest of all secular professions, who are deficient in mind, in patient thought, in the requisite knowledge, or in tender philanthropy and a sense of duty." However great may be the general attainments of a physician, there is one kind of knowledge indispensable, that of the Ma- Ale INTRODUCTION. 9 teria Medica: and as none but a charlatan affects to be able to retain an adequate amount of it in his mind, the best phy- sicians study it at the bed-side of the sick, and partly in a re- pertory, a Materia Medica in which the symptoms have an or- derly arrangement, for convenience of reference and greater certainty in the selection of the best remedy. The Homeopathic Materia Medica is the true test of the correctness of conclusions drawn from Clinical experience; indeed, it was originally the only guide to that practice which was attended with such splendid results in 1832. It was Hah- nemann's confidence in this, and in his law of cure, that en- abled him to publish the plan on which this fearful malady was successfully combated. With his usual sagacity, he pointed out the true prophylactics, and all the most important curatives, when this pestilence had not fallen under his own observation. Having discovered and demonstrated a universal, unerring, and everlasting law in medicine, he was prepared to encounter the strangest forms of disease as though they were familiar. The law is similia similibus curantur, like are cured by like; or (to expand this brief and elliptical aphorism) diseases are cured by medicines which tend to excite affections similar to the diseases themselves. From the Greek oμotov nábos (ho- moion pathos, affectus similis, the Latin term Homeopathia, and the English Homœopathy, are derived. We frequently hear persons who have no experience in Ho- mœopathy, or who at most have seen its effect in Chronic cases, saying, I would not dare to trust it if I were very sick, with a dangerous and rapid disease. I should want some- thing that would act powerfully and quickly. A potentized medicine selected in accordance with the Homœopathic law, is that very thing. Thousands of physicians know it to be such; and that in their own former Allopathic practice, and in that of their brethren of the old school, no violent and rapid diseases have been cured as surely and promptly as they 10 INTRODUCTION. " now cure them by the homoeopathic method. Large doses are not required to cure any disease whatever. Attenua- tion, whilst it weakens and ultimately nullifies poisons, as such, is in almost every substance essential to the full de- velopment of medicinal power; and, in some substances, no medicinal power whatever is manifested until the substance is rendered extremely dilute. This book will contain abundant experimental evidence of the efficacy of attenuated medicines in the treatment of Cholera. The great success of European physicians in the treatment of the Asiatic Cholera of 1832, and of many American physicians in 1849, was due to the use of attenuated medicines, as well as to the law of similitude which regulated their administration. If the author were charged with the duty of testing the relative merits of the ho- mœopathic and, allopathic laws of cure before an impartial and intelligent tribunal of either school, and if his life depended upon obtaining a verdict in favor of Homœopathy, he would not only select violent and rapid diseases, in preference to such as are mild and chronic, but would administer attenuated medicines, in small doses. As the potencies and doses recommended by Dr. QUIN of London, and on his authority in the former editions of this book, have with all who employed them in 1849, well sustain- ed the reputation gained in 1832, they have not been changed in the present edition.* In the present state of homoeopathic science they may be properly denominated the medium dilu- tions. Those who prefer lower or higher ones, will find no difficulty in using this book as a guide in the selection and administration of the remedies. The same number of globules and the same intervals between the doses, will be appropriate. New-York, July, 1854. * Other acknowledgements of some of the advantages, which this book has derived from the excellent French treatise, of this distinguished and venerated pioneer of sound Homœopathy in England, are given on pages, 71, 121, 122, 123 and 170 INTRODUCTION. 11 LIST OF THE CHOLERA MEDICINES, Names. WITH THE PROPER ATTENUATIONS. Aconitum, 24th attenuation; Arsenicum, 30th; Belladonna, 30th; Camphora, Tinct. & 3d, Cantharis, 30th; Carbo-v.getabilis, 30th; Chamomilla, 30th; Ipecacuanha, 3d, Jatropha, 12th; Mercurius-vivus, 12th; Natrum-muriaticum, 12th; Nux-vomica, 30th; PHOSPHORUS, 30th ; Stramonium, 12th; Sulphur, 30th ; Cicuta, 30th ; Cinchona, 12th; CUPRUM, 30th; Acidum-hydrocianicum, 30th ; (L <" (C CC it 66 C4 (6 (+ << 着​家 ​(C (C C (6 Li Q ،، PHOSPHORI-ACIDUM, 3d, & 30th ; Rhus-radicans, 30th ; Secale-cornutum, 12th; << ،، Tartarus-emeticus, 12th; VERATRUM, 12th & 30th 66 ( " 46 CC (( (" (C "" *4 CC (C CC (( (L * "L CA (C SYMPTOMS OF THE SECOND VARIETY, CHOLERA GASTRICA, GASTRIC CHOLERA. This form of Cholera is characterized by frequent or almost continual vomiting, but is often accompa- nied by many symptoms of other varieties. The matters at first thrown out consist of the food which the stomach happened to contain, or the liquids which had been swallowed. They are usually thrown up with a sudden jerk, without previous retching. The vomiting is sometimes preceded for a short time. by nausea. There is no diarrhoea, or only one or two evacuations at the onset. The urine is scanty. OF THE VARIETIES. 117 & The gastric variety of Cholera is neither the most frequent nor the most dangerous. When the epi- demic prevails, this form may be excited by flatulent vegetables or other indigestible food. TREATMENT OF GASTRIC CHOLERA. The principal remedies are Camphor and Vera- trum. Camphor will ordinarily be proper at the onset; one drop every five minutes. If relief is not soon obtained, give Veratrum 12, at the usual inter- vals, unless some other remedy is more indicated by the character, conditions or concomitants of the vomit- ing.* If, by the effect of the Veratrum or Ipecac., the vomiting cease, but the other symptoms remain, and there is great weight at the stomach and pains in the intestines and head, then have recourse to Nux 30. But if the disease is not checked, give Verat. 30 or other medicines according to the indi- cations. To Cholera excited by anger, and attended with either vomiting to diarrhoea, Cham. 12 is appro- priate. > SYMPTOMS OF THE THIRD VARIETY, CHOLERA SPASMODICA, SPASMODIC CHOLERA. This form is especially characterized by cramps and other spasms. The principal symptoms are, Examine the repertories to decide between these, or to deter mine whether some other remedy is preferable. 6* 118 TREATMENT contractions and cramps in the toes and fingers; afterwards, cramps in the calves, or convulsive move- ments in the muscles of the fore-arm, and legs; then spasms in the upper arms and thighs, and some- times fixed spasms in the chest, neck and jaw, re- sembling those of locked jaw or tetanus. The con- striction of the chest is preceded by vomiting. Neither vomiting nor diarrhoea frequently occur in this varie- ty; but it may succeed a neglected diarrhoea, and be ushered in by a single copious vomiting, and at- tended by occasional retchings. In some cases, there are first cramps in the calves of the legs; then tonic spasms of the whole of both inferior extremities, soon extending in succession to the abdomen, stomach, chest and throat; the in- ferior limbs remaining spasmodically extended and extremely stiff and hard, and affected with excruciat- ing pain; a hard swelling at the stomach; spasms of the muscles of the jaw, attended with grating of the teeth; respiration almost arrested; sense of extreme suffocation; apprehension of impending dissolution; deglutition difficult, sometimes impossible. The spasms at length relax, and the patient for a few minutes, is free from pain. Then the spasms and the pain return with their former severity. TREATMENT OF SPASMODIC CHOLERA. The principal remedies are Camphor, Cuprum and Veratrum. Give a drop of Camphor every five minutes. During the paroxysms, if they are ex- OF THE VARIETIES. 119 tremely severe, we may give two drops at a dose, or repeat one drop every two or three minutes. The remedy next to be employed for removing the re- mains of the spasms and preventing their return is ordinarily Cuprum 30. Give it in solution, or dry in doses of two or three globules, and repeat it many times at intervals of half an hour, or an hour, if its salutary effect is not manifested. If necessary, then give Veratrum (12th then 30th) in repeated doses, or other medicines according to the different indications. Cuprum may be given at the onset of the spasms, provided their character and concomitants indicate its use decidedly more than that of Camphor. Vide Cholera Repertory. SYMPTOMS OF THE FOURTH VARIETY, CHOLERA SICCA, DRY CHOLERA. There is no diarrhea nor vomiting. Sometimes the attack is first manifested by a blackish color of certain parts, as the ends of the fingers, whilst the general strength is not seriously impaired. In the severer forms, there is a sudden prostration of the vital powers; the urine is suppressed; tongue some- times blue or blackish; the eyes up-turned and fixed ļ; coldness of the surface of the whole body, which be- comes covered with a cold, sticky sweat; the face and limbs have a violet blue color. The voice and pulse fail. This variety requires the most prompt attention. 120 TREATMENT TREATMENT OF DRY CHOLERA. The first remedy, as in other varieties of Cholera, is Camphor. In this variety, it is especially required, for arousing the nervous system. Repeat it in doses of one or two drops, every five minutes. Then, if necessary, give Veratrum every half hour, or hour, or hour and a half. If the cramps and vomitings have entirely ceased, if the patient is cold, blue and pulse- less, i. e. collapsed-Carbo-v. *°, two or three glo- bules. In this state of complete asphyxia, some re- commend hydrocianic acid, 3d attenuation, every hour or two. We recognise the effect of these me- dicines by the pulsations becoming sensible, and sometimes by a return of the cramps, vomitings or diarrhoea; symptoms which are then to be treated by Veratrum or Cuprum, or some other remedy, according to the indication. SYMPTOMS OF THE FIFTH VARIETY, CHOLERA ACUTA, ACUTE CHOLERA. In this variety the nervous centres seem to be ef- fected in the first stage. Yet in its course it simu- lates the form of some other varieties, and like them, unless checked, ends in asphyxia and death. The patient at first feels as if he were stunned, or has a sensation of weight in the head, or vertigo; oppression of the chest; numbness of the arms and legs. Afterwards there are rumblings in the in- OF THE VARIETIES. 121 + : testines; heat of the body, pulse rapid and feeble nausea, retching or vomiting; bilious or watery diarrhoea; suppression of urine; tongue cold; voice altered; face yellowish, with a dark blue circle around the eyes; prostration; spasms, at first, in the feet and hands, afterwards extending to the arms and legs, which become dark-blue and cold; the eyes tarnished and sunk in their orbits. The diarrhoea and cramps cease, and the disease in its later stage runs into the form of dry Cholera, characterized by cold sweats, insensible pulse, and general blueness- i. e. by collapse. The above descriptions of the dry and acute Cho- lera, are extracted mainly from the treatise of Dr. F.F.Quin. In both, the strong impression of the poison on the nervous system, seems to produce an unusu- ally great and early change in oxygenation and the constitution of the blood. There is probably no im- propriety in applying the term acute to most of those cases which without being dry, are sudden in their invasion and rapid in their course. Such cases not unfrequently present complications which prevent their being embraced in any other single class, un- less we should add a new one to those here enume- rated. TREATMENT OF ACUTE CHOLERA. Give Veratrum; at first the 12th, in persons of vigorous constitution, and after three doses, the 30th, 122 TREATMENT 1 in the quantity and at the intervals before described. In cases of persons of feeble constitution, give one dose of the 12th, and follow it by as many of the 30th as shall be necessary. If in this or in any other variety of Cholera, there is severe burning in any part of the alimentary- canal, with violent colic, and great weakness or rest- lessness, give Arsenicum 30. If the colic proves ob- stinate, give an enema of ice-water. Though Vera- trum is in general the grand remedy for this some- what complicated variety, yet it will often be neces- sary to consult the repertory, and determine the re- medy by groups of symptoms.* A SYMPTOMS OF THE SIXTH VARIETY, ` CHOLERA GASTRO-ENTERICA, GASTRO-ENTERIC CHOLERA. This is a kind of combination of the gastric and diarrhoeic varieties; yet being not unfrequent in its occurrence, it merits a distinct consideration. It is characterized by vomiting and diarrhoea, almost si- multaneous in their commencement, and nearly equal in their intensity and duration. These evacuations from the stomach and intestines agree in another respect viz. in consisting at first of the usual con- tents of those cavities respectively, (i. e. food being vomited, and fœcal matter dejected,) and in soon be- * The treatment of the dry and acute varieties, is taken mainly from the treatise of Dr. F. F. Quin of London. OF THE VARIETIES. 123 coming thinner, afterwards watery, and ultimately assuming the rice-water appearance. Although this combination of upward and downward discharges is characteristic of this variety, there may be some cramps, and great coldness of the body, and the patient may be, within a few hours after the attack, in the blue and pulseless condition of collapse. TREATMENT OF GASTRO-ENTERIC CHOLERA. The principal remedy is Veratrum, in the doses and at the intervals before mentioned. If a dose or two of the 12th is given at first, the 30th should be given subsequently. If the treatment is commenced very early, Cam- phor will be appropriate, and ordinarily sufficient. Dose, one drop every five minutes. When the stools. become exceedingly copious and liquid, Veratrum is in most cases to be used. If there is complication of other symptoms, the groups may indicate some other remedy. C SYMPTOMS OF THE SEVENTH VARIETY, CHOLERA DYSENTERICA, DYSENTERIC CHOLERA.* This variety commences with the symptoms of diarrhoeic Cholera, and gradually becomes more * Dr. Quin, from whom the above classification is in part taken, comprises in " Dysenteric Cholera," what is here named Diar-· rhaic, if he does not restrict it to that. $ 124 TREATMENT A dysenteric. The diarrhoea from the outset is attended with pain in the abdomen. The stools, copious and watery, presently acquire the rice-water character. After some time they diminish in quantity, and pre- sent, in addition to the watery and ricey portions, some mucus, which still later becomes sanguineous, but is still accompanied by ricey and watery por- tions. If the disease continue some days, the ricey evacuations are replaced by others of bloody mucus or blood. Cramps of the feet may exist early in the second stage, and even precede the attack as a pre- monitory symptom. Many cases of dysenteric Cholera occurred in 1849. They were distinguishable from dysentery (many cases of which also occurred in the same epi- demic) by the Cholera symptoms which predominated in the earlier stages. On account of the frequent occurrence of this form as compared with all others of an inflammatory char- acter, and the peculiarity in the treatment required, there is a practical advantage in giving it a distinct consideration and name. It is therefore placed by itself in this edition. It is not usually in any re- markable degree, a febrile disease: the depression of the vital forces by the Cholera proper, seems in many cases to overbalance the general excitement which the associated inflammation of the mucous membrane of the large intestine tends to produce. And this inflammation when uncomplicated, is sel- dom attended with as much fulness of pulse and pains OF THE VARIETIES. 125 in various parts, as characterize many other inflam- mations and fevers. Yet there are cases where this variety is complicated with the succeeding. There may be similar complications in the case of other varieties. I am not insensible to the defects of this and all classifications, of the disease, but deem it practically useful to adopt one that is approximately correct. TREATMENT OF DYSENTERIC CHOLERA. The principal remedies for this variety, are Cam- phor, Veratrum, Mercurius-vivus, and Sulphur— in the above order. There being an inflammation of the mucous mem- brane of the large intestine, we should make but a sparing and cautious use of Camphor.* Give three or four doses of Camphor ³, at inter- vals of a quarter or half an hour, or, if this is not at hand, as many quarter-drop doses of the tincture; then Veratrum 12 or 30, until the evacuations be- come small and bloody; then Mercurius 12, followed after some time by Mercurius 30. After amendment of the dysenteric portion of the disease, commences, the cure is to be completed by Sulphur 3º. * I think a similar precaution in regard to Camphor, is advisable in treating children in cholera generally. Nearly all the fatal cases which I have heard of as occurring after an early use of Camphor, have been among children under twelve years of age. I would ad- vise that in the cases of children, Camphor be not employed lower than the third dilution. 126 TREATMENT 2 Sometimes, when there is inflammatory fever, two or three doses of Aconite will be required before the Mercurius, or during a temporary suspension of the use of the latter. SYMPTOMS OF THE EIGHTH VARIETY, CHOLERA FE- BRILIS, FEBRILE CHOLERA. ver. In some instances, cholera is complicated with fe- This is distinguishable from other febrile disea- ses, by the watery and ricey evacuations, or the nausea vomitings and spasms; and from other forms of cholera, by the frequency, hardness, and fulness of the pulse. The temperature of the body is generally above the normal standard, that of the hands and feet, sometimes below. Pains in the small of the back, hips, limbs, head, and abdomen. Redness of the eyes, tongue, or fingers. TREATMENT OF FEBRILE CHOLERA. In febrile cholera, give but little Camphor. For a short time use Veratrum, or other remedies adapted to the purging vomiting, or cramps, if either is severe. Then Aconitum 12 or 80 in solution, a dose once in two or three hours, if the pulse is hard, full and rapid, and there is great thirst, and heat of skin. Otherwise use Rhus-radicans 30, for the rheu- matic-like pains. This last remedy will be especially OF THE VARIETIES. 127 indicated if the tip of the tongue is red. Then Bell. 80, Bry. 30, or Canth. ", according to the symptoms and the organ affected. The accurate selection of the remedy in these cases can be made only by a homœo- pathicphysician. The foregoing varieties are in some cases well marked, in others not. There is an advantage in at- tending to them; though the homoeopathic physician who prescribes for the symptoms, will not deem it necessary to designate the variety. This will often be impracticable, especially if he is called when the cases are so advanced as to confound varieties which were originally distinct. In one sense, the variety may change with the stage. CHAPTER VIII. SYMPTOMS AND TREATMENT OF THE STAGES OF CHOLERA. A case of either of the foregoing varieties is not usually divisible into distinct, well-defined stages; "but we may enumerate four stages; some of them be- ing oftener present or more distinct or durable in one variety, and some in another. They are: 1st. The incipient Stage, or Stage of Invasion: 2d. The t : 128 TREATMENT Active Stage, or Stage of Full Development: 3d. The Stage of Collapse: and 4th. The Stage of Reaction. FIRST STAGE, STAGE OF INVASION. This is usually longest in the diarrhoeic variety; in which it may continue from one hour to several days. The stools, though they may be watery and whitish, are not profuse. In the gastric variety, this stage may present a transient nausea, or a few loose focal stools; in the spasmodic variety, diarrhoea, or one or two vomitings; in the acute variety, vertigo; in the gastro-enteric variety, nausea. When cholera prevails, the above symptoms are generally due to the action of its poison. This is evident from their general prevalence during the epi- demic, their amenability to cholera remedies, and the formidable and unequivocal phases which they fre- quently assume, when nature is unaided. There are two modes of considering these symp- toms-either as constituting a milder form, or an earlier stage. The latter is here preferred. Some of these cases would stop in this stage, others be- come fully developed, and finally fatal. No power of diagnosis could at first separate them into two class- es, founded on their inherent tendencies. Could we distinguish those which would spontaneously prove abortive, we would exclude them, even from the first OF THE STAGES. 129 stage. But that distinction is impracticable. With- out any assumption in regard to their nature, the event under treatment, will subsequently decide whether they assume a form more complicated and severe; and as it requires a certain number and se- verity of symptoms, to constitute the disease in its more formidable and popular sense, we never include in our cholera reports, the cases cured in this stage of invasion.* The principal remedies in the first stage are: Camphor, Phosphorus, Phosphoric-acid, and Vera- trum. SECOND STAGE, STAGE OF FULL DE- VELOPMENT. This, in the diarrhoeic variety, is characterized by the profuse or frequent rice-water evacuations; in the gastric variety, by the vomiting of similar matter; in the spasmodic variety, by severe cramps or other spasms; in the dry variety, the first two stages may be scarcely perceptible, unless the first is, by the dark color of certain parts, or the coldness of the tongue; in the acute variety, there may be a livid appearance under the eyes, vomiting, or rumblings and liquid stools. In the gastro-enteric variety, there is pro- fuse vomiting and diarrhoea; in the dysenteric varie- * In an essay published in the appendix to this book, this stage is designated by the convenient term Choleroid. This term includes Cholerine, but has the advantage of greater comprehensiveness. 130 TREATMENT ty, pain and tenderness of the abdomen, and watery, ricey, and bloody-mucous discharges. The stage of full development has usually one of two terminations; viz., either collapse, or convales- cence. In fully developed cholera, the principal remedies are: Camphor, Veratrum, Cuprum, Phosphorus, Phosphoric-acid, and Arsenicum. It is the commencement of this stage, that is allud- ed to in Chapter VI,* as "a decided attack." For the details of its early treatment, the second section of that chapter is to be consulted-also the Reperto- ries. THIRD STAGE, STAGE OF COLLAPSE. This stage of collapse may have the same charac- ter in every variety of Cholera, and in its principal features it is similar in all varieties. The term col- lapse is used to designate a certain collection of symp- toms, including pulselessness; cold, blue and shri- velled skin; the voice reduced to a whisper; the urine and other secretions suppressed, and the face presenting a certain appearance called Choleric. The term facies cholerica is used to denote a face cold, livid and shrunk, and often anxious, the eyes sunk in the orbits, and upturned, or fixed, as if in vacant staring. The vox cholerica, which belongs chiefly to * Page 102. OF THE STAGES. 131 • this stage, is a voice hoarse, feeble, whispering, or almost imperceptible. The duration of the third stage, varies from two hours to two days. It has one of three terminations; viz., either death, convalescence, or a disease which is inflammatory, congestive, or typhus. When death occurs from Cholera, it is usually at the termination of the third stage, sometimes of the fourth. The re- turn of a perceptible pulse, and of warmth, although attended with a renewal of the vomiting and diar- rhoea, are favorable signs; though even after this partial reaction, there may be a relapse into asphyxia. If the collapse is complete, the principal remedies are Cuprum, Arsenicum, Carbo-vegetabilis, and Se- cale. When the collapse is only incipient or partial, Camphor and Veratrum. These may also be re- quired for a while in complete collapse, if they have not been resorted to in an earlier stage of the same case. FOURTH STAGE, STAGE OF REACTION AND SECOND ARY AFFECTIONS. The secondary affections which ensue on reaction, are congestive, inflammatory, or febrile. The fourth stage proper, i. e., reaction attended with these seri- ous diseases, has seldom any existence after a good homoeopathic treatment of Cholera proper; though there will, in some cases, be dysuria. The affections 132 TREATMENT to be most apprehended after allopathic treatment, are, inflammation, or congestion of the brain, stomach, intestines, or lungs; or typhoid fever. So far as there is a partial reproduction of the symptoms of the second stage, which had disappear- ed during the collapse, a recurrence to the remedies of the second stage will be necessary in the fourth. But for the new symptoms following reaction, use other remedies. For the irritation of the bladder, at- tended with painful urination, use Cantharis 20, eve- ry hour or two, whilst the symptoms remain urgent. 30 In most of these inflammations, however, we may give two or three doses of Acon. 24, at intervals of an hour, and then follow it by the remedy adapted to the symptoms, and the organ affected; repeating this last medicine much less frequently. If it is the brain that is affected, the remedy will generally be Bella- donna 0; if the lungs, Bryonia 30, in some cases. followed by Rhus 30; if the stomach or intestines, Nux 30, and sometimes Bry. 30; if the bladder, Can- tharis 30. This last is also the remedy where there is inflammation in the lower intestines, attended with burning, tenesmus, and bloody stools. For the ty- phus or typhoid fever, Bryonia, and sometimes Phosphoric-acid, may be used; but the principal remedy is Rhus-radicans.* V * I deem it due to the profession as well as to myself, to state, that the Note on this plant, inserted without my consent or know- ledge, in the Appendix to the American edition of Jahr's Sympto- OF THE STAGES. 133 I will take this occasion to make a remark on a topic, not discussed in either of the notes above re- ferred to. The Rhus-tox. which Hahnemann tried, was an exotic, and hence probably did not possess as much power as a plant of the same species found growing in its native soil in America. Dr. Wallace, a scien- tific oculist of this city, informs me that this is the case with Stramonium; and that, on the other hand, the Belladonna of Europe is more powerful, in dilat- ing the pupil, than the exotic Belladonna of America. Again, if the shrub Rhus tox. is a stunted variety of the same species as the vine Rhus-rad., there is an additional reason for doubting whether it has as much activity; furthermore, the provings afford evidence that it has not. So far as the clinical experience of many physicians for some years can show, the Rhus- rad. is as efficacious as Rhus-tox. or more so, in those cases to which the latter is applicable. Like several other physicians, I prefer it. Wherever in the re- pertory, the generic term Rhus is used alone, it may be considered as including both Rhus-rad. and Rhus- tox. men-Codex, is grossly incorrect, especially where it attempts to cor- rect my botanical description of this plant in general, and of the particular plant from which I obtained the specimen for trial. This last part of the criticism is not only incorrect, but absurd; inasmuch as the botanical character of those particular leaves could be known only to myself and my respectable medical colleagues who engaged with me in the provings, and to whom the leaves were shown. I here re-affirm the correctness of my description, as given in the Note in the body of the same Symptomen-Codex, pages 671 and 672. 7 134 CASES OF CHOLERA If great debility follows the Cholera, and there are no other symptoms which require special attention, the appropriate remedy is Cinchona 12. The final remedy for the more complete restoration of health, will frequently be Sulph. 30, given in a single dose, and allowed to act a long time without repetition. When a homoeopathic physician is called in any stage, to any case of Cholera which has been under allopathic treatment, he is first to antidote the for- mer treatment by Camphor. Give it but a short time, if there is any inflammation. He can judge if other antidotes are necessary; as they frequently will be in the course of the treatment; for calomel and crude drugs-and even the undiluted colored tinc- tures of the homoeopathic shops-are so durable in their mischievous action, as to require for their cor- rection, something more durable in its curative ac- tion, than Camphor. CHAPTER IX. < CASES OF CHOLERA IN NEW-YORK, IN 1849 AND SUBSEQUENT YEARS- A FEW EXAMPLES OF CHOLEROID DISEASE. PRELIMINARY REMARK S. WITH The following cases are given as examples of the symptoms and treatment of several forms of the dis- IN NEW-YORK. 135 ease. To give them value for statistical use, a report of the entire number of cases would be requisite. The author regrets, that the engrossing nature of his practice in the epidemic, left him too little time to give as full description even of the cases here pub- lished, as would be desirable. The records of most of his other cases are meagre. Some of those here given will be of use to the student and practitioner ; they perhaps occupy sufficient space in the book for most practical purposes. The patients were persons of intelligence, and their statements reliable. All the cases except the 5th, 14th, 15th, 18th, and 19th, occurred when the Cholera was extensively prevalent. Some may be disposed to call the rarer cases sporadic. Sporadic means scattered, and is properly and gene- rally applied to cases of disease which are not only scattering, but independent of any epidemic or con- tagious influence. When cases occur at long intervals, are few and isolated, some persons doubt whether they are Asia- tic Cholera, however characteristic the symptoms- because, say the sceptics, Cholera, when it exists, is an epidemic, i. e., a prevalent disease. But an epi- demic must have a beginning and termination, in sin- gle cases; and subsequent to the first, and antece- dent to the last, are rare cases. By cutting off both ends of the pestilence, pronouncing them sporadic, and thus putting them in another category, some prove to their own satisfaction, from experience, that Cholera when it actually exists, is a prevalent disease. P 136 CASES OF CHOLERA The next step is to apply this inference in justifying the subsequent exclusion of rare and isolated cases. This is reasoning in a circle. The term epidemic may be properly employed, either with reference to the general prevalence of the atmospheric, or other invisible cause, or to the gene- ral prevalence of the resulting disease. The cause is epidemic (epidemos, upon the people,) earlier than the disease; and, after its introduction, it, or some impression made by it, may exist for years, but in such a state as to produce only a few cases. At dif- ferent times since 1849, I have seen cases here, which resembled Cholera more strongly than any which had fallen under my observation for many preceding years. " Such considerations are calculated to allay rather than excite, undue apprehension in the public mind, at times when composure is most needful. The idea that a new poison is just now imported, is more dreadful than that of an addition to one previously present. If medical men and municipal officers con- ceal the scattering cases, and suddenly announce the arrival of the pestilence after it has gained a more formidable strength, the public mind not only receives. a severe shock, but at a time when more than at any other, such excitement is dangerous. Besides, such concealment at the earliest and last stages of the epi- demic, tends to prevent the adoption of necessary precautions by individuals. I have known of fatal IN NEW-YORK. 137 cases which would have been prevented, by informa- tion of the existence of Cholera in the city.* The valuable cases which Drs. Bayard, Quin, and Wright, have reported to the author, are described in the well-selected language of those learned and expe- rienced physicians. The following cases occurred in the practice of the author, with the exception of those in which the name of some other physician is mentioned in connection with the case. Those which bore some resemblance to Cholera, but wanted a sufficient number or severity of the characteristic symptoms, may be termed Cho- leroid. It is not considered necessary to give many of these, although in the author's practice, they were about eight times as numerous as the cases reported as Cholera. Where Camphor was employed in Cholera, it was always, unless otherwise stated, given in drop-doses, in solution in sugared water, prepared according to * Epidemics seem to depend in some instances, at least in part, upon some cause which increases the predisposition. On this prin- ciple, I explain the fact, that the susceptibility to vaccination is greater when small-pox is most prevalent. The latter has at least been the case in this city, during the epidemic small-pox of the win- ter of 1853-4, as compared with years when the latter disease was far less prevalent. Of the 142 vaccinations performed by me in pri- vate practice, from November to March inclusive, more than half were successful, and some in persons who had previously had small- pox, some varioloid, and one in a lady who had had both very deci- dedly, she now took vaccination in an equally decided degree. Near- ly all the subjects had been previously vaccinated once or more. 138 CASES OF CHOLERA the method described in this book. In regard to other medicines, where only a single dose of any attenua- tion was administered, it was about three small glo- bules placed dry on the tongue, by itself, or in sugar or saccharum-lactis. Where a greater number of do- ses of an attenuated medicine were employed, the method was to dissolve about six small globules in a gill, i. e., half a tumblerful of cold water, and di- rect the patient to take three teaspoonfuls at a time, as a dose. The professional reader will understand the charac- ter to signify prescription, or treatment prescribed or commenced by the physician. When a figure is prefixed to the name of the medicine, it signifies the number of doses. The figure at the right of the name of the medicine, and a little above, denotes the attenuation or potency. CASES OF CHOLEROID DISEASE. CASE 1.-Diarrhoeic Choleroid. On Tuesday, July 10th, 1849, an unmarried gentleman, a mer- chant, aged about 24, applied to me on account of a simple diarrhoea, and received three powders of .Cam- phor³, to be taken dry, and a powder of Veratrum³ to be taken in solution, in seven doses. He was for the time relieved: but in the latter part of the follow- ing day, Wednesday, he used some indigestible food > P IN NEW-YORK. 139 in improper quantity. In the succeeding night, Thursday, 2 A. M., he was suddenly attacked with diarrhoea of a different character. In this last attack the stools were at first thin and brown, afterwards watery and white. Veratrum 3º after each evacua- tion, relieved him permanently. " Remark.-The suddenness of the attack, the noc- turnal invasion, and the watery consistence and milky color of the evacuations, are among the characteris- tics of Cholera. But others were wanting. The patient was not prostrated, but able to call at my of fice. This may be considered as a case of Cholerine, i. e., Diarrhoeic Choleroid. CASE 2-Spasmodic Choleroid.-On Sunday morning, August 19th, 1849, a merchant, aged 37 years, had a loose evacuation. Without consulting a physician, he took Veratrum. From his medical associations, I had little doubt that it was some low dilution. At midnight, he was seized with a chill, or parox- ysm of shivering, soon attended with cramps in the jaw and wrists. Being alarmed at these symptoms, he sent a carriage for me as soon as possible. The distance was about a mile. In the mean time, he took tincture of Camphor, which on my arrival at a quarter before two, A. M., had been followed by per- spiration. > 140 CASES OF CHOLEROID Prescription, Cuprum day, Monday, 20th. 30 He was well the same Remarks.-This may be considered as a case of spasmodic choleroid; or in other words, spasmodic cholera arrested in the first stage. It sustained the same relation to developed spasmodic cholera, that cholerine does to developed diarrhoeic cholera. That the cholera poison had some agency in the production of this gentleman's symptoms, I subse- quently had additional evidence, in being called on the same day, the 20th, to visit two of his children, attacked with diarrhoeic cholera; many liquid and ricey evacuations, some of them copious. One at least had a decidedly cold tongue. The symptoms had commenced on the same day as the premonitory looseness of the father, but not with severity suffi- cient to excite apprehension in the family, and induce them to seek medical aid. K In such epidemics, several nearly simultaneous at- tacks in a family are not uncommon. In the epidemic, there were many instances of slight spasmodic choleroid. Thus the cholera poison manifested its influence by exciting frequently re- peated cramps in individuals, for several weeks before they were attacked with cholera. Such cases show an early impression on the nervous system. That this impression may be instrumental in changing the blood, and be one of the earliest links in the chain, I long, since recognized in an article which was pub- OU IN NEW-YORK. 14 lished in the Transactions of the Medical Society of the State of New York, and from which I have ex- tracted most of the first two chapters of this book. It was not thought necessary to extract these more hypothetical parts on pathogeny, and they are refer- red to now to show, that the nervous theory of chole- ra is neither new nor incompatible with that given in this book. In some instances, the change of color of the blood in certain parts, was the most marked of the early symptoms, and almost the only one One of the ca- ses of this kind of dry choleroid, which came under my observation, is described in the appendix. It oc- curred in a young gentleman, at that time laboriously engaged in practising in the epidemic. He was ex- posed to many of the most malignant cases, and in the most unhealthy localities. The bluish-black color of his fingers, which he describes, I saw several times. V CASE 3.-Diarrheic Choleroid.-On Tuesday, Sept. 25th, 1849, at 8 A. M., Capt. C. called on me to visit his wife immediately. Aged about 27; had slight diarrhoea last evening. This morning was suddenly attacked with nausea, violent diarrhoea and severe pains in the abdomen. There were three stools, brown and "watery"-two of them large. B-3 Veratrum 30 one every hour; afterwards, > 7* 142 CASES OF CHOLEROID only once in three hours, unless there should be eva- cuations. Called in the evening, and found that she had im- mediately recovered under the Veratrum 30. CASE 4.-M., a girl aged 10. Attacked with vio- lent diarrhoea and colic, in the night, between two and three, A. M., Friday, Sept. 28th, 1849. I was sent for at seven, and arrived at seven and a half, A. M. Five stools, the first three about a pint each, watery, with pea-sized pieces of something yellowish. B-1 Arsenicum 30, dry, then Veratrum 3°, in so- lution, each hour till relieved; then once in two hours. Recovery on the same day under the Vera- trum 30 CASE 5.-Gastro-enteric Choleroid.-On Thurs- day, July 21st, 1853, at nine, A. M., B. F. Joslin, Jr., M.D., was called to visit a boy, æt. seven years, who had vomiting and diarrhoea. Had been attacked about four, A. M. The discharges frequent, extreme- ly so at first; most of them yellowish and watery, the last colorless, having the appearance of clear water. Rice-water vomiting; pulse 138; tongue whitish and cool; lips cold. Three hours after- wards, at twelve o'clock, I visited the patient in consultation. There was no vomiting nor diarrhoea. Some degree of reaction had taken place. Ar- senicum continued. At half past four, P. M., 30 IN NEW-YORK. 143 Dr. Joslin, Jr., made his third visit. Pulse, 120 and full; lips warm; tongue warm. B. Aconitum 30, alternately with Arsenicum 3°. On the next day, the boy was found cured. Treat- ment discontinued. MAR Remark. This case approximated very nearly to developed Cholera, but was not reported. CASE 6.-Dry Choleroid.-In the epidemic of 1849, Dr. B., aged 42, was suddenly awakened in the night with a sensation of great coldness. At first he supposed that the wind was blowing upon him. His wife remarked, "you are covered with a profuse, cold sweat." The Doctor then, on examination, perceived that the sweat was general, cold and clammy. Great weakness, with a degree of restlessness. Mrs. B., asked the Doctor what medicine he would take. He replied the third of Camphor. His wife fearing this was not sufficiently powerful, endeavored to persuade him to take the tincture in drop doses. But the Doc- tor, supposing he had Cholera-sicca, and having rea- sons to believe in the power of attenuated Camphor, when properly indicated, determined to try it on his own person, and accordingly took a few pellets of the third dilution, i. e. Camph. ⁹, dry, on the tongue, and after waiting fifteen minutes, repeated the dose. A short time after this, he was conscious of an increased 8 144 CASES OF CHOLEROID warmth, a drying up of the sweat, which rapidly took place, and a calmness of feeling, which predisposed to sleep. He awoke in the morning with his usual amount of health. : - Remark. This case is placed in the Choleroid class, not because there is any doubt respecting its cause or tendency, but because the disease was ar- rested in the first stage. Yet the most marked symptom which was present, belongs oftener to the third stage of Cholera of other varieties. The first stage of Cholera-sicca, may be as dangerous as the second or third of some other varieties. CASES OF DIARRHEIC CHOLERA. CASE 7.-On Monday, June 4th, 1849.-Mr. S., a mechanic, aged forty, residing in the upper part of the city, dined later than usual, on stewed kidneys, of which he made his meal. The night following, he was disturbed several times in his sleep by a diarrhoea, with colic before evacuation. The next day, June 5th, it increased; and on the morning fol- lowing, June 6th, feeling more unwell, he sent for Ed- ward Bayard, M. D. He found the patient vomiting and purging; profuse watery discharges without smell or color; cold sweat over the body, more parti- cularly on the forehead; skin shriveled and blue; tongue and breath cold; pulse scarcely perceptible at the wrist; throwing his arms about with excessive restlessness; complaining of cramps in the region of the stomach and in the calves of his legs; voice 1 1 IN NEW-YORK. 145 1 sepulchral. Dr. Bayard gave him a drop of the tinc- ture of Camphor in a tablespoonful of water, every fifteen minutes for three times, which produced no visible effect. He then dissolved a few pellets of the thirtieth dynamization of Veratrum in a tumbler one third full of water, and gave a tablespoonful of the mixture, and in thirty minutes repeated the remedy. The pulse rose, and likewise the temperature of the body. On the third dose, the vomiting became frothy, indicative of the action of the medicine. The remedy was then discontinued. In a short time, reaction fully set in, and in a few days, the patient was entirely restored to health. CASE 8.-On Monday, June 25th, 1849.—A mar- ried gentleman, a merchant, aged about 30, was at- tacked in the night, about two, A. M., with violent watery diarrhoea. When first visited in haste, early in the morning, he had had several evacuations, at- tended with cold perspiration on the face. Decidedly dark and unnatural color of the face. Great prostra- tion, was unable to step without assistance. Cramps in the abdomen. The watery evacuations still con- tinued. He was treated by Camph. , in drop doses, in sugared water, and Camph. ³ in solution. The diarrhoea immediately stopped under the Camphor ; but Veratrum *0, in solution, was given in the even- ing and next day. During his convalescence on this second day, he also took one Belladonna ³° and one Nux-vom. 1000, and finally, on the third day, one Nux-vom. 30 all dry. το 3 30 ว 146 CASES OF CHOLERA CASE 9.-Friday, June 29th, 1849.-A married lady, aged about 35, had a sudden attack of diarrhoea three days since. She took Camphor tincture, in one drop doses, and being relieved, did not think it ne- cessary to send for a physician. Yesterday walked much. This morning at six o'clock, was attacked with diarrhoea and colic. I saw her at eleven, A. M. The diarrhoea con- tinued up to that time. In the five hours, she has had twelve stools, I saw the last, which consisted of about three gills of rice-water liquid, with abundant white ricey flocks. Coat on the tongue whitish with a scarce- ly perceptible tinge of yellow. Urine suppressed. R. Phosphorus 30 one dose dry, the others in solution. " Saw her again about four, P. M. She had in one hour considerable cramp in the abdomen, between the umbilicus and right groin; is now free from it. Has taken the Phos. 30 every second hour, i. e. three times in all. No stool since commencing it. Is much better. Has had one moderate discharge of urine. Is to take a few more doses of Phos. solut. at intervals of two hours. 30 7 Was seen on the next day, but required no repeti- tion of the medicine. Sunday, the third day. Took one China ³°, for the remaining debility. Tuesday, the fifth day. Convalescent. Took one Sulphur 30 80 IN NEW-YORK. 147 CASE 10.-Tuesday, July 3d, 1849.-Mrs. C., aged about 32, had had more than forty stools in thirty-six hours. Had taken of her own accord, six one-drop doses of Camphor, and twelve more this evening at intervals of five minutes. At eleven and a quarter, P. M., I was called in great haste, and at eleven and a half found her. Nausea, with much effort avoided vomiting. The diarrhoea continued; the stools liquid. Pain and tenderness of the ab- domen, in which were rumblings of gas and sound of running liquid. She had suffered much pain there on both days. The noises in the abdomen had com- menced at the midnight preceding the attack, and after unusual fatigue on the preceding day. Feet cold; hands cool. Transient chilliness alternating with heat. She has felt unusually cold this season. Prescription.-One Verat. 12 dry, then Verat. 30 in solution, a dose after each evacuation. The nausea was for a few minutes increased after the Veratrum 12 Normal warmth returned to the feet soon after its administration. Wednesday, 114 A. M., the third day of the dis- ease, and the second of my treatment. } After one dose of Verat. 12 there has been no stool till this morning, when there were two, but of a very different character from the former, i. e. not liquid, but merely soft. Tenderness of abdomen much relieved-now but slight. Feet cold. The patient feels greatly prostrated-requires the recum- bent posture. 148 CASES OF CHOLERA · Ordered beef broth, and solution of Veratrum pro re nata, as before. On the following day, the patient was convales- cent. Verat. 30 Verat. 30 was once more prescribed, and the recovery was completed under its action. } CASE 11.~Thursday, July 5th, 1849.-An un- married lady, aged about 25, had between midnight and noon, when I saw her, twelve, or more, liquid stools, varying in quantity from a pint to a quart each; the first brownish. Those in the morning had the rice-water character. She described them as containing numerous small white pieces, like the curds of milk that sometimes pass an infant's bowels. Her extremities were cold in the night; and there were cramps in the calves of the legs. She took ten doses of Camphor, one drop each. Her pulse is now weak and slow. Prescription.—Verat. 3º in solution, once in two hours. Six, P. M. commencing the Veratrum. Friday, the second day. The patient is weak. Prescription: China 24, twice a day, three doses. On the fourth and fifth day of the disease, she again took Veratrum 30 in solution. The recovery was completed without any farther prescription. Remarks. The cure seems to have been princi- pally effected by Camph. and Veratrum 30 The effect of China is not stated in the record. Debili- TU ty, when caused by profuse evacuations, as it Much better. No evacuations since IN NEW-YORK. 149 seemed to be in part in this case, is one of the indications for its use. CASE 12.-A married lady, aged 34, was attacked on Thursday, Aug. 23d, 1849, in the morning, but not visited till next day at half past five, P. M., when she had had thirty alvine evacuations. The ag- gregate measure of the stools was about three gal- lons. In consistence and color many, if not most of them, resembled milky water or rice-water. The patient had but little pain, and no apprehension of danger, but expressed merely her astonishment, that the contents of the bowels should pass from her "like a flood." The pulse was extremely feeble, and the tongue cold. The Cholera prevailed much in the immediate neighborhood, and many deaths had just occurred there. 0 Now commenced Veratrum 3º in solution, to be re- peated every hour. My son, B. F. J., Jr., saw her in the evening, and continued the Verat. 30. Saturday, the third day. At half past ten o'clock, last night, the patient had a rice water and ricey stool, measuring two quarts. The next evacuation occurred at one, A. M., and showed, by the quantity and color, a decided improvement, the stool measured but one pint, and was yellowish. Since that there has been none. The tongue is warm. Prescribed Ve- ratrum 3º, in solution, once in two hours. On Sunday, the fourth day, the patient was found convalescent, but the Verat. 3° was given again that 30 150 CASES OF CHOLERA day. She recovered without the use of any other medicine, in any stage of the treatment. Remarks.-The total amount of the evacuations was nearly four gallons. I saw no fatal case, in which there was good evidence of as great a quan- tity of liquid being discharged, as in this. The more important changes in the blood seem to be more de- pendent upon the impression made by the poison on the nervous system, than upon the loss of its more liquid portions consequent upon evacuations; though in many constitutions, a copious discharge, as com- pared with a moderate one, will, cæteris paribus, re- sult from a stronger impression. But in the severest asphyxial cases, the impression is too strong to ad- mit of much if any evacuation. th CASE 13.-On Sunday, Sept. 16th, 1849, the owner and superintendent of a manufacturing esta- blishment, aged 34, had a loose evacuation in the morning. In the course of the day was somewhat thirsty. I saw him and prescribed Veratrum 3º About ten o'clock in the evening, he had a sudden and loose movement of the bowels, preceded by a sense of oppression at the stomach. Afterwards in the night there were five brown and liquid stools, each measuring about a pint and a half. The desire to evacuate was urgent and irresistible; and the eva- cuations attended with rumblings and nausea. Pain and tenderness in the stomach, but none in the ab- domen. No sleep in the night. Monday, the second day, at noon. G IN NEW-YORK. 151 Urine has been almost or quite suppressed. The patient passed about a gill and a half, after eight and a half hours. Prostrated-keeps his bed. The nausea, tenderness of the stomach, and diarrhoea con- tinue. The last two stools were examined and found to be quite watery. The evacuations excited by any movement of the body. Treatment.-Phosphoric-acid given in solution, every third hour. Tuesday, the third day. Convalescent. No stool after commencing the Phosphoric-acid 30. Tongue warm; red at the tip. Medicine was then discontinued. 3 0 1 Wednesday, the fourth day. Relapse. The patient had gone out prematurely, had eaten a peach, a potato, and soup containing to- matos and other vegetables. Had had some nausea on this and the day previous, but had not considered it worth mentioning. At ten o'clock this evening, a profuse diarrhoea commenced suddenly; had four evacuations, above two quarts in all, in an hour and a quarter. Sent immediately for medical aid. I I saw him at eleven, P. M., and examined the stools; they were liquid and brown. Nausea. Anterior part of nose cold. Tongue not cold; neither were the feet. Pulse slow, 54. Prescribed Veratrum 30, one dose dry; this was repeated in solution, after the next evacuation, which occurred in about half an > ·152 CASES OF CHOLERA hour after the preceding. About the same time had a sensation of general chilliness. Quarter before twelve, P. M. Tongue perfectly cold at the anterior part; nose still cold; restlessness. Pain at upper part of stomach, since this last attack. Prescribed one dose of Arsenicum, at this time, quarter before twelve o'clock. Quarter past twelve o'clock, at night. No evacuation since the second dose of Verat. ". Tongue became warm, half an hour after the first dose of Arsenicum 3°. The patient was then left, with directions to take Veratrum 30 and Arsenicum °, alternately after each evacuation, or in any case at intervals of one and a half hours, if awake. Should there be extensive coldness of the body, Carbo.-veg. 30, was to be administered. 3 0 Thursday, the fifth day. " Eleven, A. M. One copious stool in the night, and one this morning: they were like the preceding ones in color and quantity, but still thinner-quite watery. Has taken the Verat. and Arsen. 30 alternately. Tongue warm; slight tenderness of the stomach and abdomen; movement in the abdomen, sounding like the trickling of a liquid; pains in the temples, sharp but not shooting. Prescribed Vera- trum 30 in solution.-The patient recovered under this medicine. Remark.-Relapses during convalescence are to IN NEW-YORK. 153 be carefully guarded against, by avoiding errors of diet and undue exertion. CASE 14.-In 1854, on Sunday, May 7th, at three, P. M., Clark Wright, M. D., was called to visit a merchant of this city, who was suffering under Cholera, having been attacked in the previous night, at two, A. M. The family and patient gave the following description of the case. He was suddenly attacked with diarrhoea; the stools liquid and profuse. The evacuations con- tinued at intervals, up to the time of the first visit. The patient expressed his astonishment at the quan- tity, wondering "where so much could come from." At three, P. M., Dr. W. found the pulse very feeble; extremities cold; cramps in the calves and thighs; skin of the hands inelastic, and that of the fingers corrugated; an unnatural, hoarse, and hollow voice; bluish tinge of the face, and dark color under the eyes. Soon after this, there was another evacuation. The stool on examination, was found to be serous with whitish flocks. Urine extremely scanty. There had been no treatment. There was now prepared a solution of Camphor, made by dropping six drops of the tincture on a lump of sugar, and dissolving this in two-thirds of a tumblerful of water. Dose, a table-spoonful, once in from five to ten minutes, for an hour. Then, when there began to be more warmth in the ex- ▼ 154 CASES OF CHOLERA tremities, and some improvement in the pulse, the Camphor was discontinued, and a dose of Veratrum given. About an hour afterwards, there was an evacua- tion, like dirty rice-water, followed by extreme pros- tration and thirst; also, nausea and sensation of sinking at the stomach; and profuse and cool per- spiration. Drowsiness, with eyes half closed and eye-balls upturned. Ice was then given, ad libitum, and Camphor re- sumed in the same doses as before, i. e. half a drop each, and given every five minutes, for half an hour, when the perspiration became warm. It soon after- wards dried up, leaving the skin warm. Camphor then stopped. Veratrum, and Phos.-acid 12, then given alternately, every half hour. Two doses of each were taken. The patient then fell into a sweet sleep, slept for half an hour, and awoke refreshed. Had another but smaller passage, slightly tinged with yellow, after- wards another of a deeper yellow. After waiting two hours, there being no stool, and all other symptoms improving, Dr. Wright made the following prescription for the night: Verat. and Phosphorus alternately, one after every stool. Monday, second day, in the morning. Had had only two stools and taken two doses. The last, which had been saved, had a focal odor. 6 In the course of the day, had three stools of more consistence, and a more natural color. 1 t IN NEW-YORK. 155 On Tuesday, the third day, the medicine was discontinued, and the patient took gruel with more appetite. On Wednesday, the fourth day, he walked out. Remarks.—There was occasionally a case of Cho- lera in the city, about this time, but no reports of them were published. In respect to want of pre- valence this case was sporadic; but it was evidently of the same nature as the Asiatic or epidemic Cho- lera. There was no known occasional cause, por any thing in the habits of the patient to which the disease could be attributed. I am of opinion, that the poison, in a dilute form, is among us. CASE 15.--In 1854, on Sunday, May 21st, at four o'clock in the morning, a lady was suddenly at- tacked with diarrhoea, after having eaten, on the previous day, Rhubarb pie at dinner. Had several very large, watery and lightish brown stools, "as though" she "had taken a large dose of Calomel." Frequent but smaller stools during the day. Shẻ again eat a piece of Rhubarb pie. On the next morning, Monday, the diarrhoea re- sumed its original violence at the hour correspond- ing to that of the primary attack, four, A. M. The lady had, at that hour, a return of the copious and watery evacuations. Through the day, Monday the second day, had smaller ones of the same watery character, more frequent after eating. Face pale. Eat freely of rice-pudding. About ten o'clock in the evening, at the suggestion of a physician who was 156 CASES OF CHOLERA + visiting one of the family, she took Bi-carbonate of Soda, in table-spoonful doses of a solution made by dissolving a tea-spoonful of this salt in two thirds of a tumblerful of water; which was to be given two or three times, and followed by one-drop doses of tinc- ture of Camphor after each evacuation. She took these during the night; five doses of the former and fifteen of the latter. After three of the Soda and several of the Camphor, becoming worse, and attri- buting this to the want of sufficient Soda, she took two more doses, but without improvement; then con- tinued the Camphor, as before. The Camphor on sugar producing nausea, she afterwards took it in water, recollecting that I had thus prepared it for her father. After this change in the preparation, she experienced no nausea from the Camphor. The diarrhoea, as on previous nights, worse at and after four o'clock; stools individually less copious than in the preceding night, but more numerous and more watery and colorless. These last features excited no alarm, as she thought they might arise from some salutary action of the Camphor. The diarrhoea continued during the night and morning, at inter- vals on an average of less than half an hour, up to the time of my first visit and prescription of poten- tized Camphor. Stools whitish and watery, some colorless, some like milk mixed with an equal quan- tity of a solution of coffee, others like water contain- ing yellowish white curd-like sediment. Awake nearly the whole night, when sleep commenced being IN NEW-YORK. 157 almost immediately awoke by the diarrhoea or the premonitory pain in the abdomen. In addition to the ordinary pains, there were at times abdominal cramps. About six times in the night, had intole- rable cramps in the calves of the legs, a symptom which she had never before experienced in any de- gree, in any part of the legs, except during an attack of Cholera in the epidemic of 1832. On Tuesday morning, the third day, at nine o'clock, I, being her physician, was requested to visit her immediately, and called in a quarter of an hour. The patient and her servants were forcibly struck with the great change in her complexion, the very dark color of her face and hands. I found her face and hands of an unnaturally dark color, and the skin of the hands much wrinkled, and so inelastic as to retain for a considerable time any folds into which it was drawn or pinched up with the fingers. Lips decidedly bluish; pulse small, feeble and eighty-four. Sensation of general coldness, as if the body were ex- posed to a cool breeze; this coldness more this morn- ing than previously. The watery diarrhoea continued; the same frequency of evacuations. Sensation of dry- ness of the mouth and throat; desires drink often, but in small quantities. I immediately administered a few dry pellets of Camphor 30, and prepared three other similar doses to be given once in half an hour, also a solution of Arsenicum 30 to be commenced at dose of Camphor, and " noon, one hour after the last 8 158 CASES OF CHOLERA repeated hourly. After two doses of the 30th of Cam- phor she felt decidedly better, I perceived that the skin of the face and hands had greatly improved. in color, and that of the latter had lost much of of its corrugation. After commencing this medicine, in this attenuated form, the patient was exempt from diarrhoea for about two and a half hours-a respite unprecedented during this illness. No stool until about noon, a few minutes after taking the first dose of the 30th of Arsenicum. The stools in the afternoon and evening were only about half a gill each, being scarcely one-fourth as great as previously, though they were passed at about the same inter- vals, and were still liquid, but of a browner and more normal color. Pulse 74, still rather feeble. Some pains in the abdomen each time after taking beef broth, the diet and drink used through the day. I saw her a quarter before nine in the evening, when she felt much better than in the morning, but still feeble, and complained of aching and sensation of fulness in the anterior part of the head. I ad- vised a little ice-water, the drinking of which was immediately followed by a warm but partial perspi- ration, confined to the forehead, face, chest, hands and arms. This sweat being warm, and being the first instance, since the attack, of moisture appearing on the skin, was, though partial, a somewhat favor- able sign. But the evidences of congestion of the brain still remaining, and several symptoms including some of the particular localities of the headache and W IN NEW-YORK. 159 perspiration, also indicating Camphor, and the small, brownish, watery stools still recurring at the same short intervals, I determined to resume its use in the form of the same dynamization which had proved so effectual in arresting the evacuations in the fore- noon; and accordingly, a few minutes after nine o'clock, prescribed four doses of the 30th potency, to be taken, in the form of dry pellets, at intervals of a quarter of an hour-i. e., 4 Camph. 30, h. 1 After resuming this medicine, she had only two stools, one a quarter before, the other a quarter after ten o'clock, that evening, the former a gill, the latter a table-spoonful, the color and consistence un- changed. The aching and fulness of the head was removed; the patient became comfortable, and soon fell into a sound sleep, which continued through the whole night. Had no return of the evacuations. Next morning she awoke perfectly comfortable, and, at the time of my visit at ten o'clock, was sitting in a chair, and presenting her usual appearance of blooming health. After the half ounce evacuation, which in about a quarter of an hour had followed the last dose of potentized Camphor, given on the previous evening, the convalescent patient had no stool what- ever for twenty-four hours, then a small one of na- tural color and fair consistence. 160 CASES OF CHOLERA GASTRIC CHOLERA. CASE 16.-A nephew of Madame Hahnemann, and son of Mr. D'H., 16 months old, still at the breast, awoke out of sleep at 12 o'clock, on the night of the 15th of June, 1849, with vomiting, forcibly ejecting the contents of the stomach "with a jerk." This vomit- ing was repeated every few minutes, for about an hour and a half, becoming more watery, until it appeared like pure water. Edward Bayard, M.D. saw the patient at one o'clock that night. Eyes sunken, with dark, bluish circles around them; fea- tures pinched. Relaxation and heaviness over the whole body; extreme languor, with total apathy except at the time of vomiting. Marbly cold sweat on the face and upper parts of the body, with dry- ness of the feet and legs. The mother, after con- sulting Dr. Joslin's book, had administered five one- drop doses of Camphor, at intervals of five minutes. madh Dr. Bayard believing that the child was oppressed by the power of the drug, determined to wait for the reaction for thirty minutes. About the expiration of that time, the mother remarked that the child was dying; and it was evident that the symptoms were be- coming more intense. The Doctor believing that Cam- phor was still indicated, determined to give the third dilution, of which he had a few pellets in his box. Three dry pellets of this dilution were placed upon the child's tongue. He vomited once after taking IN NEW-YORK. 161 it; the vomiting then ceased. In thirty minutes the dose was repeated. The sweat dried up, the apathy and languor passed away; and in an hour after taking the first dose, the child rose up and played. So convinced was the mother, that her child had been plucked as it were from the jaws of death, by the small dose, that she fell upon her knees and thanked God for the gift of Homoeopathia. CASE 17.-An unmarried gentleman, a merchant, aged 25, was attacked on Monday morning, July 9th, 1849. The first symptom was vomiting with cold- ness of the feet, legs and face. Vomiting, without nausea; a whitish, grey liquid, like prepared starch, containing white flocks, spirted out violently. After two vomitings, he had one loose stool, then two more vomitings. According to previous instruc- tions, he immediately resorted to Camphor, in drop doses, and continued it every five minutes, until he received Veratrum 20, that is until the messenger could bring it from my office, a mile and a half distant. I called on him at eleven, A. M., and found his tongue, feet, legs and forehead cold. Severe pain in the abdomen. Urine suppressed. After the Veratrum 30, which he had taken, I gave, in the following order: 2 Verat. 12, 1 Nux-vom. 30, 2 Ar- senicum 30, and 1 Verat. 12. Then, the more urgent symptoms being relieved, I prescribed Verat. 3º, in solution, at one-hour intervals, as long as necessary. 30 On the day after that of the attack, he was so far restored, that the Veratrum 20 , was ordered only 162 CASES OF CHOLERA three times a day, to be taken for two days if neces- sary. No other visit or prescription was needed; but I ascertained on the fifth day, that the recovery had been complete under the Veratrum 30, probably in less than three days from the time of attack. SPASMODIC CHOLERA. CASE 18.-After having for a week or two a watery diarrhoea, without treatment or medical ad- vice, a married lady was attacked with Cholera of the Spasmodic variety, about half-past nine o'clock in the evening of Monday, January 29th, 1849. I saw her in an hour from the time when the disease assumed this form. After a single vomiting of some sour material, the patient was attacked with spasms, first as cramps in the calves of the legs; then severe tonic spasms of the whole of both inferior extremities; these tonic spasms, soon extending upwards, successively to the abdomen, stomach, chest and throat. The paroxysms recur simultaneously in the muscles of all those re- gions, from the legs to the throat, inclusive. The inferior limbs are spasmodically extended and ex- tremely stiff and hard, and affected with excruciating pain. Among the other results of spasms, there are present; a hard swelling at the stomach, respiration almost arrested, sense of extreme suffocation, and deglutition difficult, sometimes impossible. The IN NEW-YORK. 163 spasms relax, and after a few minutes return with.. the same severity. Lastly, spasms of the muscles of the jaw, attended with grating of the teeth. B. Tincture of Camphor, one or two drops, given in sugared water, every five minutes, until there was a diminution of the spasms; then 2 Cuprum-metal- licum 30 , at intervals of half an hour. Afterwards, there being retching, and vomiting of a very small quantity of froth, there was given, 1 Verat. and 3 Verat. 3º, all at intervals of one and a half hours. 1 2 What Mak The 3 Verat. 30, were given in solution, and by the friends, during the night, the patient being so much improved, as no longer to require the constant attendance of a physician. Next morning, Tuesday, the second day, the pa- tient feels comfortable, with the exception of a sen- sation of soreness. This was undoubtedly an effect of the spasms. A few more doses of Verat. were given on that day, at intervals of two hours. The patient having recovered, no other medicine was given. Remarks. The Cholera had been reported the preceding month, but was not prevalent until the latter part of the ensuing spring. This was the first case in 1849. The poison in the atmosphere was probably very dilute in this cold season, yet was sufficient with some peculiar constitution of the patient and after a week or two of diarrhoea, to de- velope the disease. This, and the two following, all spasmodic, are the only winter cases of Cholera, " } 164 CASES OF CHOLERA which have come under my observation. From such an experience I conjecture, that the cold season is less unfavorable to the development of the spasmodic than of other forms of Cholera. CASE 19.—A young unmarried man, recently en- gaged in painting, was attacked with Spasmodic Cholera, on Tuesday, Feb. 27th, 1849, about five o'clock in the evening. Feeling, at first, spasms in the shoulder, he took an allopathic dose of tartar emetic; in an hour or two he vomited; then had a few loose stools; then vertigo, and considerable deaf- ness; then tonic spasms, excited and increased by movement of the parts. The spasms commenced in the calves, and extended to the whole inferior extre- mities, the abdomen, and the stomach. Painful tonic spasms rendered the lower limbs inflexible. The vertigo and deafness continued with the spasms. The patient was deaf more especially to the sound of his own voice, the hearing of which seemed to him prevented by the rumbling of his voice in his head. Great thirst. Vomiting once more of a watery liquid with mucus, part of the ejected liquid being of a milky white color. The fluid spirted from the mouth. to the distance of about two yards, as estimated in a horizontal direction. The spasms continued, with marbly coldness of the feet, chin, nose, and tongue; face bluish-pale. Treatment and effects.-Tincture of Camphor in five doses, too large, and at intervals too long, had been given by the family, in about eighty minutes IN NEW-YORK. 165 that elapsed before my arrival. These were without apparent effect. I gave a single drop dissolved in sugared water, once in five minutes. The spasms. were in some degree mitigated in two hours after the first administration of Camphor, or forty minutes af- ter commencing the use of it in small doses-of which eight were given. Then Cuprum 30 was given, in doses of three globules cach, in a dry state. The first dose of Cuprum produced a very decided miti- gation of the spasms, restored warmth to the chin, and prevented the recurrence of the vomiting. Two more doses of this medicine at intervals of an hour, removed the spasms entirely. Another dose of it was given an hour afterwards to prevent their return. The spasms never returned. No real diarrhoea oc- curred till next morning, when there were two watery stools, for which was given Verat. °, in solution. The patient, when visited on that morning, (Wednes- day, the 2d day,) was already sitting up, and feeling comfortable. The last dose of Veratrum was taken on the following morning, Thursday, the 3d day, when he was well. 30 Cause. I believe this case of spasmodic cholera to have required for its development the presence, in the atmosphere of our city, of some portion of that poison which in a warmer season would have render- ed the disease in some form epidemic. The case in the previous month had convinced me that this cause was among us. Nearly all of the symptoms of the present case are those of epidemic cholera, and some 8* 勤 ​166 CASES OF CHOLERA of them peculiarly characteristic. The deafness, however, is not usual. The patient for about a week had been engaged in painting window-blinds, and in that occupation had been exposed to the influence of green paint, the basis of which was copper. He may have absorbed a sufficient quantity of this to aid the inception, and have taken enough of tartar emetic to produce an exacerbation of a disease, which from the action of the essential cause alone, i. e., the atmos- pheric poison, would not have occurred in any degree which would have justified us in considering and re- porting it as a case of Asiatic Cholera. We know that even when the disease is epidemic, the attack of an individual usually requires both a predisposing and an occasional cause, in addition to that essential cause which imparts to the symptoms their peculiar character. CASE 20. This was somewhat more complicated than the two preceding, yet as the spasms in their se- verity, extent, and persistence, were prominent symp- toms, it may properly enough be considered as be- longing to this variety. As I deemed it my duty, though not required by law at that season, to keep the authorities apprised of the occurrence of any such case, although it might be so far as I knew spo- radic, I reported it to the Mayor. As most of my records of this case are mislaid, I extract the follow- ing from a copy of the letter which relates to it. "NEW-YORK, Feb. 21st, 1850. SIR,-I hereby report one case of Cholera. The IN NEW-YORK. 167 patient is , a collector, aged 64 years. As this case occurs so early in the year, that you might doubt its genuineness, I think it proper to mention some of its characteristics. Diarrhoea; vomitings; severe cramps in the fingers, arms, toes, legs, thighs, and chest; urine scanty, now suppressed; coldness and blueness of the skin; anterior part of the tongue cold as marble. Attack at eight o'clock last evening, No medical treatment for more than twelve hours. I was applied to at eight this morning, sent medicine, and saw him at nine. The evacuation which I saw, was entirely like rice-water, with a sediment of white particles, like boiled rice." The patient was in such pain and jeopardy, col- lapse being imminent, if not already commenced, that he was visited five times on this, second day. The treatment was Cuprum 30, Camphor, and Vera- trum 30, in solution. They were given in the above order, but not alternately. The patient being im- proved, was left with directions to continue the same solution, Veratrum 3°. The next morning, Friday the third day of the disease, and the second of the treatment, the patient was found convalescent, and directed to take Veratrum 3º, only morning and eve- ning. On the following day, Saturday, the fourth of the disease, and the third of the treatment, he was so far recovered, as to take only one dose of Vera- trum 3º. The treatment was then discontinued, and the result reported at the earliest opportunity-Mon- day morning. - 168 CASES OF CHOLERA Note. One object in being thus careful to report the existence of every case, and the result, was to contribute my share towards giving the authorities all the information requisite for their guidance, in reference to their hygienic functions; another was to give them the means of verifying the reports, and thus to render the latter more official and reliable in statistics. In the present case, however, the season of the year rendered the former object less impor- tant; and the latter object has not yet been subserv- ed by it, as the statistics given in this book include. no cases occurring since 1849. S DRY CHOLER A. CASE 21. On the night of Tuesday, June 26th, 1849, about 11 o'clock, Capt. W., an un- married man, aged about 28, was attacked. For about three or four weeks he had been living very freely, having just returned from sea. For some days he had been eating as well as drinking to excess. Was visited by James M. Quin, M. D., at midnight. The Doctor found that the patient had been seized with vomiturition without vomiting, and urgent disposition to stool, without stool. In this condition he was brought by his attendants, from an out-building to bed, at which time he was seen by the Doctor. His pulse was full, bounding, and 110. The head excessively hot, with great mental distress and anxiety. The rest of the body, especially the extremities, were characteristically cold and clammy, IN NEW-YORK. 169 tongue and breath cold. The calves of the legs were very much cramped, and the belly was filled with horrible tormina; the patient writhed into every pos- sible position, from excess of agony. The treatment, which lasted from that time until four o'clock in the morning, at which time the patient was convalescent, consisted of the tincture Camphor, and Veratrum of the sixth attenuation, internally and externally, of bottles of hot water applied exten- sively to the body, particularly to the calves of the legs and the inside of the thighs. Another point to which the bottles of hot water were applied, was im- mediately over the kidneys. As a verification of the correctness of this application, the first permanent relief which the patient experienced was signalized by a copious emission of pale watery urine. At first the treatment consisted of Camphor tincture alone, a drop every three minutes for about the first half hour, and for the next, every five minutes. This remedy, besides its specific character, was particularly adapt- ed to the patient's then existing condition of brain. The cramps in the calves of the legs, however, con- tinuing with unabated violence, indicated strongly the use of Veratrum; and under the use of this reme- dy, the cramps in the calves of the legs subsided in less than thirty minutes, and a profuse warm perspi- ration broke out over the whole body. From this moment the patient got rapidly better, and the medi- cines were continued, but at considerably lengthened intervals. Dr. Quin left him at four o'clock, having 170 CASES OF CHOLERA 1. been incessantly with him for four hours. Up to this time, no evacuation by the bowels had taken place. The patient slept from this time till about noon, when he had a natural, soft, but consistent stool. ACUTE CHOLERA. CASE 22.-Attack, Monday, May 28th, 1849.- 缥 ​The patient, a married woman, aged 45, was not seen. until she had been suffering for nearly four hours from an attack of severe Cholera, unpreceded by any premonitory diarrhoea. The case then presented the appearance of a combination of the spasmodic and gastro-enteric varieties. It appears from the descrip- tion of Cholera-acuta, as given by Dr. F. F. Quin, and to a considerable extent copied in this book, that this variety, in its second stage, may present this complicated aspect. As the case was not seen in the first stage, it is impossible to say whether it then presented evidence of that sudden and violent im- pression on the nervous system which characterizes an attack of acute cholera. Its subsequent course corresponded sufficiently well with the description of this variety, and especially with the modification of which has been proposed, p. 121. The patient was a stranger to me and to the homœo- pathic practice. She lived in my vicinity, and pro- bably endeavored to obtain the nearest physician, after failing to secure the attendance of her family 1 IN NEW YORK. 171 ? physician, who was an allopathist, and who, by an office prescription, preceded me in the treatment of the case. The attack was about 10, P. M. I first saw the patient about 2, A. M., her physician not being able to visit her in the night. After the at- tack, she had taken, either by his advice or of her own accord, a dose consisting of ten drops of Camphor, mixed with a teaspoonful of Laudanum, what else, is not known. Collapse was already approaching, the pulse very feeble, and the cramps severe. For a more particular account of these, of the evacuations upwards and downwards, of the coldness and other symptoms, and of a remarkable phenomenon observed after death, the reader is referred to the Appendix, written by one who assisted in the treatment of the case, and who some years since had occasion to use it in an essay. 30 30 B. Camph., a drop every five minutes. This with two doses of Veratrum 12, and 3º, and two of Cuprum 3º, constituted the treatment for the first two hours after we were called. Then Secale 12 and Cuprum 30. Afterwards, about five doses Camph. To, gt. j. as before. 1 CASE 23.-Monday, July 30th, 1849. A girl, aged 8 years, was well till four o'clock this morning; then diarrhoea commenced. Four brown stools of a gruelly consistence, in four and three quarter hours, at the end of which time she was first visited, and found in a state of collapse. There had not been 172 CASES OF CHOLERA :: more than a quart of the stools in all-i. e. one-half pint each. The body was almost universally cold, quite as cold as a corpse usually is several minutes after death, and covered with a cold and clammy perspiration. Face bluish, and hands bluish and wrinkled. Desire for ice. Voice reduced to a whisper. R. Camph. gt. j. every five minutes. After about four of these one-drop doses, she had a serous stool with a copious ricey sediment. But the whole was only about a gill and a half, i. e. six ounces. There is no farther record of the treatment. The patient died about noon, about three hours from the time of the physician's first visit, and eight hours after the attack, no medical assistance was applied for until collapse had taken place. Remarks.-The discharges were not such, either in quantity, consistence or color, as to justify us in considering this a case of Cholera, unless the other symptoms had been present. This, and the follow- ing case, in which the result was favorable, were under the treatment of my son, B. F. Joslin, Jr.; but as he was at that time an under-graduate, they were reported and numbered with mine. I saw them in consultation. Both cases were acute in the sud- denness of the invasion, and the rapidity of their progress to collapse, and this one at least, without any adequate cause in the quantity of the evacua- tions. They were not even ricey or watery, until - IN NEW-YORK. 173 after full collapse had been established and the treat- ment commenced, and there was no evidence of any considerable amount of serous material that had been until then retained. CASE 24.— A girl, aged 7½, was attacked about four and a half, P. M., Thursday, Aug. 16th, 1849. The disease commenced with diarrhoea and vomit- ing. Was seen before the collapse was complete. Then took one-drop doses of tincture of Camphor, afterwards some doses of Camphor 3, then was treated with Veratrum 30 She was in collapse within two or three hours from the commencement of the first symptoms of disease. Pulseless. Voice nearly lost. Tongue, face and limbs cold. Cramps. Urine suppressed. In the evening she was put under Carbo-veg. 3° and Cuprum-metal. 3º, alternate- ly every half an hour. Friday, the second day, in the morning.-After remaining in this state of collapse for twelve hours, entirely pulseless, reaction came on in the morning, under the continued use of the Carb.-v. ° and Cupr. 30 given as above mentioned. The pulse and voice were restored, and the tongue and most of the skin acquired a temperature nearly normal. The same treatment was continued. Saturday, the third day. A stool nearly normal, except as to consistence, which was that of mush- i. e. semi-fluid. Reaction about complete. Tempe- rature normal. The recovery was oson complete. 174 CASES OF CHOLERA Remarks. This case, in respect to the rapidity with which the patient sank into collapse, was more acute than the preceding. The amount of evacua- tions was not definitely ascertained, but could not have been remarkable. As in the preceding case, my son was the attending physician, and I visited in consultation. P The locality in which this case occurred was ex- tremely unfavorable, and the disease there remark- ably malignant and fatal, especially under the old treatment. I learned from the father of the above child, who, though poor, was a respectable and intelli- gent American, that all the cases which had occurred in that filthy, blind alley or court-yard, and had been treated allopathically either there or at the hospi- tals, had died. Being aware of the danger to which his family was exposed, he had represented the state. of things (perhaps not fully) to the City Inspector, in May. At the commencement of the epidemic, there were four small adjoining houses, containing twenty-eight families, in this cæcum or blind hole, filled with the stench of three privies full of putrefying materials. Nine of the families had left in a panic when they saw so many of their friends and neigh- bors attacked, and that an attack there was the visi- tation of death. * The number which had occurred previously to that time, the 16th, was said to be nine. IN NEW-YORK. 175 The privies remained completely full, and there were still on the 16th, nineteen families occupying the premises. In behalf of these poor people, I deemed it my duty on the occurrence of the above case, to represent the condition of the place to the President of the Board of Health, and to make a sug- gestion of a remedy. As this may be of use to others, at a time when to clean vaults may be as dangerous as to leave them full, I give from the letter, an extract relating to it. "With the best means of preventing any deleterious gases and vapors from ascending from the vaults, the City Inspector is probably acquainted; but I take the liberty of suggesting a cheap preparation; which some gentlemen have used with great success. They take half a pailful of pulverized gypsum, half a pailful of pulverized charcoal, and one pound of copperas. When these have been intimately mixed, the powder is strewed over the sides and contents of the vault. It forms a crust over the latter, and keeps the air above, pure for a week. At the end of that time, the above quantity is to be again put into each vault. If the habitations of all the poor people of this city were thus protected by the Corporation, it would diminish the city expenses, and save many lives." 176 CASES OF CHOLERA GASTRO-ENTERIC CHOLERA. CASE 25.-Miss > aged about 27, was attacked Thursday, July 26th, 1849, at ten, P. M. At six o'clock next morning I was called from bed to visit. her. The distance being a mile and a half, it was seven o'clock before she was prescribed for. She had had diarrhoea for a week, and checked it from time to time by brandy. At ten, P. M. of the 26th, after a tea of rusk, and rice pudding containing eggs, she had a large, loose alvine evacuation, which was followed by vomiting. The alvine evacuations and vomitings continued through the night and until the time of my visit and prescription. There had been eight or nine of each, that is the total number, up- wards and downwards, was sixteen or eighteen. The stools were of a serous and ricey character-a watery liquid with a white ricey sediment. At seven, A.M., B. Veratrum 30, in solution, every two hours, or after each evacuation, if they occur oftener. The patient was soon relieved, and was not again seen until three days afterwards, when, for some reason, not stated in the record, she took Phos. °, and six days after the attack, one Sulph. 2°°°. 2000 DYSENTERIC CHOLERA. CASE 26.-On Wednesday, July 4th, 1849, I was called to visit a married gentleman, about 55 years of IN NEW-YORK. 177 置 ​age. He had occasionally had slight cramps in the feet for about three weeks. On the 3d of July, at 4, P.M., diarrhoea commenced; stools brown and foetid. Much pain in the bowels. Second day, July 4th, nine, A. M. Has had two brownish stools. Tongue has a brownish yellow coat. I prescribed three Camph, one every half hour, then Verat. 30 in solution, after each evacuation. Four, P. M. Has had two stools since commencing the Veratrum; the last had the liquid rice-water appearance with white flocks, was without pain, but was preceded by cramps in the soles of both feet, and in the flexor muscles of the right thumb. Feet cold about the time of the evacuations, but reaction has come on pulse now one hundred and eight. Tongue more moist and less coated. Treatment.-Continue the, Veratrum 30, as before, pro-re-nata. Ten, P. M. Stools scanty, and of bloody mucus with some whitish material. R. 2 Mercurius-viv.12. Thursday, the third day, eight, A. M. Tender- ness of the stomach and hypochondria. Has had several small evacuations in the night, with tenesmus and sense of pressing down. R. Sulph. 3º. 30 r From this time the ricey and rice-water stools were intermingled with, and at length replaced by, others of bloody mucus in small quantities. The completion of the cure of the dysenteric portion of the case, required about eight or nine days longer, J 178 CASES OF CHOLERA and was effected principally by Mercurius ³° and Sulphur 30. Remark. It was not ascertained, that previously to the attack, there had been any thing unusual in the regimen or diet, except the eating of peas at dinner, on the day preceding the commencement of the diarrhoea. CASE 27.-Wednesday, July 4th, 1849. Nine, A. M. A young married lady, was this morning attacked suddenly. First symptoms, liquid stools in large quantities, with pain in the abdomen. The first prescription was 3 Camph. ', one every half ³, hour, then 1 Verat. 12. 3 Eleven, A. M., second visit. The evacuations have been checked. The tongue has a thin yellow coat. B. Verat. 3º in solution, a dose after each evacuation. Six, P. M., third visit. Since the last visit, only two evacuations. The stools small in quantity, watery and slimy, and the last one, at least, contain- ed the characteristic ricey flocks. R. Veratrum 30, to be continued, a dose after each evacuation, or once in two hours, if there is pain, even though the evacuations should occur at inter- vals longer than this. Stools of Thursday, the second day, at noon. bloody mucus with some whitish portions. tenderness of the abdomen. R. Three doses of Aco- Pain and nitum 30 at intervals of two hours. IN NEW-YORK. 179 The patient was visited twice more on the same day, and received Sulphur 30 in solution. 3º Friday, the third day. The patient convalescent, and left under the action of the previously taken Sulphur, without repetition. She recovered without any additional treatment, except one dose of Sulphur 1200 on the fourth day, two Nux-vom. 400 on the fifth, and one Nux-vom. 4 0 0 on the seventh, i. e. six days from the time of the attack. The convalescence from the dysenteric cho- lera commenced two days after the attack. FEBRILE CHOLERA. CASE 28.-A married lady, aged about 30, was attacked in the night, Friday, Aug. 10th, 1849, at three o'clock. Between three and eight, A. M., had five large, liquid stools, judged to be as much as a pint each; and the last one chiefly a perfectly serous liquid as to consistence, and of a yellowish color. I saw her at eight and a half, A. M., being called in some haste. She had taken five doses of Tinct. Camph. gt. j. each; and then, at intervals of one-half hour, two of Verat. 30. She was lying on the sofa; rather pale, yet felt "feverish." Palms rather hot, both in sensation and to the touch. Slight pain in abdomen, considerable in the hips and limbs; some nausea. The tongue slightly red at tip; pulse about one hundred and ten; thirst considerable. Prescribed + : C 180 four doses Rhus-radicans, including the one admin- istered. One to be given every two hours. Resort to Veratrum 30, if there should be several large CASES OF CHOLERA. J evacuations. Five, P. M. Has had two more evacuations, thin, light-colored, and containing numerous white specks. Pain over the eyes, and in hips and small of back. Had taken Verat. 3º, once. } 30 B. Verat. 3º, each hour, until the evening visit. Improvement continued under Veratrum 30 which was given occasionally next day, when she was re- corded as convalescent, and on the 12th as recovered. 2 A case of Acute Choleroid occurred since the above was ready for press. On Monday, May 29th, 1854, in the morning, a lady had a stool of which the first part was normal, the last half-pint liquid. After dinner felt nausea, and a sensation of numbness in- stantly pervading the whole body, like an electric shock. The lips and fingers soon became intensely blue, and the latter strikingly wrinkled. The whole disease disappeared under Camph. 30 alone. Cases 6, 15 and 16 also show the power of attenuated Camphor. If pellets of the 1st, 3d or 30th dilution supplant the tincture, we may avoid the congestions, which the latter sometimes occasions, also the adulteration of our medicines with its vapor. CHAPTER X. CHOLERA REPERTORY. CONTAINING THE IMPORTANT SYMPTOMS, AND THE USUAL GROUPS, AND THE MEDICINES TYPOGRAPHICALLY DIS- TINGUISHED AS TO THEIR RELATIVE VALUE IN CHO- LERA. EXPLANATION OF THE USE OF THE REPERTORY, BELIEVING that the success of Homœopathic treat- ment in Cholera, is such, that this book will be used by many physicians who have had but little, if any, expe- rience in this kind of practice, as well as by many intel- ligent laymen, I deem it proper to explain the best mode of using the Repertory. Select two important symptoms, of the case to be treat- ed, and ascertain what remedies are common to both. If these are too numerous to be retained in the memory, write them down. Then compare this reduced list with the remedies as given in the Repertory for some other important symptom, and thus discover what remedies are common to the three. Then select a fourth, &c., and continue this process until there is only one remedy left. This will generally be the remedy for the case, espe- cially if the symptoms selected are really the most impor- The method of proceeding, thus far described, is the best for all homeopathic repertories, and if faithfully tant. * These symptoms and groups are frequently observed in cholerą, 9 182 CHOLERA REPERTORY. followed in reference to any disease, affords one of the best securities against that name-treating and one-symp- tom-treating practice, so general among domestic pre- scribers and hasty physicians. In using this method and this Repertory in the treat- ment of Cholera, it will generally save labor to omit, at every step of the process, all those medicines which are not emphasized in at least one of the two lists. Such medicines will almost always be eliminated before the above process is completed. No medicine, which is printed either in small Roman letters or Italics, in every place in which it occurs in this Repertory, is, in the pre- sent state of our knowledge, known to have much power in the first three stages of non-inflammatory Cholera ; and hence the use of such medicines, in Cholera, except by a very skilful practitioner, would be unsafe. If such should not all be removed by the process above described, the only safe course (at least for the beginner) would be, to commence anew, and repeat the above process with other important symptoms, combining them with each other and with some of those previously selected; and in general, the making of various combinations and in various orders, will give greater security in the selection. of the remedy. If there are two remedies which apply to all the known symptoms of the case, the selection may be determined by the type in which their names are here printed. If the remedy is doubtful, and there is time for study, consult Jahr's Manual, especially the New. One object in the construction of this Repertory has been to save part of the above labor, by occasionally combining the symptoms into such groups (of two or ;} MENTAL SYMPTOMS. 183 three) as the disease more frequently presents. For ob- taining the remedies for these groups, the Materia Me- dica of Hahnemann, the Symptomen Codex and various Repertories have been consulted. The degree of em- phasis has been determined by the clinical experience of the school in Cholera. I have, however, italicised some medicines which rank high for the symptom in general, but are not known to be useful in Cholera. The em- phasis given to the medicines in this Repertory, has no reference to the 4th stage, nor to the inflammatory varie- ty, except where it is so stated. Medicines seldom used in any disease are omitted; also some for vomiting and diarrhoea, seldom used in Cholera, and found in Chapter XI. The concomitant symptoms in any one section of this Repertory, are generally arranged in the same order as the sections themselves. Where symptoms, relating to different parts of the body, are in the same paragraph, those of the superior parts, are put first, and the more general symptoms last. The paragraphs are arranged alphabetically; but where the same symptom, (as cramp) refers to different parts of the body, these parts are put in the natural typographical order, from above downwards. MENTAL SYMPTOMS. Anguish, anxiety or inquietude: Acon., ARS., bell., bry., CAMPH., CARB.-V., caus., cham., cic., coff., CUPR., dig., hyos., ign., ipec., kal., lach., laur., lyc., merc., natr., natr.-m., nitr..ac., nux, petг., Рнos., phos.-ac., puls., rhus, SEc., sep., stram., sulph., tart., VERAT. 7 pekte bag Late to f ļ } 184 CHOLERA REPERTORY. Apathy, or indifference: Ars., bell., calc., cham., chin., cic., hyos., lach., lyc., merc., natr.-m, phos., PHOS.-AC., Sep., staph. verat. Fear of Death, with internal Burnings, and tossing in the bed: ARS. Taciturnity, or repugnance to conversation: ARS., bell., bry., calc., cham., cic., coloc., cupr., ign., lach., merc., natr.-m., nux, phos.-ac., puls., rheum, stann., staph., sulph., sulph.-ac., VERAT. HEAD. Confusion in the head: Acon., ars., bell., bry., calc., CAMPH., caus., chin., dig, merc., nux, op., phos.-ac., puls., rheum, rhus, sec., sep., sulph.-ac., tart., VERAT. Heaviness, or pressure in the head: Acon., arn., ars., bell., bry., calc., CAMPH., carb.-v., cham., chin., cic., dulc., ign., ipec., lach, laur., lyc., merc., natr.-m., nux, op., petr., PHOS., PHOS.-AC., puls., rheum., rhus, sep., sil., stann., sulph., tart., VERAT. Vertigo: Acon., ant., arn., ars., bell., bry., calc., CAMPH., carb.-v., caus., cic., cupr., dig., fer., graph., hep., hyos., ign., ipec., kal., lach., laur., lyc., merc., nat., natr.-m., nux, oр.,petr., Pноs., PHOS.-AC., puls.,rhus, SEC., sep., sil., stram., sulph., sulph.-ac., tart., thuj., VERAT. Vertigo with nausea and thirst: VERAT. Vertigo with stupor: Ars., bell., bry., calc., caus., kal., laur., lyc., merc., natr.-m., nux, op., Рноs., phos.-ac., puls., rhus, SEc., sil., spig., stram., sulph., tart., VERAT. EYES. Eyes sunk in the orbits; with livid semi-circles under them: ARS., calc., camph., cic., CUPR., kal., laur., PHOS., PHOS.-AC., SEC., sulph., VERAT. EYES.-FACE. 185 Eyes sunk in the orbits; with hoarse voice: ARS., calc., camph., cic., CUPR., kal., laur., PHOS., phos.-ac., SEC., sulph., VERAT. Eyes Up-turned and Fixed: CAMPH., cic., VERAT. Pupils contracted: ARS., bell., cham., CAMPH., cicut., nux, puls., SECAL., sep., VERAT. FACE. Bluish color of the face: Acon., ARS., bell., bry., CAMPH., cham., cic., con., CUPR., dig., dros., hep., hyos., ign., ipec., lach., lyc., merc., op., phos, puls., samb., spong., staph., stram., tart., VERAT. Bluish and pale face: ARS., bell., bry., CAMPH., cic., con., CUPR., dig., dros., hep., hyos., ign., ipec., lach., lyc., merc., op., PHOS., puls., samb., spong., stram., TART., VERAT. Bluish color about the Eyes: ARS., calc., cham., chin,, CUPR., fer., graph., hep., ign., ipec., kal., lach., lyc., merc., natr., nux, oleand., phos., PHOS.-ac., rhus, sabin., SEC., sep., spig., staph, stram., sulph., VERAT. Blueness of the lips: Ang.-spur., ars., camph. caus., berb., chin.-sulph, cupr., dig., lyc., phos. Blueness of the lips, with corrugated and withered. appearance of the skin: ARS., CAMPH., CUPR., lyc., phos. Blueness under Eyes: Sleeps with eyes open: Ipec., PHOS.-AC., sulph., VERAT. Blueness of the face and lips; Coldness of the lips: ARS., cupr., VERAT. Blueness of the face; vomiting after drinking; pulse slow; sweat clammy: VERAT. } • 186 1 1 24 CHOLERA REPERTORY. [2 Cold Perspiration on the face: Carb.-v., rheum., nux, rhus, verat. Cold perspiration on the forehead during the evacua- tion: VERAT. TONGUE. Cold Perspiration on the Face and Limbs: CARB.-V. Coldness of the nose: Arn., bell., plumb., verat. Coldness of the nose and hands: Bell., VERAT. Facies cholerica: ARS., camph., carb.-v., CUPR., ipec., laur., phos., phos.-ac., rhus, SEC., VERAT. Face choleric; Voice hoarse: ARS., camph., CARB.-V., CUPR., laur., PHOS., phos.-ac., rhus, sec. VERAT. Spasm of the Jaw: Bell., cham., CAMPH., cicut., CUPR., hydrocy., lach., laur., op., rhus, Sec., VERAT. Coats on the Tongue. Brown Bell., CARB.-V., hyos., PHOS., rhus-rad., sabin., sulph. : Mucous Bell., cupr., dulc., lach., merc., PHOS.-AC. puls., sulph. Viscid: PHOS.-AC. White Ant., arn., bell., bry., calc. carb.-v., cupr., dig., ign., ipec., merc., nitr., nux, petr., puls., sabin., sec., sep., sulph. Yellowish: Bell., bry., carb.-v., cham., chin., coloc., IPEC., nux, plumb., puls., rhus-rad., verat. Coldness of the tongue: Ars., bell., camph., laur., natr.-m., sec., VERAT. Coldness of the tongue and breath: ARS., CARB.-V.. camph., VERAT. TH NAUSEA AND THIRST.—VOMITING. 187 Coldness of the tongue, with dryness of it and of the mouth ARS., bell., camph., laur., SEc., VERAT. Coldness of the tongue, with cold sweat on the body : Ars., CAMPH., sec., VERAT. The same symptoms in a more advanced state of collapse: ARS., camph., carb.-v., CUPR., SEC., VERAT. Redness of the tongue: Ars., bell., bry., cham., hyos., lach., nux, rhus, stann., sulph., verat. Redness of the tip of the tongue, in the febrile variety, or in the 4th stage: RHUS-RAD. Tongue Red, and coated yellow: Bry., cham., nux, r.-rad., VERAT. Tongue Red; Pulse Slow: Bell, rhus-rad. VERAT. NAUSEA AND THIRST. Nausea with thirst: Bell., PHOS., VERAT. Nausea with vertigo: CAMPH., merc., verat. Nausea with continued pain at the pit of the stomach: Acon., ARS., bell., CAMPH., cham., CUPR., merc., natr.-m., nux, Pнos., puls., rhus, sulph., tart, VERAT. Nausea with diarrhea: Ars., ipec., merc., PнOS. Thirst, violent: Acon., ARS., bry., CAMPH., CARB.-V., cham., cic., CUPR., ipec., laur., merc., natr.-m., nux, phos, phos.-ac., SEc., stram., VERAT. Thirst, with nausea : PHOS., VERAT. VOMITING. Vomiting after a meal; blueness of the lips: ARS., phos Vomiting after drinking; with blueness of the face: ARS., VERAT. 188 CHOLERA REPERTORY. Vomiting after drinking: Arn., ARS., bry., nux, puls., VERAT. Vomiting frothy: VERAT. Vomiting of a watery liquid, analogous to that of the stools, with pieces of mucus: ARS., bell., camph., CUPR., JATROPH., Sec., IPEC., stram., VERAT. Vomiting with pain in the stomach: ARs., bry., camph., CUPR., IPEC., lach., nux, PHOS., sulph., stram., tart., VERAT. Vomiting with Colic: Ars., CUPR., nux, PHOS., puls., stram., tart., VERAT. Vomiting with diarrhea: Ars., cupr., jat., IPEC., phos., sec., stram., tart., VERAT. Vomiting with Colic and Diarrhea: ARS., CUPR., PHOS., stram., tart., VERAT. Vomiting with lassitude: Ars., camph., IPEC., phos., VERAT. PAINFUL SENSATIONS AT THE STOMACH AND PIT OF THE STOMACH. 1 Anxiety, distension and pressure at the pit of the stomach: Ars. Burning in the stomach: ARS., bell., bry., camph., canth., CARB.-V., cham., cic., jat., laur., merc., nux, PHOS., phos.-αc., SEC., verat. Burning in the pit of the stomach: Acon., ARS., bell., bry., laur., merc., nux, PHOS., sec., VERAT. Burning Heat in the stomach or pit of stomach: ARS., CAMPH., HYDROC., PHOS. Burning sensation in the stomach and intestines, some- times extending along the oesophagus to the mouth: ARS. H ABDOMEN. Cramp in the stomach: Bell, bry., carb.-v., cham., CUPR., natr.-m., nux, PHOS., SEC., VERAT. Pressure and Anxiety at the pit of the stomach: ARS., CAMPH., cupr., IPEC, NUX-VOM., verat. Continued Pain at the pit of the stomach with nausea : Acon., ARS., bell., CAMPH., cham., CUPR., merc., natr.-m., nux, Pнos., rhus, sulph., tart., VERAT. Pain in the stomach, with vomiting: ARS., camph., CUPR,, IPEC., PHOS., TART., VERAT. 189 Continued Pain in the pit of the Stomach with Rumb- lings in the intestines: Acon., ars., bell., camph., CARB.-V., CUPR., jatroph., merc., natr.-m., nux, Рноs., PHOS.-AC., puls., rhus, SEc., sulph., tart., VERAT. Pressive or aching pain at the pit of the stomach with liquid stools: Ars., CAMPH., cupr., PHOS., sec., tart., VERAT. Pressive or aching pain at the pit of the stomach, with cramps or other spasms in the extremities or elsewhere: CAMPH, CUPR., phos., phos.-ac., natr.-m., sec., tart., VERAT. Sensibility and Swelling of the pit of the stomach: Hep., lyc., natr.-m., sulph. Painful sensibility of the pit of the stomach, with spasms of the extremities: Ars., CAMPH., CUPR., natr.-m., phos., phos.-ac., tart., VERAT. ABDOMEN. Pains in the abdomen, with, diarrhea: ARS., cham., IPEC., laur., merc., merc.-c., natr.-m., nux, phos., rhus, stram., sulph., tart., VERAT. 3 ۱۳ 9* 190 CHOLERA REPERTORY. Rumblings in the intestines: Acon., ars., bell., bry., canth., CARB.-V., cupr., jatroph., laur., lyc., merc., natr.-m., nux, PHOS., PнOS.-AC., plumb., puls., rhus, sec., stram., sulph., tart., VERAT. Rumblings in the intestines, with continued pain in the pit of the Stomach: Acon., ars., bell., camph., CARB.-V., CUPR., jatroph., merc., natr.-m., nux, PHOS., PHOS.-AC., puls., rhus, SEc., sulph., tart., VERAT. Rumblings in the intestines, with liquid stools: Ars., jatroph., nux, petr., PHOS., PHOS.-AC., puls., rhus, sec., sulph., tart, VERAT. Throbbings in the abdomen: Caps., ign., op., plumb., sang., tart. DIARRHEA. Diarrhea, with a pasty tongue, which sticks to tho fingers: PHOS.-AC. Diarrhea with nausea: Ars., ipec., merc., PHOS. Diarrhea with vomitings: Ars., cupr., jat., IPEC., PHOS., stram., tart., VERAT. Diarrhea, with vomiting of the Food eaten, and of wa- tery liquid: ARS., CUPR., IPEC., PHOS., VERAT. Diarrhea, with aching or pressure, at or near the pit of the Stomach: CAMPH., cham., CUPR., merc., natr.-m., PHOS., PHOS.-AC., sec., VERAT. Diarrhea, with pain in the Abdomen: ARS., cham., ipec., laur., merc., merc.-c., natr.-m., phos., stram., sulph., tart., VERAT. Diarrhea, occasioning great Prostration of strength : ARS., bry., chin., con., merc., PHOS., rheum, SECAL., sep., sulph. DIARRHEA. 191 Diarrhea occasioning great prostration of strength, in Aged persons: Con., SECAL. Stools brown: Ars., CAMPH., merc.-e., sulph., tart., VERAT. Stools greenish: ARS., bell., canth., cham., ipec., laur., merc., nux, PHOS., PHOS.-AC., sulph., Verat. Stools grey, or slightly whitish: Acon., ars., bell., carb.-v., cham., lach., merc., PHOS., PHOS.-AC., puls., rhus, sulph., verat. Stools liquid: Arn., ars, carb.-v., chin., cic., jat., lach., meph., PHOS., PHOS.-AC., SEC., VERAT. Stools liquid and whitish: Ars., camph., cupr., jat., PHOS., PHOS.-AC., sec., VERAT. Liquid and whitish stools, with white coat of tongue : Cupr., PHOS., SEC. Liquid stools, with continued pain at the pit of the stomach: Ars., CAMPH., chin., cupr., PHOS., VERAT. Liquid stools, with rumblings in the intestines: Ars., jat., nux, petr., PHOS., PHOS.-AC., puls., rhuys, sec., sulph., tart., VERAT. Stools liquid; evacuation painful, (attended with colic): ARS., carb.-v; PHOS., spig., staph., VERAT. Stools liquid; evacuation painless: ARS., carb.-v., chin., cic., PHOS., PHOS.-AC., SEc., spig., VERAT. Stools mucous and watery: Ars., bell., chin., ipec., nux, PHOS., PHOS.-AC., puls., rhus, SEc., sulph.-ac., tart., VERAT. Rice-water stools, or stools like whey or water, with whitish or greyish flocks in it: Ars., CAMPH, cupr., ipec., jat., PHOS., PHOS.-AC., secal., VERAT. If there is inflammation, consult also, Acon., bry., and rhus. 192 CHOLERA REPERTORY. Rice-water stools, or watery, greyish, whitish and floc- culent stools, with great thirst: ARS., camph., cupr., ipec., PHOS., PHOS.-AC., VERAT. If in the febrile variety, or in the 4th stage Acon., bry., or rhus. Stools whitish: Acon., ars., camph., bell., cham., chin., cupr., ipec., jat., merc., nux, PHOS., PHOS.-AC., sec., sulph., verat. Walery and white flocky stools, with cramps and thirst: Acon., ars., bry., CAMPR., CUPR., ipec. phos., phos.-ac., rhus, SEc., VERAT. Watery and white-flocky stools, with clonic spasms: (spasmodic movements) and thirst: Acon., ARS., bry., CAMPH., CUPR., ipec., phos., phos.-ac., SEc., VERAT. Whitish Flocks in serous stools, with pulse scarcely perceptible: Acon., ARs., bry., CAMPH., PHOS.-AC., rhus, SEC., VERAT. Liquid stools, with white flocks and grains, having the consistence and color of tallow: PHOS. Stools yellowish: Ars., cham., ipec., merc., PHOS., PHOS.-AC., puls., tart., verat. Yellowish stools, especially in an early stage of the disease: Ars., cham., ipec., merc., PHOS., PHOS.-AC., tart., VERAT. URINE. Retention of urine: CAMPH., CANTH., lach., op., plumb., VERAT. Retention of Urine, with ineffectual desire to urinate; at the commencement of the stage of reaction: CANTH., verat. VOICE.—CHEST. ; 193 Urine scantily secreted, or suppressed: Ars., camph., CARB.-V, CUPR., ipec., SEC., stram., VERAT. The same symptom in the consecutive fever: BELL., carb.-v., RHUS, stram. Secretion of urine diminished; with cramps in the calves of the legs: ARS., calc.. CAMPH., cann., carb.-v., coff., coloc., con., CUPR., graph., hyos., lach., lyc., merc., natr., nux, petr., rhus, sec., sep., sil., sulph., VERAT. VOICE. Voice hoarse: ARS., bell., bry., calc., camph, CARB.- V., caus., cham., chin., cic., CUPR., dros., graph., hep., laur., merc., natr.-m., nux, PHOS., phos.-ac., puls., rhus, sec., spong., sulph., VERAt. Voice hoarse; face choleric: ARS., camph., CARB.-V., CUPR., laur., PHOS., phos.-ac., rhus, SEc., VErat. sil., Voice lost, (aphonia): Ant., bell., CARB.-V., caus., cham., chin., CUPR., dros., hep., kal., lach., laur., merc., natr.-m., nux, petr., PHOS., puls., sep., spong., stann., sulph., VERAT. CHEST. Anguish in the chest: Acon., ARS., bell., bry., camph., carb.-v., cic., CUPR., hydrocyan., ipec., jatroph., laur., natr.-m., phos., PHOS.-AC., rhus, stram., VERAT. Breath cold: CARB.-V. And, according to some clinical observations, ars., camph., verat. + Constriction (spasmodic) of the chest: CAMPH., caus., CUPR., fer., IPEC., lach., nitr.-ac., nux, op., PHOS., phos.- ac., puls., spig., stram., sulph., VERAT. 194 CHOLERA REPERTORY. Cramps or tonic spasms in the chest: Ars., bell., CAMPH., caus., CIC., CUPR., fer., graph., hyos., IPEC., kal., merc., nux, op., Pнos., phos.-ac., puls., SEC., sep., stram., sulph., VERAT. Cramps in the muscles of the chest, with continual vomitings, and with the eyes turned upwards: CAMPH., CIC., VERAT. Respiration laborious; cold and blue skin: ARS., CAMPH., CARB.-V., CUPR., ipec., sec., VERAT. SUPERIOR EXTREMITIES. Cramps in the upper arms: Phos.-ac., SEc. Cramps in the forearms: Laur., phos.-ac., SEc. Cramps in the wrist: Phos-ac. Coldness of the hands: Acon., bell., cham., ipec., natr.- m., nux, petr., phos., sulph., tart., VERAT. Cramps in the hands: Bell., calc., cann., coloc., graph., laur., phos-ac., SEc., stram. Cramps in the fingers: Arn., ars., calc., cann., coff., dros., fer., lyc., nux, phos., phos.-ac., SEc., stann. staph., sulph., VERAT. Cramps in the fingers, with clamminess of the tongue and skin: PHOS.-AC. Cramps in the fingers, with clammy perspiration: Ars., fer., lyc., nux, phos., phos-ac., VERAT. INFERIOR EXTREMITIES. Coldness of the feet: Acon., bell., calc., caus., dig., graph., ipec., kal., lach., lyc., merc., natr., natr.-m., nitr.-ac., petr., PHOS., plat., plumb., rhod., rhus-rad., sep., sil., sulph., tart., VERAT. Cramps in the nates: VERAT. SKIN. 195 Cramps in the hips: Coloc., phos-ac. Cramps in the thighs: CAMPH., cann., hyos. pec., merc., petr., phos.-ac., rhus, sep., VERAT. Cramps in the hams: Calc., cann., phos. Cramps in the legs: Carb.-v., coloc., CUPR., JAT., phos.-ac. Cramps in the calves of the legs: Ars., bry., calc., CAMPH., cann., carb.-v., cham., coff., coloc., CUPR., graph., hyos., JAT., lach.,.lyc., merc., natr., nitr.-ač., nux, petr., Pнos., rhus, sec., sep., sil., sol.-n., staph., sulph., tart., VERAT. Cramps in the calves of the legs, with burning heat in the stomach, or pit of stomach: ARS., CAMPH., PHOS. Cramps in the calves of the legs, with diminished se- cretion of urine: Ars., calc., CAMPH., cann., carb.-v., coff., coloc., CUPR., graph., hyos., lach., lyc., magn., merc., natr., nux, petr., rhus, sec., sep., sil., staph., sulph., VERAT. Cramps in the calves; coldness of the feet: Calc., graph., lach., lyc., merc., natr., nitr., ac., petr., PHOS., rhus- rad., sep., sil., sulph., tart., VERAT. Cramps in the feet: CAMPH., caus., graph., lyc., natr., nux, sec., stram., sulph. Cramps in the feet, with burning in the stomach, or pit of stomach: CAMPH. Cramps in the soles of the feet: Calc., carb.-v., coff., fer., hep., petr., phos.-ac., plumb., sec., sil., staph., sulph. Cramps in the toes: Calc., fer., hep., lyc., merc., nux, phos.-ac., SEc., sulph. SKIN. Blueness of the skin: Acon., arn., ARs., bell., bry., 196 REPERTORY. CHOLERA calc., camph., CARB.-V., CUPR., dig., lach., merc., natr.-m., nux, op., phos., phos.-ac., plumb., puls., rhus, SEC., sil., spong., thuj., VERAT. Blueness of the skin in different parts, and withered ap- pearance of it: ARS., bry., calc., CAMPH., CUPR., merc., nux, phos., phos.-ac., SECAL., sil., spong., VERAT. Coldness of the skin: Acon., ant., arn., ars., bell., bry., calc., CAMPH., cann., canth., CARB.-V., caus., cham., chin., cic., cupr., dros., dulc., fer., graph., hell., hep., hyos., ign., IPEC., kal., lach., laur., lyc., merc., mez., natr., natr.m., nitr.-ac., nux, op., petr., Pнos., phos.-ac., plumb., puls., rhus, sabad., sabin., sec., sep., sil., spig., spong., stann., staph., stram., sulph., tart., thuj., VERAT. The medicines which correspond both to coldness and blueness (of the skin), respectively or collectively, are: Acon., arn., ARS., bell., bry., calc., CAMPH., CARB.-V., CUPR., lach., merc., natr.-m., nux, op., Pнos., PHOS.-AC., plumb., puls., rhus, SEc., sil., spong., thuj., VERAT. Skin cold and bluish, and covered with cold perspira- tion: ARS., camph., carb.-v., CUPR., ipec., SECAL., VE- RAT. Coldness of the skin, with mental indifference or tran- quillity: ARS., ipec., NATR.-M., VERAT. Withered or wrinkled skin: Ant., ARs., bry., colc., camph., cham., chin., CUPR., fer., graph., hell., hyos., iod., kal., lyc., merc., mur.-ac., nux, phos., PHOS.-AC., rheum., SEC., sep., sil., spig., spong., stram., sulph., VERAT. The medicines which correspond, respectively or col- lectively, to blueness, coldness, and shrivelled state of the skin, are: ARs., bry., calc., CAMPH., CUPR., merc., nux, PHOS., PHOS.-AC., SEC., sil., spong., VERAT. als 197 The medicines which, on the ground of clinical experi- ence, have been more especially recommended for this combination of symptoms, in the stage of collapse in cho- lera, are: ARS., CAMPH., CARB.-V., CUPR., hydrocy., jat., SEC., VERAT. PERSPIRATION AND PULSE. PERSPIRATION AND PULSE. Perspiration, cold: Acon., ARS, bell., bry., calc., CAMPH., canth., CARB.-V., cham., chin., cin., coff., CUPR., dulc., hell., hep., hyos., ign., IPEC., lach., lyc., merc., natr., nitr.-ac., nux, op., petr., phos., phos.-ac., plumb., puls., rheum., rhus, sabad, SEC., sep., sil., spig., stram., sulph., thuj., tart., VERAT. Perspiration, viscid, clammy: ARS., camph., daph., fer., hep., jat., lach., lyc., merc., nux, phos., phos.-ac., plumb., sec., VERAT. Perspiration clammy, with slow pulse: CAMPH., merc., VERAT. Perspiration clammy, with spasmodic movements of the jaw: CAMPH., merc., nux, phos., plumb., SEC. VE- RAT. Pulse feeble and frequent: Ars., CARB.-V., lach., nux, rhus-rad. Pulse Feeble and Slow, in the 1st stage: CAMPH., cann., dig., LAUR., merc., puls., rhus.-rad., VERAT. Pulse Feeble and Slow, in the 4th stage; Camph., cann., dig., laur., merc., puls., R.-RAD., VERAT. Pulse feeble and small: ARS., CAMPH., chin., dig., LACH., nux, PHOS.-AC., puls., RHUS, VERAT. Pulse scarcely perceptible, with watery and white-flocky stools: Acon., ARS., bry., CAMPH., PHOS.-AC,, rhus, SEc., VERAT. } I 198 CHOLERA REPERTORY. GENERAL AND MISCELLANEOUS SYMPTOMS. Burning internally, and tossing, with fear of death: ARS. Burnings in the stomach and abdomen, with anguish and tossing: ARS., CAMPH. Cholera followed by cerebral and abdominal affections: BELL. Collapse so complete, that no vomiting, diarrhoea, or spasms remain, though some or all of them have existed previously; ARS., camph., CARB.-V., CUPR., HYDRO- cv., laur., verat. Collapse, without previous or present vomiting, or diar- rhoa: CAMPH., CARB.-V., hydrocy., laur., VERAT. Cramps or other Spasms at night: Ars., camph., calc., cin., CUPR., hyos., ipcc., kal., lyc., merc., op., SEC. Cramps in the stomach and extremities, with coldness of the body in an early stage, with but little diarrhea: CAMPH. Spasms, Clonic, (convulsions): Ars., bell., bry., calc., CAMPH., canth, carb.-v., caus., cham., cic., con., CUPR., hyos., ign., ipec., cal., lyc., merc., natr.-m., op., phos., phos.-ac., plat., rhus, SEc., sep, sil., stann., STRAM., tart., sulph., VERAT. Spasms, severe and clonic, with but little diarrhoea or vomiting: Ars., CAMPH., CUPR., ipec., sec., VERAT. Spasms, Tonic, (Tetanus, Cramps, &c.): Ars., bell., caus., cham., Cic., CUPR., ign., ipec., lyc., merc., petr., phos., plat., rhus, SEc., sep., stram., sulph., VERAT. Spasms, severe and tonic, with but little diarrhoea or vomiting CAMPH., CUPR., ipec., Sec., Verat. : GENERAL AND MISCELLANEOUS SYMPTOMS. 199 Spasms or Cramps, in the extremities or elsewhere, with weight, pressive pain or aching, at the pit of the stomach: CAMPH., CUPR., natr.-m., phos., phos.-ac., sec., tart., VE- RAT. Spasms of the extremities, with painful sensibility of the pit of the stomach: Ars., CAMPH., CUPR., natr.-m., phos., phos.-ac., tart., VERAT. Spasms return at night: Cuprum, SECALE. Excessive and sudden debility: Ars., carb.-v., CUPR., ipec., lach., laur., nux, PHOS., PHOS.-AC., Sec., VERAT. The patient worse after midnight, or early in the morn- ing: Acon., ARS., bell., canth., CARB.-V., CUPR., kal., lach., merc., natr., natr.-m., nux, petr., PHOS., PHOS.-AC., RHUS, sec., stram., sulph., tart., VERAT. The patient made worse by movement: Acon., Ars., BELL., bry., CAMPH., canth., carb.-v., cic., CUPR., dig., hyos., IPEC., kal., lach., laur., merc., natr.-m., nux, petr., PHOS., PHOS.-Ac., plumb., rhus, rad., SEc., stram., sulph., tart., VERAT. CHAPTER XI. GASTRIC AND INTESTINAL REPERTORY.* * AUXILIARY TO THE CHOLERA REPERTORY, AND ADAPTED ALSO TO VOMITING AND DIARRHEA IN GENERAL, AND TO CHOLERA INFANTUM AND DYSENTERY. EXPLANATION OF THE USE OF THE REPERTORY. THE arrangement of the symptoms of each section, is in general alphabetical. * Taken chiefly from Jahr's excellent Manual, with some modifi- cations. 200 CHOLERA REPERTORY. : The mode of obtaining the remedy for a group, is the same in this, as in the Cholera Repertory. The medi- cines seldom required, are here omitted. The emphasis in Chapter XI., has no special reference to Cholera; but in the treatment of this disease, this chapter may be con- sulted, when any case presents symptoms contained in this, but not in the Cholera Repertory; and that Reper- tory may be used as auxiliary to this and in general prac- tice; for the medicines there enumerated apply to the symptoms, in whatever disease they may occur. The 30th, will in general be a suitable dilution for most medicines, in ordinary gastric and intestinal diseases, for which this Repertory (Chap. XI,) is more especially con- structed. VOMITING IN GENERAL. Acon., ant., arn., ars., bell., bry., calc., camph., cann., canth., carb.-v., cham., chin., cic., cin., coff., colch., coloc., cupr., dros., dulc., fer., graph., hep., hyos., ign., ipec., lach., laur., lyc., merc., natr.-m., nitr.-ac.. nux, phos., plumb., puls., sec., sep., sil., stann., stram., sulph, tart., verat. CHARACTER OF THE VOMITING. Vomiting Acrid: Arg., ipec. Bilious, bitter: Acon., ant., ars., bry., camph., cann., colch., cupr., dros., grat., ipec., lach., merc., nux., phos., puls., sec., sep., stann., stram., sulph., verat. Bitterish-Sour: Grat., ipec., puls. Blackish Ars., calc., chin., hell., laur., nux, phos, plumb., sec., sulph., verat. of Blood: Acon., arn., ars., bell., bry., calc., CHARACTER OF THE VOMITING. 201 camph., canth., carb.-v., caus., chin., cupr., dros., fer., hep., hyos., lach., lyc., mez., nux, op., phos., plumb., puls., sulph., verat., zinc. of Blood clotted: Arn., caus. Vomiting of Blood; sour regurgitations: Ars., calc., carb.-v., lyc., nux, phos., plumb., puls., sulph. Vomiting Brownish: Ars., bis. Vomiting of what has been drank: Acon., ant., arn., ars., bry., cham., chin., dulc., ipec., nux, puls., sec., sil., sulph., tart., verat. of what has been eaten: Ant., ars., bell., bry., calc., chin., colch., coloc., cupr., dros., fer., hyos., ign., ipec., lach., laur., lyc., natr.-m., nux, phos., plumb., puls., sep., sil., stann., sulph., verat. of Excrement: Bell., bry., nux, op., plumb. Frothy: Eth., verat. Gelatinous: Ipec. Green: Acon., ars., cann., ipec., lach., phos., plumb., puls., verat. Milky: Æth. of Milk used: Æth., samb. of Mucus: Acon., æth., ars., bell., bor., bry., cham., chin., cupr., dig., dros., dulc., hyos., ipec., lach., merc., nux, phos., puls., sulph., verat. of Bloody Mucus: Acon.. hep., hyos., lach., nitr. of Green Mucus; Acon., ars., ipec., lach., phos., puls., verat. Painful: Asar., tart. Periodical: Cupr., nux. Salt: Magn., natr.-s. Vomiting Sour: Ars., bell., bor., calc., caus., cham., 202 CHOLERA REPERTORY. chin., fer., graph., hep., ipec., lyc., nux, phos., phos.-ac., puls., sass., stram., sulph., tab., tart., thuj., verat. Vomiting Violent: Ars., bell., cupr., iod., lach., nux, plumb., tart., verat. Watery: Ars., bell., caus., chin., cupr., hyos., jat., magn., sil., stann., stram., sulph.-ac., tab., verat. Yellowish: Ars., iod., oleand., plumb. Yellow, with tinge of Green: Oleand., verat. CAUSES OR CONDITIONS OF THE VOMITING. Vomiting after acids: Fer. after Bread: Nitr.-ac. from the motion of a carriage: Ars., cocc., nux, petr., sil., sulph. after a Chill: Bell. Vomiting after Drinking; Arn., ars., bry., nux, puls., sil. relieved by Drinking: Cupr. bitter after Drinking: Ars., nux., sil., verat. Vomiting after Eating: Ars., calc., fer., iod., ipec., lach., nux, phos., puls., sep., sil., stann., sulph., verat. Evening (in the): Bell., bry., phos., puls., sulph. Morning (in the): Bar.-m., dig., dros., nux, sil., sulph. Night (at) Ars., bry., caus., dig., dros., fer., lyc., merc., mur.-ac., nux, phos., puls., sulph., verat. in Pregnancy: Acon., ars., con., fer., ipec., kreos., lach., magn.-m., natr.-m., n.-mos., nux, petr., phos., puls., sep., verat. Vomiting after Smoking or Stooping: Ipec. from the motion of a Ship: Ars., cocc., nux, petr., sil., sulph. after Sucking Sil. CONCOMITANTS OF THE VOMITING. 203 CONCOMITANTS OF THE VOMITING. Vomiting with Anxiety: Ant., ars., nux. offensive Breath: Ipec. Choking: Hyos. Colic: Ars., bry., nux, plumb., puls., stram., tart., verat. Convulsions: Ant., cupr., hyos., merc. Cries: Ars. fear of Death: Ars. Diarrhœa: Æth., ant., ars., bell., coloc., cupr., jat., ipec., lach., phos., rheum., stram., tart., verat. pains in the Ears: Puls. Eructations: Caus., mur.-ac. Eyes convulsed: Cic. Face, pale: Puls., tart. perspiration on the Face: Camph., sulph. Feet, cold: Kreos., phos. Feet, numb: Phos. Hands, cold: Kreos., phos., verat. Hands, hot: Verat. Hands, numb: Phos. Heat: Ars., bell., ipec., verat. Hiccough: Bry. Legs, cramped: Nux. desire to lie down: Verut. Nausea Nux, sulph., verat. Pain in the back: Puls. Pain in the stomach: Ars., cupr., hyos., ipec., lach., op., phos., plumb., sulph., tart., verat. Perspiration: Ipec., sulph. Perspiration, cold; Camph. 204 CHOLERA REPERTORY. Vomiting, with rumbling: Puls. Shivering: Bry., phos., puls., tart., sulph. Shivering in the evening: Bry., phos., sulph. Shuddering: Verat. Sight, obscure: Lach. Sleepiness: Tart. Taste, bitter: Puls. Thirst: Ipec. Throat, burning: Arg., puls. Trembling Nux, tart. Vertigo: Hyos., natr.-s. Weakness: Ars., hyos., ipec., phos., verat. SENSATIONS (PAINS, &c.,) AT THE STOMACH AND PIT OF THE STOMACH. Burning in the pit of the stomach: Acon., ant., ars., bell., bry., laur., merc., nux, phos., sec., sep., sil., sulph., verat. In the stomach: Ars., bell., bry., camph., canth., caps., carb.-v., cham., cic., graph., ign., laur., merc. merc.-c., nitr., nux, phos., phos.-ac., sabad., sec., sep., sulph., verat. Cold sensation in the Stomach or pit: Ars., bell., ign., lach., laur., phos., phos.-ac., rhus, sulph. Cramp: (See spasmodic pains.) Sensation of Emptiness in the Stomach: Ant., ign., petr., sep., tart., verat. Sensation of Fulness in the Stomach and pit: Arn., bar.-c., bell., carb.-v., cham., grat., hell., kal., lyc., nux, petr., phos., sulph. after a meal: Also, chin., merc., puls., sep., sil. Pressure in the pit of the stomach: Acon., arn., ars. STOMACH. 205 bell., camph., cham., chin., coff., coloc., cupr., hep., ign., merc., natr.-m., nitr., nux, phos., phos.-ac., prun., puls., ran., ran.-sc., rhod., rhus, sep., stann., sulph., tart., verat. Pressure in the stomach: Acon., agar., anac., arn., ars., bar.-c., bell., bis., bry., calc., canth., carb.-an., carb.-v., cham., chin., cic., coff., colọc., fer., graph., grat., hep., iod., ipec., lach., laur., led., lyc., merc., mez., mosch., natr., natr.- m., nux, par., petr., phos., plat., plumb., puls., rhod., rhus, sabin., sec., sen., sep., sil., spig., squill., stann., stram., sulph., tart. Pain in the Pit of the Stomach, and in the chest, after a meal: Bry. Pain in the Stomach and chest, after a meal: Chin., lach., phos. Shootings in the pit of the Stomach: Arn., bell., bry., kal., nit-ac., phos., puls., rhus., sep., sulph., tart. In the stomach: Bell., bry., coff., ign., kal., plat., sep., sulph. Spasmodic pains in the stomach: Ant., ars., bell., bis., bry., calc., carb.-a, carb.-v., caus., cham., chin., cocc., coff., con., cupr., fer., graph., hyos., kal., lach., lyc., merc., natr.-m., nux, phos., puls., sec., sep., sulph., verat. Swelling of the pit of the stomach: Acon., calc., hep., lyc., sulph. Sensation of swelling there: Bry. Tenderness of the stomach and region of the stomach: Am.-c., am.-m., ant., ars., bar.-c., bry., calc., camph., canth., carb.-v., caus., colch., coloc., hep., hyos., kreos., lach., lyc., magn.-m., merc., natr, natr.-m., nux, ol.-an., phos., phos.-ac., puls., rhus-rad., sil., spong., stann., sulph., sulph.-ac., tart., tereb., verat. 10 206 CHOLERA REPERTORY. 1 Tension in the Pit of the stomach: Acon., ant., cham., nux. in the Stomach: Acon., bry., carb.-v., kal., merc., staph. Throbbings in the region of the stomach: Acon., bell., kal., puls., rhus., sep., sulph., tart., thuy. DIARRHEA IN GENERAL. Acon., alum., am.-m., ant., arn., ars., bell., bor., bry., calc., carb.-v., cham., chin., cic., coff., coloc., con., cupr., dig., dros., dulc., fer., graph., hep., hyos., ign., ipec., lach., laur., lyc., merc., natr.-m., nitr.-ac., nux., petr., phos., phos-ac., puls., rheum., rhus., sep., sil., stram., sulph., sulph.-ac., verat. COLOR OF THE FECES. Color, Black: Ars., bry., calc., camph., chin., ipec., merc., nux., op., phos., stram., sulph., sulph.-ac., verat. Brownish Ars., camph., dulc., magn., magn.-m., merc.-c., rheum., rhus-rad., sulph., verat. Clay-like: Calc., hep. Greyish: Merc., phos., phos.-ac., rheum. Greenish Ars., bell., cham., coloc., dulc., hep., ipec., magn., magn.-m., merc., merc.-c., nux,, phos., phos.-ac., puls., rheum., sep., sulph., sulph.-ac., verat. Pale Carb.-v., lyc. Whitish: Acon., ars., calc., caust., cham., chin., colch., cop., dig., hep., ign., iod., nux., phos., phos.-ac., puls., rhus, spig., spong., sulph. ODOR OF THE FECES. 207 White, like milk: Arn., bell., dulc., merc., nux, rheum. White, like flocks: Vide, Cholera Repertory. ; White, in streaks: Rhus-tox. Yellowish: Ars., calc., cham., chin., cocc., coloc., ign., ipec., merc., phos, plumb., puls., sulph., terb. Yellow, in streaks: Rhus-tox. ODOR OF THE FECES. Odor: Corpse-like: Sil., Carb.-v. | Fætid: Ars., calc., cham., coloc., lach., merc., merc.-c., nitr.-ac., 'nux, op., phos.-ac., plumb., rheum., sep., squill., sulph.-ac., tab. Putrid Ars., bry., carb.-v., cham., chin., coloc., graph., merc., nitr.-ac., nux, sep., sulph., sulph.-ac. Sour: Arn., calc., coloc., graph., magn.. merc., rheum., sep., sulph. COMPOSITION AND CONSISTENCE OF THE FÆCES. Fæces acrid: Ars., cham., fer., lach., merc, puls. sass., verat. Bilious: Ars., dulc., ipec., merc., merc.-c., puls. Bloody: Arn., ars., caps., carb.-v., colch., coloc., dulc., ipec., lach., merc., merc.-c., nitr.-ac., nux. Coated with Blood: Con., magn.-m., nux, squill., thuy. Burning: Ars., lach., merc. Clay-like: Calc. Corrosive: See Acrid. not Digested: Arn., ars., bry., calc., cham., chin., 208 CHOLERA REPERTORY. " 11 ||||! con., fer., lach., merc., nitr.-ac., oleand., phos., phos.-ac., squill., sulph. not Digested at night, or after meals: Chin. Fermented: Ipec., sabad. Frothy Calc., coloc., iod., lach., merc., op., rhus., sulph.-ac. Gelatinous: Rhus., sep. Purulent: Arn., bell., calc., canth., chin., clem., cocc., con., ignat., iod., kal., lyc., merc., nux, petr., puls., sabin., sec., sil., sulph. Slimy Ang., arn., ars., bell., caps., carb.-v. cham., chin., coloc., dulc., fer., graph., hell., iod., ipec., kal., merc., nitr.-ac., nux, phos., phos.-ac., puls., rheum., rhus., sec., sep., squill., stann., sulph., tart., verat. Viscous; sticky: Calc., carb.-v., caust., hep., lach., merc., nux., plumb., sass., verat. Watery: Acon., ant., arn., ars., bell., calc., cham., chin., fer., hyos., jat., ipec., lach., nux., petr., phos., phos,-ac., puls., rhus., sec., sulph., tart., verat. CAUSES, OR CONDITIONS OF DIARRHOEA. Diarrhea from Acid things: Lach. after taking Cold: Bell., bry., caust., cham., chin., dulc., merc., n.-mos., nux., puls., sulph., verat. in the Coolness of the evening: Merc. in Damp weather: Lach., rhod. Day and Night: Sulph. after Drinking: Ars., cin. in the Evening: Caust., kal., lach., merc. CONCOMITANTS OF DIARRHEA. 209 Diarrhea, in Feeble persons: Chin., fer., rhus, phos.-ac., sec. Chin., lach., rhod. after Fruits from Grief: Ign. from Indigestion: Ant., coff., ipec., puls., nux. after a Meal: Ars., chin., lach., verat. after Milk: Bry., lyc., sep., sulph. in the Morning: Bry. at Night: Ars., bry., cham., chin., dulc., lach., merc., mosch., puls., rhus., sulph., verat. of Old persons: Ant., bry., phos., sec. of Pregnant females: Ant., dulc., hyos., lyc., petr., phos., sep., sulph. of Scrofulous persons: Ars., bar.-c., calc., chin., dulc., lyc., sep., sil., sulph. when Sleeping: Arn., puls., rhus. during Warm Weather: Lach. CONCOMITANTS OF DIARRHEA. Diarrhoea with: Abdomen distended: Graph,, sulph., verat. Anguish Ant., lach., merc. excoriation of the Anus: Cham., merc., sass. Colic, cutting: Acon., agar., ang., ant., ars., asa., bar.-c., bry., cann., canth., cham., coloc., dulc., hep., ipec., lach., merc., merc.-c., mez., nux., petr., puls., rat., rheum., rhus., stront., sulph., verat. alternately with Constipation: Bry., lach., nux., rhus. with Cries and tears, in Children: Carb.-v., cham., ipec., rheum., sulph. Debility: Ars., chin., ipec., phos., sep, verat. CHOLERA REPERTORY. 210 Diarrhea, Eructations: Con., dulc., merc. Heat: Merc. 2-4 m pain in the Limbs: Am.-m., rhus. pain in the Loins: Nux. Nausea Ars., bell., ip., lach., merc. cold Perspiration on the face: Merc. Shiverings: merc., puls., sulph. pain in the Stomach: Bell., bry. Tenesmus: Ars., ipec., lach., merc., nux., rheum., rhus., sulph. Thirst: Ars, dulc. Vomitings: Ars., bell., coloc., cupr., dulc., ipec., lach., phos., rheum., stram., tart., verat. THE MORE USUAL GROUPS OF DIARRHEIC SYMPTOMS.* Acrid and brown stools: Ars., verat. Black and green stools: Ars., ipec., merc., phos., sulph.-ac., verat. Blackish stools after abuse of ipecac: Chin. Bloody, mucous and fœtid stools: Lach., merc.-c., sulph., sulph.-ac. Brown and green stools: Ars., dulc., magn., magn.-m., merc.-c., sulph., verat. * These, being nature's groupings, are of more practical value, than those which are formed merely from the Materia Medica, with- out reference to any observation of their actual occurrence in natural disease. The author, like most practitioners, has observed all of them in the latter, and most of them a great number of times. Those who practice accurately, often study to find the remedies adapted to groups: if they recorded and preserved the results of their calculations, the aggregate of those collected by different physicians would form a valuable repertory for general practice. DIARRHEIC GROUPS. 211 Brown and watery stools: Ars., dulc., sulph., tart. Brown stools, with nausea from movement: Ars. Clay-colored and frothy stools in diarrhoea: Calc., rhus-rad. Diarrhoea after fruit; with sighing respiration: Lach. at night, with distension of the stomach and ab- domen after meals: Bor., bry., caust., cham., chin., dulc., kal., lach., merc., puls., rhus-tox., sulph. during dentition; white coat on the tongue; yel- lowish stools: Calc., ipec., merc., sulph. painless and at night: Ars., bor., bry., canth., cham., chin., dulc., merc., puls., rhus-tox., sulph., verat. with colic and at night: Ars., bor., bry., cham., dulc., lach., merc., puls., rhus-tox., sulph., verat. with colic and tenderness of the abdomen: Acon., canth., cham., merc.-c., nux, puls., rhus-rad., stram., sulph., terb., verat. with colic; stools fœtid: Ars., bry., coloc., ipec., lach., merc., nux, stram., sulph. with colic; stools green: Ars., bor., coloc., phos., puls., verat. with white coat on the tongue, and yellow stools; Amb., calc., ign., ipec., merc., oleand., petr., phos., puls., sulph. with involuntary evacuations at night: Ars., bry., chin., lach., merc., puls., rhus-tox., sulph, verat. with sweat on the face, nausea and stiffness of the neck, and pain in it when moving it: Camph. 212 CHOLERA REPERTORY. Fœtid and green stools: Ars., cham., coloc., lach., merc., merc.-c., nux, sep., sulph, sulph.-ac. tab. Fœtid stools, in diarrhea with colic: Ars., bry., coloc., ipec., lach., merc., nux, stram., sulph. Frothy and involuntary stools, in diarrhoea: Chin., merc., op., rhus-tox., sulph. Green and slimy stools: Ars., bell., bor., canth., cham., coloc., dulc., ipec.. laur., merc., nux, phos., puls., sep., stan., sulph., sulph.-ac., tab. Green, slimy and undigested stools: Ars., bor., cham., nitr.-ac., phos., phos.-ac., rheum, sulph., sulph-ac. Green, sour and undigested stools: Merc., sulph. Watery stools, in diarrhoea with colic: Ars., cham., dulc., lach., nux, puls., rhus-tox., sulph, Watery stools with brown coat on the tongue, and vomiting at night: Bell., phos., sulph. CHOLERA INFANTUM, DIARRHOEA OR CHOLERA MORBUS OF INFANTS,* Cholera Infantum in general: Acon., ars., bell., bry., calc., cham., dulc., hep., ipec., merc., nux, puls., sep., sulph., verat. Cholera Infantum, with: Abdomen distended: Ars., bell., bry., cham., merc., nux, puls., sep., sulph. distended, and pained during the evacuations : Ars., bry., cham., merc., nux, sep., sulph. Cholera Infantum, with Cerebral disease: Bell. * The disease called Cholera Infantum, by American physicians, prevails during the hot season in the Middle States, and is often fata In cities. 213 Cholera Infantum, with Fever, thirst, hot and dry skin, pulse hard, and frequent: Acon.* with Stools green: Ars., bell., cham., dulc., ipec., merc., nux, puls., sep., sulph., verat. with Stools yellow and slimy: Ars., cham., ipec., merc., puls., sulph. with Vomiting diarrhea and Slimy Stools: Ars., bell., ipec., rheum, verat. It is unnecessary to dwell longer on Cholera Infantum in particular, inasmuch as the other parts of this Reper- tory afford a sufficient guide for the treatment of this dis- ease; especially if the remedies for each symptom of the case be compared with the list given (at the head of this section,) as the remedies for Cholera Infantum in general. It is not, however, necessary to be confined to them, if the whole group of symptoms indicates some other remedy. Symptomatology, here as elsewhere, is the grand basis of treatment. DYSENTERY. DYSENTERY. Dysentery in general: Acon., ars., bell., bry., canth., caps., carb.-v., cham., chin., colch., coloc., dulc., ipec., merc. merc.-c., nitr.-ac., nux, phos., puls., rhus, sulph., verat. ht Dysentery with dryness of the Lips: Acon., bell., bry., chin., lach., merc., nux, rhus, sulph. with tenderness of Stomach and Abdomen: Nux, puls., sulph. 10* * At the commencement of the treatment, Aconite is generally advisable. 214 CHOLERA REPERTORY. } Dysentery, with tenderness of Abdomen: Acon., bell., cham., merc., nux, puls., sulph. with Stools of Bloody mucus, sometimes Green: Merc., merc.-c., nux, puls., sulph. with Burning in the Abdomen and Soles: Merc. with Bloody mucous Stools and Tenesmus: Lach. merc., merc.-c., nux, rhus., sulph. For other symptoms and groups in any particular case of dysentery, see other sections of this Repertory, and compare the medicines, under each symptom of the case, with those for dysentery in general. APPENDIX I. AN ESSAY ON EPIDEMIC CHOLERA, By B. F. JOSLIN, JR., M.D. PRESENTED TO THE UNIVERSITY OF THE CITY OF NEW-YORK, FOR THE DEGREE OF DOCTOR OF MEDICINE.-SESSION 1851-2. THE early history of the Cholera is involved in some obscurity; for while some contend that it has existed in this country and in Europe only during a comparatively recent period, others believe firmly, that the epidemics with which we have been visited were only a more general prevalence of the Cholera Morbus, which is always more or less preva- lent during the warmer months. In the descrip- tions of Cholera Morbus contained in the older books, the evacuations both from the stomach and bowels, are described as consisting "chiefly of bile." Any person who has seen the epidemic cholera, knows that in it the evacuations are characterized by an entire absence of this fluid; that though in rare cases, the dejections may be slightly tinged with bile, still in no case which they would consider as epidemic Cholera, are the matters ejected from the 216 APPENDIX. body decidedly bilious. A comparison of the symp- toms enumerated as belonging to Cholera morbus, and those of epidemic or malignant Cholera, will I think, be sufficient to convince any one, that those diseases, though resembling each other in some par- ticulars, are nevertheless not identical. The testi- mony of medical men who had had long experience, and who witnessed the first epidemic of Cholera, proves that the disease was one which they had not previously been accustomed to meet in practice. Watson says, (Prac. of Med. p. 407,) "the late Dr. Babington told me that it was quite new to him. He had for a very long period been in exten- sive practice in those parts of the metropolis and its vicinity where the epidemic Cholera raged most: and when it first came among us, he had the curiosity to ask every medical man whom he met, whether he had seen any case of the Cholera, and if the answer was "Yes," he went on to inquire, whether before that year the person had ever met with the same complaint and the reply was always, without a single exception "No." Dr. Ackerly, who was physi- cian to one of the Cholera hospitals in New-York, during the epidemic of 1832, says in his report, that "nothing like the late epidemic and malignant Chole- ra has occurred to my notice in twenty-four years practice." : Among those who believe epidemic cholera to be a disease essentially different from Cholera morbus, it has been a question whether it first originated in AN ESSAY ON EPIDEMIC CHOLERA. 217 India in 1817, or had been endemic there for a much longer period. That the disease which we know by the several designations of Epidemic, Malignant, or Asiatic Cholera, was known in India previous to the commencement there of the epidemic which traversed a great portion of the globe from 1817 to 1833 or 34, is probable from the evidence of resident surgeons and early writers. As early as 1629, BONTIUS, a Dutch physician, wrote at Batavia, an account of what he calls "Cholera Morbus," but from his description it appears to have more nearly resembled epidemic cholera. He says "this disease is attended with a weak pulse, difficult respiration, and coldness of the extreme parts; to which are joined great internal heat, insatiable thirst, perpetual watching, and rest- less and incessant tossing of the body. If together with these symptoms, a cold and foetid sweat should break forth, it is certain that death is at hand." In his description of Cholera Morbus he says nothing of the spasms of the extremities, but he speaks of a person who died of this disease, as having died in convulsions. He also witnessed a disease that he calls " Spasm," which there is reason to think was nothing but the spasmodic variety of Cholera. Dr. PAISLEY, writing at Madras, in 1774, speaks of "Cholera Morbus" as being "often epidemic,” and accompanied with "sudden prostration of strength, and spasms over the whole surface of the body." He attributes the disease to the ef 218 APPENDIX. w fects of "highly putrid bile;" but his description contains no information in regard to the appearance. of the evacuations: his opinion as to the cause of the disease appears to be merely hypothetical. SON- NERAT, who travelled in India, between the years 1774 and 1781, speaks of several epidemics of dis- ease, the symptoms of which, as he relates them, very nearly resemble the Cholera as it has appeared in this country. He says, "the symptoms of this disorder were a watery flux, accompanied with vomit- ing and extreme faintness, a burning thirst, an op- pression of the breast, and suppression of urine. Sometimes the diseased felt violent colicky pains; often lost his speech and recollection, or became deaf; the pulse was small." Another epidemic, occurring two years after, "first showed itself by a watery flux, which came in an instant; and sometimes cut the diseased off in less than four and twenty hours. Those who were attacked had thirty evacuations in five or six hours; which reduced them to such a state of weakness that they could neither speak nor move. They were often without pulse; the hands and ears were cold; the face lengthened; the sinking of the cavity of the socket of the eye was the sign of death; they felt neither pains in the stomach, colics, nor gripings. The greatest pain was a burning thirst." An English surgeon, Mr. CURTIS, in India, in 1782, described a disease which occurred in the national vessel to which he was attached. He enumerates most of the more striking phenomena, AN ESSAY ON EPIDEMIC CHOLERA. 219 of the cholera as being present in the disease he witnessed; as, general tonic spasms, the evacuations consisting of "nothing but a thin watery matter, or mucus;" coldness of the extremities, and subse- quently of the whole body; the pulse "sometimes sunk so much as not to be felt at the wrist, in two or three hours after the spasms came on,” “in many, the stomach became so irritable that nothing could be got to rest upon it; but every thing that was drank was spouted out immediately; without straining or retching. His account of the appearance of the hands in ex- treme collapse is characteristic. "The hands now begin to put on a striking and peculiar appearance. The nails of the fingers became livid, and bent inwards; the skin of the palms became white, bleached, and wrinkled up into folds, as if long soaked in cold water; the effect, no doubt, of the profuse cold sweat, which is one of the most per- nicious and fatal symptoms of the disease." He also speaks of patients retaining possession of their faculties "to the last moment of their life, even when the whole body had become perfectly cold, and all pulsation of the heart had ceased for a long time to be distinguishable." This disease can be shown to have been present in some part of India, during the period which elapsed between the last mentioned date and the year 1817, when it seems to have at- tracted more general attention than it had done at any previous time. From the above extracts we may 220 APPENDIX. conclude, that a disease similar to that which has visited us during the past twenty years, has been prevalent in various parts of India as an epidemic, at intervals during two centuries; and it is not unlikely for a longer period, though anterior to this we have no records. In August, 1817, the Cholera appeared almost si- multaneously in Calcutta and Jessore, in Hindostan, places about sixty miles apart. It is somewhat difficult to determine the exact point at which this epidemic took its start; but it is certain that within three months after its appearance in the above places, scarcely a spot existed within several thousand miles, in which it. had not committed its ravages. In some localities the mass of the population was said to have been sen- sibly diminished. It is not my design to detail the routes pursued by this fearful scourge; suffice it to say, that its general course was westerly, though marked by many deviations. Whether Cholera is or is not contagious, it very certainly has some other means than contagion of propagating itself; and its history has shown that neither non-intercourse nor rigid quarantine regula- tions were sufficient to stop its progress. I do not intend to enter fully into the discussion of the con- tagiousness of this disease, but will however relate the particulars of one instance, which illustrates my own view of this subject. On the second of Decem- ber, 1848, the ship New-York, arrived at the quaran- tine, Staten Island. According to the report of AN ESSAY OF EPIDEMIC CHOLERA. 221 Dr. WHITING, health officer, this vessel had started from Havre with 345 passengers. About a week previ- ously to arrival here, when off the coast of Nova Scotia, a number of cases of disease resembling Asiatic Cholera occurred, which terminated very sud- denly. Out of seventeen cases, seven died. Subse- quently to these persons having been taken to the hospital, there occurred in the latter place seventy- nine cases, out of whom forty-five died, making in all ninety-six cases and fifty-two deaths. Several of these cases were persons not having been passengers of the New-York. Among the latter was one of the nurses of the Institution. This is perhaps as fair an instance as could have been selected for an illustra- tion of the peculiar habitudes of this disease. Here were a number of persons completely isolated, as a body, from the influence of contagion, and at a distance from any point at which the Cholera was then pre- vailing: it would be difficult to suppose any but an atmospheric origin in this instance. But further; the ship arriving at quarantine, where no cases of this disease had previously occurred, the disease still continues, and even attacks some who had never been in the infected ship: From whence did these last receive the infection? This last circumstance would seem to indicate that the Cholera was conta- gious, in a slight degree. From the above facts I deduce the following conclusions: 1st, that Cholera is propagated by means other than contagion; 2d, that under circumstances favorable for its develop- 222 APPENDIX. ment, the presence of cases in the immediate neigh borhood acts as an exciting cause. It is also worthy of being noted in this connection, that at least three persons died of Cholera in the City between the sixth and the twentieth of the same month, the first of whom had previously been discharged as cured from the quarantine hospital. We may assume that Cholera is produced by a definite poison, without aknowledging the truth of any of the various hypotheses which have been brought forward respecting its absolute nature. This poison we know only by its effects; what it is, whether ponderable or imponderable, we know not : our only knowledge is derived from the effects which it produces upon the human system. Whether we suppose it to be, like variola, generated in the course of the disease and propagated by contagion, or pro- duced by a generally diffused miasm, we may still consider it to be the effect of a specific poison. Acting under more or less favorable circumstances, we see this poison producing proportionate results : for though we might suppose the existence of this poison at all times, still without the coöperation of certain predisposing causes, its effect would not be general. That much of this specific poison does at all times exist in those localities which have been visited of late years by the disease, to me appears improbable; for as we have seen that there is no proof of its having often shown itself by the produc- tion of its effect, it must have remained latent under AN ESSAY ON EPIDEMIC CHOLERA. 223 a multitude of circumstances which during the pre- sence of an epidemic of Cholera seem to act strongly as predisposing causes. This remark is applicable to the periods intervening between the occurrence of the several epidemics, as well as to times previous to the first and subsequent to the last. The predisposing causes may be comprised under the meteorological influences, the influence of locality, of age, of individual habits, and manner of living. Meteorological variations have in numerous in- stances preceded the appearance of Cholera. Those conditions of the atmosphere which have appeared most to favor its development are, unusual conditions of heat and moisture, and alterations in its electrical condition. Thus its appearance would be preceded by long-continued storms of rain and wind, or by thunder storms. In other instances it has been known to succeed a long continuance of dry hot weather, especially if this state be succeeded by a sudden fall of rain. The localities which have been most severely visited, have been low damp situations. Places sit- uated near marches and upon the borders of rivers have been especially distinguished during the course of an epidemic. Persons at about the middle period of life are more liable to an attack of this disease than either children or the aged. Young children are not un- frequently, during an epidemic, attacked with symp- toms of the first and second stages of Cholera; but 224 APPENDIX. in them it rarely terminates in collapse; it is more common in these cases for the disease to run into a chronic diarrhoea accompanied with vomiting, into, in fact, Cholera infantum. The following are tables, compiled from reports of the physicians having charge of Cholera hospitals, during the epidemics of 1832 and 1849. I have been unable to comprise all the reports of either epidemic; as only those arranged according to a uniform plan would answer my purpose. Of 590 patients admitted into the Park hospital, during the epidemic of 1832, there were 11 patients between the ages of 1 and 10 years, 20 66 (6 (4 66 49 "10" tr " 20" 30 (6 " 30" (C 40 " 40" 50 " 50" 60 " 60" 70 " 70" 90 (6 178 174 91 53 28 6 66 (( 66 (C (( (( (6 (6 66 CC 66 66 (6 "( (( (( "( (( (6 (6 (6 << (6 tc (6 (( Of 407 patients admitted into the Rivington-street hospital, (C 66 5 were between the ages of 1 month and 1 year, 42 66 (C (( "C 66 1 year and 10 years, 41 20 ( 116 102 66 21 (6 66 (( (( (6 ،، (C (6 44 .. 66 (( (( (( (C (6 "10 (6 66 "20 "30 "40 "650 (( (C 66 "6 "C << 66 (( (L (C (6 30 (( 40 66 50 60 (C 66 AN ESSAY OF EPIDEMIC CHOLERA. 225 2 were between the ages of 70 and 80 years, 1 66 66 (( (6 " 80" 90 (6 Of 281 patients in Corlear's Hook hospital, there were 25 under 14 years of age, 9 between 14 and 20 years, 66 84 (C 20 66 30 88 30 40 47 40 50 12 50 60 14 (6 60 66 70 (( 2 who were over 70 years of age. (6 (( 66 (. (( (6 66 (6 (( From the above it will be perceived, that there is very little difference between the liability of persons to an attack of Cholera between 20 and 30 years and of those between 30 and 40 years. The fore- going are from the reports of the epidemic of 1832, It is interesting to observe how nearly the following, taken from the reports of 1849, resemble them. Centre-street hospital received 483 cases: 53 under 20 years of age, 279 between 20 and 40 years of age, 141 40. 66 60 66 10 (6 60 (( "" (6 66 70 (C 66 66 (( (( Thirteenth-street hospital received 275 patients, of whom 63 were under 20 years of age, 157 between 20 and 40 years, 48 (6 40 (6 60 66 7 60 80 (C 226 APPENDIX. The remarkable similarity in regard to the rela- tive proportion of those attacked at certain ages in 1832 and 1849, is shown in the following synopsis of the preceding tables. In 1832, 14 per cent. of those attacked were under 20 years of age, 58 per cent. were between 20 and 40 years, 40 "60 (6 22 (C · 66 (( 4 were over 60 years of age. (6 In 1849, 15 per cent. were under 20 years, "6 60 21 2 66 (C between ،، 20 and 40 years, ،، 40 (( 60 were over 60 years. Thus it will be perceived, that the greatest number attacked were of persons between the ages of 20 and 40 years. In proportion to the number of persons living at a certain age, probably a less number are attacked of those under 20 years, than during any other period of the same length. It would appear as if the aged were in some degree exempt from its influence; but if we take into consideration the small proportion of persons in a city over 60 years of age, it will be seen that their liability to Cholera is quite as great as that of those under 20. To illustrate the comparative mortality of certain ages I have pre- pared the following tables by combining the hospital reports of 1832 and 1849. AN ESSAY OF EPIDEMIC CHOLERA. 227 AGE. (6 Under 10 years Between 10 and 20 years (( 20 "40 (C NUMBER OF CASES. CURED. DIED. PER CENT. 58 31 27 46 122 79 43 35 788 367 421 53 194 72 122 63 40 " 60 (( 27 11 16 69 Over 60 years The mortality increases from youth to old age, as shown by the per-centage in this table. The consideration of the influence of the habits and manner of living which predispose to this com- plaint, is important as guiding us to a knowledge of the true means of prevention. Not being wholly arrested in its progress by non-intercourse with af fected localities, nor often held in check by quaran- tine regulations, it is evident that the security, either of individuals, or of masses of men, is only to be at- tained by removing from themselves, as far as possi- ble, every cause which may be liable to act as a pre- disponent. Any thing which tends to diminish the general tone of the system, acts as a predisposing cause; irregularity of living, or dissipation of any kind, long watching with the sick, exposure to night air, and anxiety of mind, are all unfavorable. Of all occupations, that of a physician during the preva- lence of an epidemic of Cholera, pre-eminently dis- poses to an attack; liable to be called upon at all hours of the day to visit the sick, not unfrequently OF DEATHS. 228 APPENDIX. in crowded and ill-ventilated apartments, compelled to undergo fatigue and loss of sleep, and to take his meals at irregular hours, it is not surprising that many of this profession are numbered among its vic- tims. Nurses and those who attend upon the sick. are of course exposed in some degree, not so much in consequence of the infectious character of the disease, as owing to the fact that such persons are liable to be deprived of proper rest and pure air. When several persons occupy one room not very well venti- lated, as is too frequently the case in large cities, they are very much exposed during an epidemic, par- ticularly if the situation be low and damp. I have remarked that the dissipated were frequent subjects. This is the case; but of all vices none predisposes in so great a degree as intemperance: this has been remarked by almost every writer upon Cholera. Of 1615 cases received into Cholera hospitals in the epidemic of 1832, 1023 were decidedly intemperate, a proportion of nearly two-thirds of the remainder, 482 were intemperate and of 110 cases, it was not known whether they were intemperate or not; it is probable that a proportion were. Both in the epi- demic of 1832 and in that of 1849, the Cholera in New-York first appeared and was more fatal in the locality known as the "Five Points;" a fact which illustrates what has been previously said of its pre- disposing causes; this place possessing in itself all the elements best fitted for its reception, being low and damp, and the inhabitants filthy in the last de- : AN ESSAY ON EPIDEMIC CHOLERA. 229 gree. Among the occasional causes, we may enume- rate the eating of indigestible food, exposure to great fatigue, and a depressed state of the mind. For the purpose of description, we may divide Cholera into three stages or periods. The first stage I shall call choleroid, it may be also called the inci- pient stage. The second is the period of full devel- opment, and the third the stage of collapse; should the patient survive this stage, we will have the period of reaction. Either of these stages, choleroid, full development, or collapse, may occur without being preceded or succeeded by either of the others. This remark is more strictly true as applied to the first two periods; though numerous cases of collapse have occurred, without having been preceded by any pre- cursory symptoms sufficient to excite apprehension either in physician or patient. The term cholerine is usually applied to the diarrhoea which prevails during the presence of an epidemic of Cholera, and which is properly the first stage of the disease. I' have employed the term choleroid as designating the first stage, for the purpose of including a class of ca- ses in which no diarrhoea exists. I shall define cho- leroid to be the occurrence of one or more of any of the symptoms of Cholera in an individual, only not sufficiently numerous or severe to justify us in 'con- sidering it as a case of fully developed Cholera. The diarrhea which prevails during an epidemic of this disease, does not differ in its character from the di- arrhoea which prevails at other times when no Cholera 11 wh 230 APPENDIX. exists. The evacuations may consist of ordinary fœçal matter, or they may be large and watery; they are scarcely attended with pain or uncomfortable sen- sation to the patient: this I consider to be the most distinctive character of the diarrhoea preceding Cho- lera. During the epidemic of 1849, instances occur- red, in which persons would be affected with some very curious symptoms, apparently in consequence of the presence of the Cholera poison. These persons were affected by some among the more peculiar symp- toms of Cholera. These cases are, I am satisfied, to be ranked with the diarrhoea, which we have been considering as effects of the Cholera poison, so modi- fied by circumstances at not to produce its full effect. It was not unusual for persons to be troubled with slight spasms of the gastrocnemii, or of other volun- tary muscles; these taking place in persons who were not ordinarily subject to them. But the more interesting cases, were those in which I observed symptoms of a more advanced period of the disease: thus a large number of persons had cold tongues, im- parting a sensation to the touch like that of a frog's belly and in one instance I observed the tongue to be not only cold, but of a bluish-black. color, appear- ing as if it had been covered with ink. In my own person, I experienced some symptoms of a similar character to the above, which occurred several times. during the continuance of the epidemic in New-York; and it may be as well to state, that I have never ex- perienced them at any other time. The symptom K ayala AN ESSAY ON EPIDEMIC CHOLERA. 231 J most marked in my own case, was a blue color of the last phalynx of the fingers. The blue color was very decided, not unlike that of indigo. It was accompa- nied by some degree of corrugation, the appearance being precisely similar to that observed in collapse; it was generally attended with vertigo, which is not an unfrequent symptom in Cholera. These symp- toms would last some minutes. I observed similar phenomena in other persons, only in less degree. The duration of the choleric stage may be only a few hours, or it may be several days. It is in this stage, that the disease has by all physicians been found most amenable to treatment, but owing to the salu- tary effect attributed to evacuations; under all pos- sible circumstances, by the ignorant, this period is frequently altogether neglected, and the disease al- lowed to become fully developed before active means for relief are resorted to. In the fully developed stage, the evacuations be- come large and colorless, or whitish and contain albu- minous particles; they resemble water in which rice has been boiled, with particles of rice floating or set- tling in it. The patient ejects matters from the stomach of a similar character to those dejected. The matters vomited are ejected suddenly, generally with- out retching or nausea, and are frequently expelled with such force as to carry them to the distance of several yards. The evacuations frequently amount in quantity to several gallons, though the quantity does not have any relation to the severity of the attack. 232 APPENDIX. I remember one case, which I saw in 1849, in which the patient was in collapse in three hours after the first symptoms were observed, and in which the pa- tient died in about seven hours; the whole of the matters expelled from the stomach and bowels not exceeding three pints, and of a light brown color. Spasms of the voluntary muscles occur in this stage, which affect the abdominal muscles, the calves of the legs, the thighs, and frequently the muscles of the upper extremities and chest. Occasionally all the voluntary muscles will be affected. The pulse during this stage is generally less frequent than in health; it is not unusual to find it no more than 50 or 60 beats in a minute. The pulse does not vary much. from its natural fulness until the disease is considera- bly advanced. The symptoms of this period may continue from one to twelve hours. When the disease is about to terminate favorably, the spasms disappear, the vomiting ceases, the dejections become tinged with bile, and perhaps acquire some consistence, or they stop entirely; in which event the patient may have no evacuations during the period of convales- cence, which may be twenty-four or forty-eight hours. In some instances, the patients may have copious evacuations from the alimentary canal, without spasms; these are called the Diarrhæic cases. We have also the Gastric variety, when vomiting is the prominent symptom; also the Spasmodic cases, in which there may be no evacuations of any kind-only cramps. These designations are recognized by some authors, AN ESSAY ON EPIDEMIC CHOLERA. 233 and are convenient in description; all agreeing in one particular, in their tendency to collapse, if not soon relieved by appropriate medical treatment. There is a class of cases which have been included in the designation Cholera sicca-dry Cholera: these are the instances in which we have the symptoms of col- lapse, without its having been preceded by any eva- cuation or other precursory symptom. Collapse signifies an almost total suspension of the powers of organic life, not necessarily attended with loss of consciousness or impairment of the mental powers. It is the opposite condition to coma, in which all the functions of organic life are carried on, while the functions of animal life are totally sus- pended; we have a total suspension of the functions of the two principal secretory organs of the animal system, viz: the liver and the kidneys, two of the characteristic symptoms being an entire absence of bile in the evacuations, and a total suppression of urine, so that the patient will not pass the smallest quantity during the period of collapse. The other secretions are diminished, if not altogether suspend- ed; thus though there may be the greatest suffering from spasms of the voluntary muscles, or from a sen- sation of internal heat, and from an insatiable thirst, the patient will not shed tears. There is an appa- rent exception to the absence of secretions, in the discharges from the alimentary canal; but even this is suspended in extreme collapse. The functions of respiration and circulation, though not entirely sus- 231 APPENDIX. pended, are nevertheless carried on in an extremely imperfect manner; the principal objects of these func- tions, viz: the oxygenation of the blood and the main- tenance of a uniform temperature, being but par- tially accomplished; as is shown by the blue color of the surface, by the coldness of air expired from the lungs, and by the general coldness of the body. We must, however, consider that the mechanical portion of these functions is carried on more perfectly than the vital or chemical. These functions are not whol- ly subservient to the direction of the forces of orga- nic life, but the function of respiration at least, is to a considerable extent under the direction of the will. While the functions of organic life are affected in so remarkable a degree, we have those of animal life re- maining almost entire. The sentient faculties remain in many cases almost until respiration ceases; the patient can feel, see, hear,- smell or taste, nearly to the last. The voice, being a function connected with respiration, is weak and sometimes scarcely audible. partly in consequence I presume of the diminished quantity of air taken into and expired from the lungs. The muscular system remains in great measure unim- paired, the patient being capable of performing many acts of voluntary motion. In complete .collapse, as seen in some cases of Asiatic Cholera, the features are pinched and the eyes appear sunken; the skin is of a bluish color, the whole surface being covered with a cold clammy sweat, imparting a sensation of icey coldness to the 7 3 AN ESSAY ON EPIDEMIC CHOLERA. 235 touch, the hands are corrugated, appearing as though they had been soaked in water for some time; hence this appearance has been called the "washerwoman's hands:" the voice is peculiar, so that it has been known as the "Vox Cholerica ;" it becomes husky and faint; the breath is cold. The pulse is general- ly frequent, small and quick, sometimes intermittent and irregular. In many cases the pulse remains imperceptible for several hours, in other instances where it is not totally imperceptible, the sensation which it imparts to the touch may be compared to that which would be produced if the finger were placed upon one point of an exceedingly fine wire, tightly drawn between two fixed points, while some- thing were drawn quickly across another point of the wire, producing minute vibrations. This I think illustrates the pulse of collapse, as nearly as possi- ble. The evacuations from the stomach and bowels be- come less and less frequent, as the symptoms of this stage appear, and in most cases cease entirely a few hours before death, in which in a majority of cases, collapse terminates. The spasms frequently continue after collapse has appeared, though they very generally cease a short time previous to death. The secretion of urine, which becomes diminished in the stage of full development, is entirely suppressed in collapse, and in post-mortem examinations the bladder is uni- formly found empty. In this stage an insatiable thirst in many cases torments the patients, they 7 236 APPENDIX. taking drink frequently, but in small quantities; and while the external surface is cold to the touch, the patient complains of an internal burning. Among the characteristic symptoms of Cholera, is to be enu- merated the stoical indifference which the patient manifests in regard to the final result of the disease. This apathy exists during the first stage, and increa- ses with the progress of the malady. The period of collapse lasts from two to twelve hours, and it may terminate in death, or be succeeded by reaction. Among the symptoms from which we may infer that reaction is about being established there are a return of the natural warmth to the surface, and the pulse reappearing and becoming full and regular. A very important symptom is the re- turn of the secretion of urine. The breath, which before was cold, becomes warm, and in fact all the symptoms which constitute collapse disappear. It frequently happens that reaction does not stop until some degree of febrile action is set up; and here again we have another period of danger, arising from excessive reaction. In this period, the patient may have inflammation or congestion of any of the important organs of life, or again, it may be followed by continued fever. The most frequent inflammations are dysentery and inflammation of the brain. • In the foregoing description of Cholera, I have spoken of it as though it consisted of three clearly defined stages or periods: in a number of cases we find the disease running its course with as much AN ESSAY ON EP.DEMIC CHOLERA 237 عطى regularity as the previous description would imply, but in a larger proportion of the cases which occur, this is not true, the symptoms described as belonging to the several periods being combined in every va- riety. Thus it can be said that no two cases are precisely similar. The results of post-mortem examinations have thrown little light upon the nature of this disease; as but few of the lesions observed. were constant. The only appearances which were constantly observed in autopsies of Cholera patients, were more or less of the rice-water and ricey matters in the alimentary canal, similar in appearance to that which had pre- viously been ejected, and a thick black substance re- sembling in appearance tar, filling the veins, and the - bladder was uniformly found empty and contracted. Spasmodic movements of the limbs have been ob- served to take place after respiration had ceased. Instances of this kind are probably of not very fre- quent occurrence, as very little mention is made of them in works upon Cholera. My own attention was drawn to the fact by the following case which occurred in New-York on the 29th of May, 1849, about fifteen days after the first appearance of the epidemic in the city. The patient was the wife of a respectable me- chanic, and was of perfectly temperate habits; age 40 years. She was attacked about ten, P. M., May 28th, having previously partaken of radishes for her · supper that evening, which seemed to have been the occasional cause of her sickness. Symptoms: rice- 11* 238 APPENDIX. water evacuations per anum; vomiting of a serous and slightly milky liquid, with pieces of radish, cramps in extremities, chiefly in calves and thighs. Tongue cold; urine suppressed; eyes upturned and fixed a part of the time; tongue covered with whitish coat, which afterwards became yellowish. The pulse was feeble, and became insensible two hours before death. Breath cold; feet, face and hands cold and moist, except palms, which retain some heat. Epi- gastrium swollen, painful and sensitive. Died about eleven and a half, A. M., 29th inst. After respira- tion had ceased half an hour, spasmodic movements occurred in her right arm; her fore-arm became flexed upon her arm; flexion of the fingers also took place. These motions were repeated a number of times, leading the friends to suppose that life was not extinct, and causing them to send for medical as- sistance. Another curious phenomenon, is the return of warmth to the surface, and its continuance for a considerable time after respiration has ceased. The temperature of the corpse, which previously to death was externally cold, becomes, in many cases after respiration has ceased, so warm as to impart to the touch a sensation of heat. • APPENDIX II. HOMEOPATHIC CHOLERA HOSPITAL. As the Cholera has now reappeared in New-York and many other places, the republication of certain remarks, made on the above subject in 1849, is deemed seasonable and proper. As a majority of the medical profession retain the same prejudices, the friends of humanity and justice, here and elsewhere, will be again liable to encounter similar obstacles, in carrying out their plans for the relief of the poor, who are especi- ally liable to become victims of this pestilence. The great success of the homoeopathic treatment in the cholera of 1849, by attenuated medicines, is now extensively known. When the epidemic had disappeared, the Board of Health of the city of New- York, through its Sanatary Committee, made a Re- port in which reasons were assigned for refusing to establish a homoeopathic cholera hospital, for which a petition had been presented by hundreds of our re- spectable citizens. Some of the reasons were assigned by the Sanatary Committee, others by their Medical Counsel, com- posed of several physicians of high rank. The parts 240 APPENDIX. referred to in the letter, are quoted in the words of the authors. It will be seen that (to use the language of a dis- tinguished writer) "though the Board, even while thus deciding, profess not to be competent to decide, they seem to consider themselves competent to sneer." The Medical Counsel, in their report to the Sana- tary Committee, say, that "By intelligent and well-educated physicians ge- nerally, Homœopathy is looked upon as a species of empiricism. It is neither practised by them, nor countenanced by them. Concurring entirely with their professional brethren on this subject, the under- signed conceive that the public authorities of our city would not consult either their own dignity or the public good, by lending the sanction of their name or influence to Homoeopathy or any other irregular mode of practice." The Committee say, that "In adopting this report, the Sanatary Committee do not wish to be considered as expressing any opinion. either in favor or against what is commonly denomi- nated Homœopathy. This they viewed as a subject entirely beyond their province." After some other remarks, they end by saying, Taking this view of the subject, the committee felt it to be their duty to have nothing to do with medicine, except as they found it embodied in what is understood and known both by the public, as well as physicians, as the regular profession. While in 66 HOMEOPATHIC CHOLERA HOSPITAL. 241 this way they paid all suitable respect to so honor- able a profession as that of medicine, the committee felt that they did no injustice to those who suppose themselves in advance of the age, and profess them- selves gifted with superior knowledge and wisdom." LETTER To the Sanatary Committee of the Board of Health of the City of New-York: Gentlemen:—In the report of your proceedings recently published, you assign reasons for not es- tablishing a Homoeopathic Cholera Hospital. Not- withstanding the equivocal compliment which you bestow on the homoeopathists, as "those who sup- pose themselves in advance of the age, and profess themselves gifted with superior knowledge and wis- dom," I shall assume that you intended " no injus- tice" toward either of the two great medical parties into which the community, as well as the regular pro- fession, is divided. The regular medical profession includes all those who have pursued the course of medical studies pre- scribed by the laws of the State, and complied with all the professional requirements of the medical col- leges and medical societies which the State has esta- blished. The diplomas held by the homœopathic physicians of New-York, afford proof that they have passed these ordeals. 242 APPENDIX. As such are the only tests of professional re- gularity recognised under this or any civilized go- vernment, I cannot presume that you "suppose" yourselves so far "in advance of the age, and pro- fess" yourselves "gifted with" such "superior know- ledge and wisdom" as to impose, intentionally, a new test not recognised by those laws from which you derive all your authority. How is it, then, that you refused to place one of the cholera hospitals under the care of regular homoeopathic physicians, on the ground that "the committee felt it to be their duty to have nothing to do with medicine, except as they found it embodied in what is understood and known, both by the public as well as physicians, as the re- gular profession ?" Is it possible that you were de- ceived by a mere name, which some physicians have assumed for themselves, and persuaded their friends to appropriate to them? Regularity, in its proper sense, is an excellent thing: so are catholicism and democracy: but I doubt whether you have all re- solved to have nothing to do with religion, except as you find it embodied in the Catholic church, or with politics, except as you find it embodied in the demo- cratic party. You must mean, either that the homoeopathic phy- sicians constitute no part of the regular profession, or else that they constitute only a minority. The first position I have shown to be untenable. In con- sidering the second, I assume that minorities have rights, on which no agents of government can properly HOMEOPATHIC CHOLERA HOSPITAL. 243 trample. During a pestilence, the homoeopathic citi- zens of New-York can justly claim, that a due pro- portion of what they have contributed to the funds of the city, be appropriated to the use of a homoeo- pathic hospital. They have a right to dictate what provision shall be made for the treatment of the in- digent and stranger of their own medical faith, so far as this can be conceded without infringing the rights of others. In regard to this last point, you were not requested to refrain from establishing as many allœo- pathic hospitals as you deemed expedient, nor to compel any patient to enter the homoeopathic. The statement of the main objection which your. medical counsel urged against Homoeopathy may be ambiguous; but it is susceptible of only two con- structions one is that "it is neither practised" "nor, countenanced by” a majority of “intelligent and well- educated physicians." This proves no more than the equally notorious fact, that it is neither practised nor countenanced by the majority of stupid and unedu- cated physicians. Alloeopathy has more great men and more small ones; for the same reason that white sheep have more wool than black ones. The only other meaning of which the statement of the "counsel" is susceptible, is, that Homoeopathy "is neither practised" "nor countenanced by", any intelligent and well-educated physicians. Is this the assertion of the medical counsel, a majority (i. e. two) of whose members are medical professors, who are annually recommending homoeopathic medical 244 APPENDIX. P students as qualified to receive the degree of doctor of medicine? From these and similar alloeopathic professors, the homœopathic physicians now practis- ing have received their credentials. When a pro- fessor affirms that his own certificate is false, to which of his statements shall we give credence? The case reminds us of the problem which exercised the sophists. When a man says, I lie, does he lie or does he speak the truth? Neither the committee nor their counsel have at- tempted to refute the statistics by which the petition was sustained, nor to deny that Homoeopathy af- fords the best method of curing the sick, however much the "public authorities" might, by rejecting it, "consult their own dignity," and thus, indirectly, "the public good." Of their objections, I am not able to perceive any which are not substantially in- cluded in those which I have answered. If there is an appearance of mystification or muddiness in the whole train of their reasoning, I have too much re- spect for them to attribute it to anything else than the unavoidable difficulties attending the defence of a weak cause. M B. F. JOSLIN, M. D. NEW-YORK, Nov. 17, 1849. INDEX. Acute cholera, cases of... * its symptoms and treatment Etiology, especially with reference to the predisposing or occa- sional causes of cholera.. A. Ages, relative liability to an attack at different. mortality at different. Alcohol, predisposes to cholera. Animal food, during the epidemic. Ancient and modern epidemic cholera identical. Appendix I... II. Atmospheric heat, a cause of cholera..... Attenuated Camphor useful.... Auxiliary cholera repertory. • Board of Health in 1849.... 30 223 226 38 40 216 215 239 32 107, 124, 148, 157, 160, 180 199 B. 1 • • Page 170· 120 Bathing, its uses and abuses. 36 35 Becoming chilled by cold air, or bathing. Blood in asphyxia, original observations and experiments on, 24, 28 its color and composition in cholera Blueness of the skin, in choleroid.... 18 141, 180 remedies for, in cholera.. 195 78, 240 246 INDEX. Camphor, effects of high potencies of.. how to be used for children. rules for its administration. size and repetition of the dose of.. Case of acute choleroid in 1854, with its treatment. dry cholera, with its treatment.. Cases in New-York in 1854. febrile cholera, with its treatment. gastro-enteric cholera, with its treatment. A vi · of cholera recapitulated. Me p C. Characteristic of cholera... Cholera infantum, remedies for. sių moki · qa of acute cholera, with their treatment. of choleroid disease, with their treatment. of diarrhoeic cholera, with their treatment. of dysenteric cholera, with their treatment of gastric cholera, with their treatment of spasmodic cholera, with their treatment. Causes of cholera • in 1832, history of treatment of. 1849, cases and their treatment. history of treatment of... 1854, cases and their treatment. in Honduras.. • • · • • · · • • • Composition and consistence of the fæces. Contagion and poison quantitatively considered. • • • .:. • · •• Cholerine .. Choleroid, cases of.. Choleroid, what it is.. Circular issued by homeopathic physicians. Cleanliness, neglect of.. Cold bathing, reason why under some circumstances, it is a pre- disposing cause. Collapse, its treatment. • • · • · • Page 107 125 103 103 180 169 179 176 153 170 138 144 176 160 162 30 49 13 212 70 144 76 153 97 100 188 137 87 45 35 130 207 51, 55 INDEX. 247 Contagion of cholera... Contagiousness of cholera, how destroyed by dilution. Contents, table of..... Cramps in Cholera, how treated.. Crowded or insufficiently ventilated rooms. D. Dark color of the blood in cholera.. Depressing passions, how they render the system more liable to cholera. Diarrhoeic cholera, symptoms and treatment. Dilution, its influence on infection.. • Doses of medicine, repetition of. Dry cholera, how distinguished.. how treated... Dysenteric cholera, its symptoms.. its treatment. Early history of cholera. Dysentery, remedies for..... Domestic and professional treatment of cholera at its onset in any form.... • E. Page ..50, 220 53 3 102 and professional treatment of premonitory symptoms.. 100 Dose of cholera, is one of the elements in the problem of its in- fectiousness Etiology of cholera... Exercise, when violent, is a predisposing cause. Explanation of the auxiliary cholera repertory. of the cholera repertory. ·· . 118 44 • • 18 .. 215 treatment of cholera.. 100 135 13, 215 Epidemic and sporadic, remarks on the terms. cholera and cholera morbus, not identical. Errors that prevail in regard to contagion.. Essential cause of cholera, imperceptible except by its effects.. 30 its effects before and after an epidemic 31 50 30 38 199 181 38 113 53 213 55 103, 110 119 120 123 125 248 INDEX. F. Fatigue, a predisposing cause of cholera Fasting during the epidemic... Febrile cholera, its symptoms. its treatment. Food, the kinds of, forbidden.. Forms in which cholera appears. G. Gastric cholera, its symptoms and treatment. Gastro-enteric cholera, its symptoms. its treatment. General average of the results of homeopathic treatment in cholera.... Hygiene..... Hygienic rules. • • • H. Head symptoms in cholera, remedies for... Health, how to preserve. Heat, effect of..... High potencies of camphor, effects of. temperature, effects of. 94 30 Generalization of the causes of cholera.... Groups of diarrhoeic symptoms in cholera, with their remedies.. 190 of symptoms in diarrhoea with their remedies.... 210 • • • • • Indigestion, a cause of cholera.. Infection, the true doctrine of. • · History of homeopathic and allopathic treatment of cholera... Homœopathy in cholera, proofs of its relative success. Honduras, cholera in. Hospital, homoeopathic for cholera patients.. • Page 38 38 126 126 61, 63 109 • I. Indefiniteness of the usual statement of the problem of the infectiousness of cholera ·· 116 122 123 184 61 32 107 32 67 67 97 84, 240 61 62 52 43 50 INDEX. 249 Influence of degrees of dilution of the poison.. Intestinal symptoms in cholera, repertory for... Law of cure... M. Management of a cholera patient, rules for the... Mental symptoms, in cholera, remedies for.. N. 189 with or without cholera, repertory for..... 206 L. Nature of cholera... Neglect of personal cleanliness... Night, one reason why it is a predisposing cause. 0. Occasional causes of cholera. Oppression of the digestive organs. Over-eating an occasional cause. P. Passions, predispose to cholera.. Pathology of cholera...... • Per centage of deaths in New-York, remarks on. < of deaths under homoeopathy and allopathy in 1832 1849 Prevention of cholera, by what medicines.. by what regimen.... Preventive medicines, what, and how to be used. Progress of cholera epidemics. Proportion of, of cases, cured in 1832. 1849 38 18 83 70 76 16. Physiology of respiration... 55 Poisons are such by dose, not in essence. Popular and medical errors in regard to infection or contagion. 50 Powders, plain directions as to the best mode of taking them.. 102 Predisposing causes of cholera.. 32 ► D • Page 53 life. . 109 108 183 13 45 37 32 43 43 65 258 2 62 65 60 70 76 250 INDEX. Quarantine, the effect of... Remedies for cholera infantum. Remedies for cholera with affections of the abdomen.. chest. eyes face. head 1 | Remedies for cholera with cramps Q. R. | for dysentery.. stomach pains • • thirst and nausea diarrhoea.... limbs.. mind. pulse.. skin nausea and thirst pains in the stomach perspiration.. • tongue urine. voice spasms. vomiting. : .. • Remedies for diarrhoea from certain causes. with or without cholera. • D • • • · • • other symptoms stools of certain colors.. stools of certain odor. • company it... for vomiting, with or without cholera • • 212 189 193 184 185 184 194 .. 183 197 195 186 192 • • • vomiting according to its causes character to the symptoms which ac- • 193 194, 198 187 190 187 188 197 .194, 198 187 208 206 210 206 207 213 204 202 200 U • Page 60 203 200 C INDEX. 251 * Results of homeopathic treatment, summary of... Rooms for cholera patients, how to select and use. Repertories, explanation of the mode of using. Repertory for cholera especially . 181 for vomiting and diarrhea, with or without cholera.. 199 Repetition of doses... 103, 110 16 Respiration, physiology of applied to the pathology of cholera 18 94 54 Rules for the preservation of health during the epidemic...... 62 Stages of cholera Statistics of cholera, homeopathic and allopathic. Spasmodic cholera, how treated. ages Table of contents • Treatment, during collapse . S. I │ D during convalescence from cholera.. of acute cholera... of diarrhoeic cholera. of dry cholera. of febrile cholera. • • • Susceptibility, cæteris paribus, determines whether the disease 58 shall be taken Symptoms and treatment of the usual varieties of cholera..... 113 of affections succeeding reaction from cholera. of cholera by families at its commencement in the forming or choleroid stage when fully developed.... when it begins to be developed. with dysentery .. with vomiting and purging.. T. Tables illustrating the relative mortality at different ages..... 227 number of attacks at different • • • • Page 181 · 23 128 67 118 · 224 3 130 134 121 131 102 100 102, 129 102 125 123, 187, 190 115, 190 120 .: 126 252 INDEX. Treatment of gastric cholera ... of premonitory symptoms of spasmodic cholera. of the different varieties of cholera of vomiting in cholera • • V. Varieties of cholera, their symptoms and treatment Ventilation, the want of, operates in two ways Vomiting and purging in cholera, how treated. in cholera, how treated... ·· • F Page .117, 187 100 118, 194, 198 113 [17, 187 113 44 123, 187, 190 117 187 200 remedies for the different kinds of, in cholera. in general .. • Filmed by Preservation 1999 UNIVERSITY OF MICHIGAN JAVA 3 9015 03979 0582 M D T J