Pg. 340

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November 2, 2020

¶ 1 Leave a comment on paragraph 1 0 340

¶ 2 Leave a comment on paragraph 2 0 CASES OF CHOLERA, BY F. A. BULLEY, ESQ.

¶ 3 Leave a comment on paragraph 3 1 and night previous to the attack of pain, having gone to the closet fifteen or sixteen times during that period; but it had somewhat suddenly stopped in the morning, which induced him to believe that the increased pain and spasms were occasioned by its abrupt cessation. His pulse was feeble, almost imperceptible at the wrists, and his feet, and legs and hands, were intensely cold to the touch; tongue covered with a white dry fur, and he complains greatly of thirst. Being placed upon a bed, large thick pads of porous house flannel, composed of four layers each, wrung out of water as hot as he could bear, were laid over the stomach and lower part of the abdomen, and the body was immediately wrapped up in a coarse sheet, and blankets to the number of fourteen or fifteen were afterwards put upon the bed, and securely tucked round the patient’s body, to preserve the heat and the perspiration which it was expected would ensue from the process. Great difficulty was experienced in keeping him under the wrappings, as the general spasm had now so much increased as to resemble, more than anything else, an attack of tetanus, and it required the efforts of two men to keep the mass of bed-clothes upon his body. He was ordered to take the following draught every hour :—

¶ 4 Leave a comment on paragraph 4 0 Rx Nepenthes (an anodyne tincture of opium prepared by Messrs. Ferris and Score, Bristol) Mx., olei caryophyll. mij., confect. aromat. 3ss., ol. menth. virid. mj., tinct. capsici mx., aquae menth. pip. ad. 3iss., which seemed to afford a slight relief to the spasm.

¶ 5 Leave a comment on paragraph 5 1 9 p.m.-—I found that, very shortly after the application of the hot-water packing, the natural heat of the body had gradually returned, and, subsequently, a profuse diaphoresis had ensued, in which he had been kept for two hours and a-half; the spasms and the pain had now almost entirely ceased, and he was lying comfortably in a uniform gentle perspiration under the ordinary quantity of bed-clothes, the hot packing having been carefully removed, about three hours after its application, in consequence of faintness, for which he took a little warm brandy and water, which almost immediately revived him.

¶ 6 Leave a comment on paragraph 6 0 Tuesday, next day, 8 o’clock, a m.—At half-past three o’clock this morning, as I was informed by the nurse, the spasms and the pain had entirely left him, and he afterwards had about two hours comfortable sleep. I now found him quite free from pain, his skin uniformly moist and warm, complaining only of a weakness and giddiness in his head, and some soreness of the abdomen and extremities, from the previous violence of the spasm.

¶ 7 Leave a comment on paragraph 7 0 Rx Potassae chloratis gr. x., sodae carb. gr. xx., aquae menthae pip. ad 3iss. Ft. haust tertia quaque hora sumend.

¶ 8 Leave a comment on paragraph 8 1 11 a.m.—Shortly after the period of the last report he had a slight relapse, being somewhat suddenly seized with a feeling of general coldness and trembling of the limbs, and a sinking sensation, as he described it, all over him. The extremities beginning to feel cold to the touch, he was again packed up in the same manner as before, but with much fewer wrappings, and, in the course of half an hour, his body had recovered its natural warmth. A dose of the carminative mixture was administered just previous to the packing.

¶ 9 Leave a comment on paragraph 9 0 Wednesday morning, 10 a.m.—He has had no return either of the coldness or spasm. He has passed a comfortable night, and has had several healthy, slightly relaxed bilious motions. There has been no reactive fever. The pulse is steady and moderately full. His countenance has lost the anxious and pinched appearance it had at first. He has taken considerable quantities of strong, cold beef-tea, with a natural appetite, and he is now evidently convalescent. To continue the saline mixture every five hours.

¶ 10 Leave a comment on paragraph 10 0 Friday (five days from the date of the seizure).—He is now quite recovered from the attack, suffering only from a little weakness.

¶ 11 Leave a comment on paragraph 11 0 Case 2.—Incessant vomiting and purging of rice-water fluid; Spasms of the abdomen; loss of temperature; partial collapse; treated by hot-water applications; recovery.

¶ 12 Leave a comment on paragraph 12 0  John Ely, aged 25, a recruit for the 23rd Regiment of Foot, was brought to my house in the afternoon of Wednesday, Sept. 6, on account of a most severe pinching pain in the stomach and bowels, which had suddenly seized him while travelling in the railway from Oxford to this town. The pain was so excruciating, and the spasm so constant and severe, as to prevent his raising himself upright while it lasted. The abdominal muscles appeared to be drawn up into hard lumps by the spasm, causing the most intolerable pain. He was constantly bringing up Quantities of light-coloured fluid, like gruel, from the stomach, which was ejected with great spasmodic force, quite in a different manner from what is observed in ordinary vomiting. He had

¶ 13 Leave a comment on paragraph 13 0 been suffering from diarrhoea for several days, which for the last few days had lost its usual faecal character, and now what passed from the intestines could scarcely be distinguished from what was incessantly passing upwards from the stomach. I understood that he had been indulging in incessant beer-drinking for several days prior to the premonitory diarrhoea, and he had also been much depressed in spirits in consequence of having enlisted while under the influence of liquor. His feet and legs, as far as the groins, were icy cold to the touch, as well as his hands, and forearm. His pulse was scarcely perceptible at the wrist; his tongue white and dry, with distressing thirst, and his countenance had a peculiar pinched and haggard appearance. He threw up everything which he took into his stomach immediately.

¶ 14 Leave a comment on paragraph 14 0 Being removed to his billet in the town, I found that, even in the short time that had been occupied in removing him, his symptoms had become more urgent, and he appeared to be rapidly approaching a state of collapse, his lips and the ends of his fingers having now assumed a blue, livid appearance. Seeing that no time was to be lost in endeavouring to restore the fastfailing circulation, thick flannel pads, wrung out of hot water, Were placed upon the chest and abdomen as he lay in bed, and his body, being closely enveloped in a coarse sheet, was wrapped up in a considerable number of blankets and horse-rugs, in the same manner as in the former case, a hot-water bottle haying been previously applied to the feet, and a glass of warm brandy and water was given him, which was, however, immediately rejected. To take the same carminative draught as was prescribed in the last case every hour.

¶ 15 Leave a comment on paragraph 15 0 Visiting him about two hours and a half after the application of the packing, I found he had been in a profuse perspiration, in which he had been allowed to remain undisturbed about an hour, when the wrappings were carefully removed. He was now gently perspiring under the ordinary quantity of bed-clothes. The pain in the abdomen and cramps had completely left him, his body and extremities were uniformly warm, and the pulse had recovered -its natural strength. He expressed himself as grateful for the benefit derived from the applications. He had had about half an hour’s comfortable sleep after the sweating.

¶ 16 Leave a comment on paragraph 16 0 11 p.m.—He is quite free from pain and spasm; still gently perspiring; the sickness and purging have continued, although at longer intervals, but, to use the man’s own words, it is a more natural sickness,—more like ordinary vomiting preceded by nausea, as if the stomach had acquired a habit of vomiting in consequence of the continued irritability to which it had been subject during the acute stage of the disorder. Thinking this might in time subside, and that medicines might only increase this condition, he was ordered to take only cold water whenever his thirst might seem to require it.

¶ 17 Leave a comment on paragraph 17 0 Thursday, 10 a.m.—He has passed a tolerably comfortable night, but occasionally troubled with vomiting. To take—

¶ 18 Leave a comment on paragraph 18 0 Rx Acidi sulph. dil. )i., syrupi papav. 3ij., aquae ad. 3iss. M. ft. haust 4ta quaque hora sumend.

¶ 19 Leave a comment on paragraph 19 1 5 p.m.—The vomiting and purging has diminished, but the motions have now entirely lost their choleraic character, being tinged of a light-brown bilious colour. They are expelled by the natural efforts of the patient, and not spasmodically and with force, as was the case in the earlier period of the disease. It is probable that the continuance of the diarrhoea in this and similar cases may likewise depend upon a habit of irritability, induced by the previous congestion of the mucous surfaces of the alimentary canal, and would subside without any particular means being taken to prevent it, tending, perhaps, to the elimination of the last remaining portions of the poison from the system.

¶ 20 Leave a comment on paragraph 20 0 Friday, 10 a.m.—He has passed a tolerably comfortable night, the sickness and purging having been gradually subsiding up to five o’clock this evening, since which time they have both entirely ceased. He has taken some tea, with some toast and an egg, this morning, all of which have been retained on the stomach. There has been an entire absence of secondary fever.

¶ 21 Leave a comment on paragraph 21 0 Rx Sodae carb. gr. vi., potass. chlorat. gr. x., aquae menthae virid ad 3iss., 5ta quaque hora sumend.

¶ 22 Leave a comment on paragraph 22 0 5 p.m.—He has taken considerable quantities of strong beeftea during the day without inconvenience. He is quite free from pain, but complains of being very weak and sore in the abdomen. From this period he gradually improved in strength; and on the Monday following, six days from the date of the attack, he was so far recovered as to be able proceed to Winchester to join his regiment.

¶ 23 Leave a comment on paragraph 23 0 Remarks.—The foregoing cases may be considered interesting at the present period, as illustrating a particular mode of treatment, which, as far as I can learn, has not been brought to bear