24 DECEMBER 1831, Page 18


DR. COPLAND has published a little compact work on Pestilential Cholera, which may be called the Choleric Ency-clopmdia. It is a history of the origin of the disorder, its nature, progress, treat- ment, prevention ; and is exceedingly well condensed and ar- ranged. The author appears to be a sensible man; and he writes clearly, concisely, and forcibly. In theory he is an infectionist ; he thinks the disorder is propagated by a pestilential miasma' and communicated by an effluvium arising arisincr from patients who have been struck by the poiSenous vapour. The marrow of the work, and what may be considered as the results arrived at in respect to treatment, will be found in our extracts. We shall extract the prescriptions, because we know they will interest our medical friends and as they are in Latin, and moreover only applicable at particular crises, of which none can judge but a medical observer, their publication will not defraud the profession of its fees,—a cir- cumstance not indifferent, we presume, to most practitioners, although Dr. COPLAND has been as liberal of recipes as if he were giving up practice. Dr. GRANVILLE knows better : take, for instance, the invaluable lotion, which he has been "fortunate enough to discover," but of which he takes care to tell us no more than that it consists of three ingredients, and will raise a blister in five minutes,—a property inappreciable in cholera; so that the physician, when the disease arrives, will be as indispensable as his embrocation. The Granville Lotion will doubtless become as famous as Thieves' Vinegar; the more especially as he has thrown such discredit upon the ordinary stimulants, 'and other -medicaments which good men like Dr. COPLAND go on prescribing and compounding, just as if the "fortunate discovery" had never been made.

We think exceedingly well on the whole of Dr. COPLAND'S work; but, for our parts, we consider the fact of an experience of the dis' order for a number of years, a very important element in the cluableation of a medical man who would prescribe for this ter- uuble malady. Pr. COPLAND has only had actual experience of analogous maladies ; anti, according to him, there is none which nearly approaches it. He separates it entirely from the com- mon Cholera, and even proposes a new name, that of Cholera being utterly inapplicable : he would call it Asphyxia Pestilenta, from its instant seizure upon the respiratory organs. It is not, however, mere experience of a disorder which enables a man to form an en : lightened opinion fifty imbeciles may have attended a disorder for years, without success; and one man of genius, after consider ing the reports of these very individuals, may draw conclusions of the utmost importance and value. But they have not merely been men of moderate talent who have observed this malady in India and elsewhere. Among the multitude of pamphlets and books on the subject, written by our countrymen whose practice has lain abroad, there are many whose works have struck us as ingenious, sensible, and in some instances of admirable judgment and clear- sightedness. For example, the thin publication of Dr. YOUNG, long time on the Bengal Medical Establishment. When we read his work, and after having maturely considered: its masterly mode of viewing and treating the subject, we began to consider, in case of attack, how far our abode was distant from Devonshire Street, Portland Place,—where it appears he resides : for in cases of cho- leric attack, the remedy must be one of instant application. We propose, with his permission, to establish a telegraph between No. 9, Wellington Street, and 19, Devonshire Street. When the arms of this machine are at work, the public will kindly sympa- thize in our pains, and hasten, if they can, the arrival of Dr.


But now to the Choleric Encyclopmclia of Dr. COPLAND.


(159.) The removal of congestion and the equalization of the circulation will he promoted, and the good effects of blood-letting increased, by the contempora- neous application of dry warmth to the surface of the body, and by frictions. Dry warmth may be readily applied by placing the patient instantly in bed, and elevating the bed-clothes around him by two or three common hoops, or pieces of whalebone, and then introducing one end of a wide tube, at the other extre- mity of which the flame of a spirit-lamp, or even of a common lamp or candle, should be made to pass ; or bags of hot salt, or hot bran, or oats, may be placed around him.

(160.) The above intention will be greatly promoted by employing assidu- ously, at the same time that external heat is being applied, frictions of the abdo- men, chest, and thighs, with a liniment composed of two ounces each of liquid ammonia, of olive oil, and of spirits of camphor, with three ounces of spirits of turpentine, and a few drachms (from three to six) of hard soap and Cayenne pepper, to which one or two drachms of eajeput and lemon oils may be added.

(161.) These means may be assisted by the administration of tether, camphor, ammonia, calomel, opium, aromatic spirits, and volatile essential oils, in such forms of combination as the circumstances of particular cases may point out. The subjoined formulm may be taken as examples,* and be employed alone, or to wash down from fifteen to twenty grains of calomel, given either as a simple powder, or in pills. If the vomiting and purging be extremely urgent, and par- ticularly after full vomiting has been produced, or when it proceeds beyond what is sufficient to remove internal congestion, and restore the balance of the circula- tion, and yet is incapable of accomplishing it,—if the vomiting exhaust the vital energies instead of bringing about reaction,—the above medicines should be ex- hibited in the least bulky manner, or in that which may best secure their reten- tion, and be combined accordingly4 If they are rejected, they should be re- peated notwithstanding, when they will generally be ultimately retained. They may afterwards be repeated at intervals, varying with the circumstances of the case. * R. Apse menthm pip. 3j. ammon. mot. 3ij.

ammon. arom.

— ether. sulph. co.

— larand. co. aa.. 3ss.

Tiuct. opii. ttpx. M.

Fiat haustus statim sumendus et pro re nata repetendus.

R. Ides. caryophyi. 3jss.

Spirit. pimento

— rosmarini, s.5. 3ss.

Tint t. opii rm. Olei cajeputi mix. M.

Fiat haustus ut supra sumendus.

R. Aq. einuam. 3jss. Magnus. carbon. 3ss. Spirit. =mum aroma. 3ss, wther. acorn. 3j.

()lei rosmarini ntvij. M. Fiat haustus statim sumendus.

R. Hydrarg. submur. gr. xx. Pulv. opii gr. j. M.

Fiat pelvis, cum Must. aliquo super-prmserip. sumendus.

Hydrarg. subinur. gr. xv. miss. Pulv. °pi, gr. j.

---chanamorn. gr.

—lluOis mosch. gr. 1. M.

Fiat pulvis in vehiculo quovis crasso sumendus cum haustuum aliquo super-prmscript.

B. Camphorte rasw gr. iij. ad x. Hydrarg. submur. gr. xij. ad xx.

Opii purl. gr. ss. ad gr. jss.

Conserv. rosarum. q. s.

ut fiat bolus statim sumendus.

B. Ilydrarg. submur. gr. x. ad xx. Opii purl. gr. ss. ad gr. jss. Syrup. simp. q. s. Si.

Fiaut Oahe ij. vel. iij. quamprimun capiendus.

B. Opii purl, gr. ss.

Hydrarg. submur. gr. iij. ad 1. Magues. sub-carbon. gr. x.

Ole? cajeputi (vel menth. pip.) q. s. ut Sant pilulm iij. tertiis yet querns horis sumendm cum haustuum aliquo ante;


B. Camphone ram gr. MI. ad vit. Ammoniie sub-carb. gr. xij. Hydrarg. submur. gr. x. Opii purl. gr. j.

Conser. rosar. q; s.

Fiat bolus.

(162.) If the irritability of the stomaekcontinne, and if the attack be severe, then flannels wrung dry out of very hot water and immediately soaked in wara oil of turpentine, ought to be instantly applied, as warm. as possible, over the stomach and abdomen, and retained there, or renewed, until a decided effect is produced. This is the most powerful means I am acquainted with, And the most successful, in procuring reaction and restoring the heat of the body. (163.) The foregoing metres frequently accomplish the last of the intentions I of cure enumerated above ( 149), by flailing those which preceded it. But 1 we should never consider the patient to be placed in a fair way of recovery by bringing about reaction merely, unless the suppressed secretions be also restored. It should be kept in recollection, that an early effect of the exciting cause of the disease is to vitiate the -whole mass of blood, and that this morbid state can be removed only by supplying the loss of the serous parts of the blood exuded from the mucous surfaces, and byexciting and calling into active and healthy action the functions of the secreting organs, particularly those of the abdomen. In order to attain this end, large doses of calomel, followed by purgatives or aperients, are required.


(168.) In the stage of reaction attended by cerebral symptoms, particularly if the vessels of the coniunctiva be loaded, leeches should be applied to the posterior parts of the head and temples, purgativa medicines employed with the view of removing the congestion of, and the determination to, the bead, and of increasing all the abdominal secretions and excretions(and external derivatives resorted to, in order to relieve the internal viscera from the load which oppresses them. In this particular state of the disease, as well as in its early stage, active enemata are especially indicated. They should be repeated, without our being discou- raged by the circumstance of their not being retained. Our end will be obtained at last, -if we persevere in a judicious manner. I have frequently seen marked advantage derived, in analogous states of disease, from the subjoined formula...* * R. Assiefcetidre 3ij,

Camphors, rase gr. xii. tore mal Decoct. ;twine 3viii. dein adlie Oil torobinth. 35s ad 3j ss,

Nisce, et tiot enema. vet. R. Clot terobinth. -divan3jss. Campbora■ rasa.

Davi:Laverne M. Fiat enema.

Camphorm rasd cc. xii. Out juniperi Aug]. 3ss. vateriame 3x.

acuehe 3j. M. Fiat enema.

r(l69.) Derivatives ere of the utmost advantage in the state of reaction with dangerous cerebral ofketion. Belonging to this class of means, blister: and sinaPisms have been most commonly resorted to, the former applied between the shoulders, the latter over the epigas:trium, and insides of the thighs. M. Ranque has strongly recommended certain rubefacient and irritating applications to the abdomen, and M. de Boismont has approved of them. They are equally re- quired during the first stage, particularly when the vomiting and spasms are very urgent, awl during this period when the head is much affected. The sub- joined" will answer the above purpose in a more efficient manner than those re- commended by the French writers. The linen or leather on which they are spread should be so large as to cover the greater part of the abdomen.

$ 11. Emplast. aromat. (Ph. D.); yel, Empl. cumini, 3ijss. &Mph. sublimat. 3ss.

Olei macis gixxxv. M.

Fiat. emplastrmn, dein asperge cum pulvere sequeute :

R. Am imoini tart. jiss.

Camphorm pulvcriz. 3ss. Sulphur. sablim. 3ss. M. Et fiat epithema, vel emplastrum, super abdomen, impositutum.

(170.) Preferable to the above, in nw opinion, inasmuch as its action is more quick and decided in its operation than the above, is the warm turpentine fomen- tation to the abdomen, already recommended (§ 162). The liniment men- tioned above ( IGO), or the fewer of the two prescribed below, may likewise l.)e assiduously rubbed over the spine and lower extremities ;* the latter on the insides of the thighs only, its it is more apt to remove the cuticle than the for- mer. When the turpentine fomentation is not used to the abdomen, the liniment may be applied to tins situation.

* 11 IsMiment. saponis co.

campliorm co. aa 3jss. Oki terebiutinme 31j. Salamis

Fiat linimentum.

IL Compliant Solve in Tina. eanthariii. et Mitt. eapsiei, àä 3tij. Dein :able Liniment. sapan. co. 3ss. el gradatim, miseendo, Liquoris ammon. 3vj.

Oki elicit 3x.

isce lame et sit linimentnm.

(171.) When the stage of reaction is accompanied with gastro-enteric affec- tion, or with the additional complication of marked affection of the liver, or dis- turbance of its functions, or if it assume the nearly allied form of bilious fever, the external medicaments recommended above are also requisite. If the stomach and bowels are chiefly greeted, the application of leeches to the epigastrium will be necessary, previous to the employment of these, or of other external or inter- nal means ; and emollient injections should be occasionally thown up. Snail doses of opium' combined with camphor and the blue-pill, or the hydrarg. cum creta may also lie given from time to time. (172.) Very nearly the same treatment as now stated will be required when the symptoms indicate a congested or sub-iallammatory state of the liver. The application of leeches to the epigastrium and right hypochondrium, full doses of calomel given at lied-time, combined with small quantities of camphor, and an aperient draught the following morning, or a few hours afterwards, the use of warm diaphoretics " at short intervals, aperient and emollient injections,' and the external means recommended above ( 160,170), will generally, be requisite. will be found extremely serviceable. As the dysenteric form of the state of reaction is frequently either associated with, or dependent upon, a very acrid and otherwise morbid state of the secretions poured into the bowels and sometimes on affection of the liver, the occasional exhibition of a dose of calomel, with James's powder, and the use of aperients, will be indispensable, in addition to the other internal and external means of cure already particularized.

* R. Camphorte ram gr. iv.

Piny. iambi veil gr. iij.

Opii purl. gr. ss. Syrup. strap. q. s.

Fiant pilulan ij, quarto. Tel sexta. quaque hone sumendm.

f 11. Decoct. unarm co. 3xii.

80die tartariz.3ss. Olei arse Sij.

. Fiat enema.

(173.) If the consecutive affection assume a- dysenteric character, leeches to the prninreum or sacrum, emollient and diaphoretic medicines,f and injections,§ ' R. Poly. Ipecacuanlue co, gr. iv.

. Camphors) mane gr. iij. Syrup. papaveris q. s. M.

Fiant pilulre iij, qnarta quaquc hora sumendm. R. Infus. lini co. vel

- althseteeo. 3jss. Sub-horatis sod* 'aj. Spirit, tether. nit. 3ss. Syrup. papaveris

aurantii aa 3ss. M. Fiat haustus tertiis vel quartis horis capiendus. § R. Infus. tint comp. 3x.

Tinct. opii 3ss. Sub-horatis sodte 3ss. Camphoric rasae gr. x. M. Fiat enema his terve in die injicienduni.


(190. ) After endeavouring to excite full vomiting, and to procure blood, particularly when the early period of the attack, and the circumstances of the patient, furnish rational expectations of advantage from them, I would resort to still more energetic means than have hitherto been employed. These are very nearly the same as were made public by me in the Foreign, Quarterly Review, for October 1831, and in the Medical Gazette, for the 19th of November of that year. When approved means fail, others, which have succeeded in similar states of morbid action, particularly when they cannot prove detrimental, should be prescribed. I would next recommend the patient to have a bolus, consisting of from ten to fifteen grains of camphor, an equal number of grains of calomel, one grain of opium, and ten drops of any essential oil, as of mint, cajeput, &e. with a sufficient quantity of conserve of roses. This should be administered after full vomiting, if it can be quickly procured, but without any regard to its continuance. If this be retained, another may be given, and repeated in from one to two, tluee, or four hours, according to the urgency of the attack ; but if rejected, it should be immediately repeated, until it at last remains. Not more than three or four of those boluses ought to be given, and frequently two will be sufficient.

(191. ) Simultaneously with the administration of the above, dry heat ought to be employed, and the turpentine fomentation should be applied, as hot as possible, to the abdomen and chest ; and friction of the spine and thighs, with any of the liniments prescribed above (§ 160, 170), made warm by plunging the vessel containing it in hot water, resorted to. From one to three hours after the exhibition. of the bolus, a draught, consisting of from two drachms to half an ounce each of spirits of turpentine and castor oil, or of olive oil, with a few drops of the above essential oils, and forty grains of magnesia, should be taken m mint water ; and if it be rejected from the stomach, another should be given, and repeated, if again rejected, in half an hour afterwards ; if retained, not until from six to twelve hours, when another maybe taken. I have seen cases where the most urgent vomiting existed ; and yet the above remedies (although both the bolus and the draught were taken at the same time) allayed instead of aggravating this symptom. Besides, it is our object to obtain full vomiting at first; therefore ibis cannot be viewed as an unfavourable operation of the medicine, if it should follow the exhibition of the first doses of it. In order to promote the influence of these means, a lavement, consisting of twenty grains of camphor, from half an ounce to an ounce and a half of the spirits of turpentine, and an equal quantity of olive oil, in a suitable vehicle, should be administered, and repeated- according to the circumstances of the case. Much will depend upon the succession in Which these remedies are given, the periods which are allowed to elapse between their exhibition, on the doses, and the decision with which they are prescribed. The hot turpentine fomentation, assisted by hot air and frictions with stimulating substances, is the most power- ful means I am acquainted with of procuring reaction, restoring the heat of the body, and relieving the viscera from congest-ion. • (192.) The internal remedies now recommended,- as well as the external means so frequently insisted upon, have been employed by me in many hundred instances of malignant and extremely dangerous disposes, and I have found them the most efficient of all others with which I am acquainted, when judiciously combined and administered, in rousing, the energies of life, restoring the secre- tions, removing the congestion of internal organs, and in subduing that un- healthy sub-inflammatory state of action, which often occurs in fevers, and in diseases proceeding from infection and animal poisons, and which generally advances rapidly to fatal disorganization. In aid of the above remedies, and par- ticularly when the energies of the constitution seem to react, although most imperfectly, effervescent draughts with the carbonate of ammonia, and the pyrolig,neous acetous acid in mint water, or in an infusion of cloves, may be given from time to time, and a large blister applied over the epigaatrium upon the removal of the turpentine epithems.

(193.) Before proceeding further, I would also recommend, both in this most severe grade of the malady and that next it in degree, the administration of me- dicinal substances in the state of vapour, and medicated gases through the channel of the respiratory organs. I have already argued, and I may add, shown, that it is through these organs that the specific cause of the disease invades the frame, and that they suffer in a most remarkable manner from its impression, having their ;functions altogether paralyzed. If this view be entertained, tin, means of individual prevention which I have recommended will appear the more

deserving of adoption ; and the directing of medicinal agents to this quarter will, at least, not be considered unreasonable or undeserving a fair trial. Per- haps the inhalation of the nitrous oxide gas, or common air with a slight addition of oxygen, will be the most energetic remedies -that can be em- ployed in this way. Other means, also, which will readily suggest themselves to the well-informed physician, may be employed ; and amongst others the vapour of the sulphuret of iodine, the tincture of iodine, or of iodine itself, or chlorine gas, or the vapour arising from gently heating a strong solution of cam- phor in aromatic vinegar, or the vapour of the aromatic preparations of ammo- nia may be mentioned ; and shocks of galvanic electricity maybe passed through the chest.

(194.) Besides the use of frictions with hot cloths, or dry substances, or with

liniments, which will net occasion cold by their evaporation-means which have already been advised-the application of hot air, or of hot bricks, hot sand, or salt, or bran, or hot oats around the body, have all been recommended. In cases where the hot turpentine fomentation, or common sinapisms, have no effect, or in this most intense grade of the malady, without waiting for the effects of less active means, the subjoined cataplasm* may be applied over the abdomen. A * R. Pith. sinaros tbss.

- caps= smut.

- zingiberis Ca 3j.

Acidi acetici pyroliguei q. s.ut. fiat cata.plasma,dein addo Olei terehinthinre, 3ij. Misce. The following compound tincture of camphor and opium seems well, suited to the worst grades of this malady, in doses of from two drachms to half an ounce, given in any suitable vehicle.

R. Opii pulveimz. 3iij.

Camphoric 3%-j. Corbels canellte contus.

Croci stigmat.3ij. Caryophyllorum Pule. capsici, 3jes. Potasste sub-earbon. 3i1. Olei anisi, 3j.

. -Spirit. vial tennior. (vel -.Sp. vin. galliess, vel sp. vipn. ;


-Macera leni atm adore, per dies viij. ad xii. dein exprime et cola, trial may also be given to medicated vapour-baths; to baths, with the fumes of some of the volatile essential oils extricated by heat ; and to cupping in the course of the spine, with a view of removing the congestion within the spinal canal, as well as in other parts. In general, it may be remarked of the use of remedies in this disease, that in its most severe attacks, or when far advanced before medical aid is procured, scarcely any means, however well and energeti- cally devised and Practised, will arrest its fatal tendency ; while the less severe visitations will generally be removed by any of the remedies enumerated, when judiciously combined and employed. There is reason to suppose that the slightest manifestations of the malady will even, by means of the vomiting and tumult excited in the frame, operate their own clue; and hence the reputation acquired by various mild or inefficient medicines and methods of treatment. There are few diseases, perhaps, which, while they preserve a perfect identity of character, present a greater range in grade than this ; excepting, indeed, those maladies which propagate themselves in a similar manner to it. We conceive, therefore, that it is Chiefly to the mildness of the attack that we are to attribute the im- puted success of such remedies as successive draughts of warm milk, olive oil, the Glauber's salts, common salt, and various other mild preparations. In the • more intense visitations of the malady, where the depression of the vital energies of the frame, and the vitiation of the blood are extreme, remedial agents must possess a co-ordinate degree of activity, in order to produce any effect whatever on the system. (195.) If the above energetic means be judiciously put in practice, and brought to act simultaneously on different parts of the body, or prescribed in due succession and states of combination, as the scientific, zealous, and experienced practitioner may consider appropriate to the grade and stage of the malady, Signs of reaction will often manifest themselves; when—particularly if it have not previously been employed, or when the state and circumstances of the patient furnish no reason against it—blood-letting, either general or local, may be cau- tiously resorted to. If the stage of reaction he brought about, however imper- fectly, the same intentions of cure, and the satne measures to fulfil them, which

I have already described when treating of the various manifestations of this stage in the less intense grades of the malady, must be appropriately employed against each of them respectively, as they may supervene in this most severe form of the pestilence.

We have simply stated the fact that Dr. COPLAND is an infec- tionist, without expressing any opinion as to the soundness of his views on this head. The question is one of evidence, collected from every variety of source, and of every species of value. We are not sure that it has been ever yet fairly and ably summed up. Parties have run very high on the subject—absurdly enough, nay more, disgracefully. We have just read Letters on the Cholera, " showing that it is not a communicable disease." The writer is a'very zealous advocate, and quotes some remarkable facts and authorities; but he is not a master of the lucidus ordo, so necessary in controversial composi- tion. The result on our minds is, that, on the whole, they who have seen most of the disorder are the least believers in contagion.