CORBYN ON CHOLERA.
THIS elaborate work on Cholera, written and printed in India, con- tains, first, a statement of the author's own views of the disease; second, an examination of the writings of others; third, the re- sult of the different modes of treatment. The cause of cholera, Mr. CORBYN maintains, consists in inequalities of weather pro- ducing sudden checks of perspiration, a determination of blood from the surface to the centre, and consequent inflammation inter- nally, at the same time that the skin is seized with a deadly chill. If this be the cause of cholera, why is cholera a new disease ? It is, however, of more importance to ascertain Mr. CORBYN'S system of remedy than his speculations on the cause. The grand cha- racteristic of his treatment is the immediate exhibition of sedatives, with the careful exclusion of stimulants of every kind. The most useful extract that we can make from this very va- rious and industrious work, is the letter which was circulated in India by authority, describing Mr. CORBYN'S method of treatment. "Camp. Resta, 26th November 1017. " In compliance with your request to give you instructions for the treatment of the disease which prevails in camp, from the circumstance of your being fre- quently detached from the army without medical assistance, I give, you a state"
meat with much pleasure. . .
" The symptoms are as follows :—Violent vo and purging of watery: - matter ; spasmodic cramp in the extremities, =Ang to the abdomen and muscles of the chest ; a collapsed countenance; the pupil and the white of the eye covered with a thick film ; a suffusicin of blood on.turgidity of their ves- sels; and the eye at length sinks into thesockatowl, immediately becomes WI- l'fiiiiireialifirriatitilfeionie.coll; and the pulse is not to be felt, and indeed the energy and-action of the heart are considerably diminished. "The first man I sate thus affected was treated with three grains of calomel and a quarter of a grain of opium every two hours, with frequent draughts of brandy and water, and other stimulants. The man died, and I opened him on the same evening. I found the stomach partly. filled with muddy water; the bowels were empty. and considerably inflated with air ; hardly any bile in the gall-bladder, none in the biliary ducts; there was general inflammation of the bowels, liver, stomach, and lungs. " These were indications to follow a directly opposite mode of treatment : consequently, on assuming the charge of the Native Hospital, for the reception of camp sick of the centre division of the army, on the 16th of this month, one hundred and ten patients were admitted with the symptoms I have described. I immediately gave to each patient 15 grains of caloinel, which I dropped on the tongue, and washed it down with 60 drops of laudanum and 20 drops of pep- permint, in two ounces of water. Before I go further, it will be necessary to mention to you, that laudanum in a large dose of 60 drops is not a stimulant, but a sedative, whereas laudanuin from 15 to 20 or 30 is a stimulant : the former produces sound sleep, removes pain and irritability, whilst the latter excites con- siderable uneasiness and convulsive startiugs. It will appear the more remark- able to von, when I also mention, that the variation of a dose of caloinel has the same effects. Calomel, in a dose of from 5, 8, to 10 grains, excites lassitude, sickness, irritation of the bowels, and, on account of its being a stimulant, acts as a good purgative; but in a dose of from 15 to 20 grains, it is a sedative, allays mvooatioitisg, removes spasms, sends the patient to sleep, and produces one or two e You will now observe on what principle I treated my patients,—not on a plan of giving powerful stimulants, but on one which at once removes the irrita- bility and spasms, composes the stomach and bowels, produces sleep and tran- quillity of the mind, excites the secretion of the liver, and prevents the progress of the inflammation. On the second day, it was indeed a consolatory sight to observe the wonderful change. The vomiting and purging had stopped, the spasms removed, with general moisture on the skin; they lead experienced sound sleep, and the pulse had returned to the wrist. I now hundred 30 grains of jalap, which effected one or two bilious motions. Of the hundred- and ten men, I lost only two ; and those were deerepid aged men, in whom the vital energies were at once extinguished. The remaining hundred and eight 1 had the good fortune to see all recover.
"In the treatment of Europeans, however, I should strongly recommend co- pious bleeding, and never less than 20 grains of calomel with 60 drops of lauda- num, and 20 drops of peppermint in two ounces of water ; and on the spasms attacking the abdomen, the application of a large blister. Should the blister fail in drawing, and the blood not flow from the veins, immersion in the warm bath will have the beneficial effect ; should the warm bath not be procurable, warm frictions and pots of warm water thrown over the patient will produce an equally favourable result, in bringing about the reaction of the circulating system. " When the purging and vomiting are incessant, as well as violent, we ought never to be alarmed in giving as far as SO drops of laudanum, with 20 drops of peppermint, and 20 grains of calomel, and injecting 40 drops of laudanum in congee by enema. A few hours determine the safety of the patient ; therefore those few hours must not he lost in an undetermined manner, and by small and useless doses. After the first attack is over, that is after three or four hours, if there is much spasm and irritability remaining, the dose of calomel and drauglit must be repeated ; the patient will then fall into sound sleep, and awake nearly recovered. The after-treatment will only be to keep the bowels regularly open with calomel and jalap, and to give occasionally 60 drops of laudanum to pro- . cure sleep. It is, however, to be remembered, that it would be an error and do considerable harm, to bleed in persons who are weak, worn down by disease, and aged. ," The most urgent symptoms in this disease, are violent thirst, and dreadful sensation of burning heat in the bowels and pit of the stomach. The frequent and lamentable call for cold water should never be satisfied, for I observed many unfortunate camp-followers who had died in the act of drinking : I therefore gave warm congee, and, by the means of sentries, prevented any water being taken into the hospital. Hiccough is not a dangerous symptom in this disease, for there was hardly a patient recovered without suffering this spasmodic irritability.
" I am of opinion, that unless a patient takes these remedies within six hours after the attack, the case is hopeless : at least I only recovered ten patients with a regular form of the disease, after a greater lapse of time, and in those the symptoms were peculiarly mild. "It is of the greatest importance to bear in mind the necessity of giving calo- mel in powder, Instead of pills; for I have known many instances where pills were passed through the patient in the same state and form they were taken into the stomach. This point, therefore, is of such high importance, that in fever, dysentery, but above all in this complaint, of which a patient is carried off in twelve, at furthest thirty hours after the attack, that it becomes necessary to affect the system immediately ; otherwise, if this point should be overlooked, the chief object in the operation of the medicine may be frustrated, and the pa- tient lost. It is on this principle I recommend laudanum in preference to opium : one is directly active in its operation, but the other has to undergo the process of dissolving ; or perhaps, never dissolving, passes through the system in the same state it was taken into the stomach, without producing any effect whatever. I am so convinced of what I now assert and recommend, that for the last three years I have never once used any medicine in the form of pills; and I look back to the day when I first discovered this error in practice, as one great improvement in the treatment of acute diseases. I have to add, that my reason for using peppermint in co-operation with laudanum, in so large a quantity, was its known efficacy in expelling air from inflated bowels and stomach: this effect I have always found it to have in the most desirable manner. " That this disease is not infectious, I am perfectly convinced. All any at- tendants on the sick have escaped the disease ; and I have myself, more particu- larly, at all hours of the day and night, respired the atmosphere of a crowded hospital with impunity. But, I fancy, there has been a.combination of causes, and perhaps one of the principal was the sudden changes of the atmospherical temperature: for I never knew the thermometer vary so much as it has this masa. La the morning at-day-break, it stood at 520; at one o'clock p. no. at • 96°,—a variation of 44 degrees in six hours and a half. "(Signed) FREDERICK CORRYIT,
Assist.-Surgeon,
In charge of the Native hospital, Centre Division of the Anny."-
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