A MIRROR OF
HOSPITAL PRACTICE.
CASE OF CHOLERA TREATED BY SULPHUROUS ACID.
By Surgeon-Major
R. G. Pakker, 12th Segment, Madras Native Infantry.
Close upon 6 p.m. on Saturday last, the 24th July, I received that her , stating urgent verbal message from Mrs. husband was very ill, would I come over at once. I, of course, and found Mr. a large powerfully-built hurried over , man, in bed, covered with blankets, and in great pain. all well the been He had perfectly morning, had his breakfast at 10? o'clock, consisting of mutton chops, curry puffs made and and rice, tea, and at 1? p.m. his bowels with butter, curry p.m., while sitting in the verandah, were moved naturally. At he suddenly felt faiut aud ill, went into his bed-room and was immediately attacked with tremendous purging and vomiting. The first two motions were liquid,- dark coloured, and very copious; the third was light yellow; the fourth and subsequent ones colourless like rice-water, with a smell like that of raw
an
meat.
There were about twenty motions in all, and all very copious. was passed with the earlier motions and then suppressed. As to vomiting he brought up first his breakfast undigested with a large quantity of fluid-like congee or rice-water, about a wash-hand basin full in all, then on two separate occasion# rather more than a pint and three quarters of a pint respectively of similar fluid, and finally, just before I came, he vomited a large quantity of clear fluid, but some of this may have been water only, of which he had several tumblers after the third vomiting. Severe and agonizing cramps also set in about p.m. just after the third vomiting. They began in the lit'.le fingers, and extended to the thumbs, toes, calves of the legs and abdominal muscles in succession, 60 becoming general. When I saw him just after 6 o'clock he was suffering terribly from cramps, for which two of his dressers were applying hot bottles to the various parts affected. He had not yet passed into the algide state; the skin, though clammy and cold, was not markedly so, nor was it shrivelled except on the fingers. The pulse was small, scarcely perceptible; there was great thirst. The bowels had acted about ten minutes before my arrival, and very copiously, but by his orders all the motions had been taken away and buried. There had been, as I have mentioned, about twenty stools in was so exhausted that he fainted and had all, and Mr. to be carried to bis bed after the last one. As to treatment, one of his dressers had given him
"Urine
Spirit. Camph. Spirit. Animon, Arom.
*txv.
..
..
..
393.
Cinnam water ... .. ,, ji. which was brought up at once, and after the thirl vomit, Mrs. him half a wine of gave glass brandy in some water, which was also rejected at once. It was evident that this was a serious case, and that to do any good immediate measures must be taken. 1 therefore gave him r>ixxv. of chlorodyne, the only medicine at hand, in about gss. of water at once, and sent to my house (the nearest place) for some sulphur. The chlorodyne made him feel a little more comfortable he said, hut in less than half an hour he brought it up again. In the meantime the sulphur had arrived, and I had burnt two or three bits of it, weighing probably about an ounce, in a flat saucer about a yard from the patients' bed. The cramps were very severe when the sulphur was burnt, hut almost immediately on that being done, they began to lessen and gradually to subside. By 7 p.m. he was much easier, and I again burnt some sulphur in the same way. At 7? p.m., the cramps having virtually disappeared, there being only an occasional and very slight twitch, and the skin being warm" and comfortable I left him, first giving a dose of nixx. of chlorodyne, and leaving directions for sulphur to be burnt near the bed, several tim>'s through the night, and the chlorodyne to be repeated at 9 and every subsequent three hours.
THE INDIAN MEDICAL GAZETTE.
268 He
complained
of
great
allowed him just half
thirst while I
an ounce
or
an ounce
was
there,
of water at
and I time
a
to moisten his mouth. After bringing up the first dose of chlorodyne he retched once, but brought up nothing but the water he had had and some glairy mucus. The second dose of chlorodyne was rejected in three quarters of an hour. I did not see Mr.again till the next morning at 7^ o'clock; he was perfectly easy, the only remnant of the cramps being a slight occasional twitch in the hands. The skin was comfortably warm, and the pulse, though weak, regular. He had retched three times during the night, and at 8 p.m. (soon In after I left) had one stool semi-consistent and light yellow. fact so much better did he feel that, though still of course weak, ri?e to went out that day, and the next morning he unknown (Monday) was out before I called. He passed about a tea-spoonful of very high coloured urine on Saturday night, about a table spoonful on Sunday morning, the same on Sunday evening, quantity increased on Monday and natural on Tuesday. I think I may, without hesitation, call this a case of sporadic cholera. There i3 no cholera here or in the neighbourhood, while yet the symptoms sufficiently denote the disease. I think I may also say that the subsidence of the disease was unprecedentedly sudden and rapid. To what may we attribute it ? There are, so far as I can see, only three ways in which it can be accounted for. ?By assuming that the attack had expended itself, and that recovery consequently ensued ; 2nd.?By ascribing the beneficial result to the chlorodyne administered ; or '6rd.?Dy allowing that the recovery of the patient was due to some influence exerted by sulphurous acid over the disease. With regard to the first view, I will merely say, that though just within the bounds of possibility, every appearance of probability is against it. There had been a very copious rice water stool just before my arrival, and the cramps were, if anything, increasing in force till the sulphur was burnt, so that 1 think we may fairly consider that there is no evidence that the attack had expended itself. The second view is also within the bounds of possibility, but I think little, if at all, more probable than the first one. That a single dose of chlorodyne of ?\xxv. rejected too within half an hour, should in such a striking way subdue an attack of cholera in full progress, is to say the least, not likely. For we must not omit to note that recovery was established before the second dose of chlorodyne was given. It seems therefore a necessity to attribute to sulphurous acid the beneficial influence exerted in this case. I am aware that it is not safe to generalize from slender data or to draw hasty conclusions from the experience of a single case, yet let me observe that this case, so far as it goes, entirely supports the view I have repeatedlv brought forward, that sulphurous acid is a remedy for cholera?a view warranted not by slender data but by a large series of observed facts. I would therefore beg my medical brethren to test and to try this remedy themselves, and if, by God's blessing, it should prove effectual in checking and subduing that terrible disease cholera, and in thus preserving human life, I shall indeed be
thankful. Let me add
a
few words
as
sulphur. The ordinary charcoal chatty
to my manner of
burning
the
used in cook-rooms in India is
well-known.
This fire should be fanned to a bright heat, and a small flat earthen chatty placed on it and thoroughly heated. When ready let the whole apparatus be brought into the sick room, and placed near (about a yard or so) from the patients' bed, then put into the flat chatty a few bits of bazaar sulphur, about an ounce in weight. If the chatty is hot enough, the sulphur will at once melt and spontaneously ignite ; if it should not do so, let the fire be fanned and the sulphur will soon burst into a flame. ViziANAGRAM. 3ls< July 1875.
for Q,uinine in Urine.?The urine to be tested rendered alkaline with ammonia, then shaken with ether, which dissolves out the quinine, the ether is poured off, a drop of hydrochloric acid is added and the ether evaporated. The minute residue is taken up in chlorine water, and on adding ammonia the characteristic green color appears.?The Thiladeljj/ua Medical Tunes. is
Testing
/
[October 1,
1875.
HOSPITAL PRACTICE.
CASE OF CHOLERA TREATED BY SULPHUROUS ACID.
By Surgeon-Major
R. G. Pakker, 12th Segment, Madras Native Infantry.
Close upon 6 p.m. on Saturday last, the 24th July, I received that her , stating urgent verbal message from Mrs. husband was very ill, would I come over at once. I, of course, and found Mr. a large powerfully-built hurried over , man, in bed, covered with blankets, and in great pain. all well the been He had perfectly morning, had his breakfast at 10? o'clock, consisting of mutton chops, curry puffs made and and rice, tea, and at 1? p.m. his bowels with butter, curry p.m., while sitting in the verandah, were moved naturally. At he suddenly felt faiut aud ill, went into his bed-room and was immediately attacked with tremendous purging and vomiting. The first two motions were liquid,- dark coloured, and very copious; the third was light yellow; the fourth and subsequent ones colourless like rice-water, with a smell like that of raw
an
meat.
There were about twenty motions in all, and all very copious. was passed with the earlier motions and then suppressed. As to vomiting he brought up first his breakfast undigested with a large quantity of fluid-like congee or rice-water, about a wash-hand basin full in all, then on two separate occasion# rather more than a pint and three quarters of a pint respectively of similar fluid, and finally, just before I came, he vomited a large quantity of clear fluid, but some of this may have been water only, of which he had several tumblers after the third vomiting. Severe and agonizing cramps also set in about p.m. just after the third vomiting. They began in the lit'.le fingers, and extended to the thumbs, toes, calves of the legs and abdominal muscles in succession, 60 becoming general. When I saw him just after 6 o'clock he was suffering terribly from cramps, for which two of his dressers were applying hot bottles to the various parts affected. He had not yet passed into the algide state; the skin, though clammy and cold, was not markedly so, nor was it shrivelled except on the fingers. The pulse was small, scarcely perceptible; there was great thirst. The bowels had acted about ten minutes before my arrival, and very copiously, but by his orders all the motions had been taken away and buried. There had been, as I have mentioned, about twenty stools in was so exhausted that he fainted and had all, and Mr. to be carried to bis bed after the last one. As to treatment, one of his dressers had given him
"Urine
Spirit. Camph. Spirit. Animon, Arom.
*txv.
..
..
..
393.
Cinnam water ... .. ,, ji. which was brought up at once, and after the thirl vomit, Mrs. him half a wine of gave glass brandy in some water, which was also rejected at once. It was evident that this was a serious case, and that to do any good immediate measures must be taken. 1 therefore gave him r>ixxv. of chlorodyne, the only medicine at hand, in about gss. of water at once, and sent to my house (the nearest place) for some sulphur. The chlorodyne made him feel a little more comfortable he said, hut in less than half an hour he brought it up again. In the meantime the sulphur had arrived, and I had burnt two or three bits of it, weighing probably about an ounce, in a flat saucer about a yard from the patients' bed. The cramps were very severe when the sulphur was burnt, hut almost immediately on that being done, they began to lessen and gradually to subside. By 7 p.m. he was much easier, and I again burnt some sulphur in the same way. At 7? p.m., the cramps having virtually disappeared, there being only an occasional and very slight twitch, and the skin being warm" and comfortable I left him, first giving a dose of nixx. of chlorodyne, and leaving directions for sulphur to be burnt near the bed, several tim>'s through the night, and the chlorodyne to be repeated at 9 and every subsequent three hours.
THE INDIAN MEDICAL GAZETTE.
268 He
complained
of
great
allowed him just half
thirst while I
an ounce
or
an ounce
was
there,
of water at
and I time
a
to moisten his mouth. After bringing up the first dose of chlorodyne he retched once, but brought up nothing but the water he had had and some glairy mucus. The second dose of chlorodyne was rejected in three quarters of an hour. I did not see Mr.again till the next morning at 7^ o'clock; he was perfectly easy, the only remnant of the cramps being a slight occasional twitch in the hands. The skin was comfortably warm, and the pulse, though weak, regular. He had retched three times during the night, and at 8 p.m. (soon In after I left) had one stool semi-consistent and light yellow. fact so much better did he feel that, though still of course weak, ri?e to went out that day, and the next morning he unknown (Monday) was out before I called. He passed about a tea-spoonful of very high coloured urine on Saturday night, about a table spoonful on Sunday morning, the same on Sunday evening, quantity increased on Monday and natural on Tuesday. I think I may, without hesitation, call this a case of sporadic cholera. There i3 no cholera here or in the neighbourhood, while yet the symptoms sufficiently denote the disease. I think I may also say that the subsidence of the disease was unprecedentedly sudden and rapid. To what may we attribute it ? There are, so far as I can see, only three ways in which it can be accounted for. ?By assuming that the attack had expended itself, and that recovery consequently ensued ; 2nd.?By ascribing the beneficial result to the chlorodyne administered ; or '6rd.?Dy allowing that the recovery of the patient was due to some influence exerted by sulphurous acid over the disease. With regard to the first view, I will merely say, that though just within the bounds of possibility, every appearance of probability is against it. There had been a very copious rice water stool just before my arrival, and the cramps were, if anything, increasing in force till the sulphur was burnt, so that 1 think we may fairly consider that there is no evidence that the attack had expended itself. The second view is also within the bounds of possibility, but I think little, if at all, more probable than the first one. That a single dose of chlorodyne of ?\xxv. rejected too within half an hour, should in such a striking way subdue an attack of cholera in full progress, is to say the least, not likely. For we must not omit to note that recovery was established before the second dose of chlorodyne was given. It seems therefore a necessity to attribute to sulphurous acid the beneficial influence exerted in this case. I am aware that it is not safe to generalize from slender data or to draw hasty conclusions from the experience of a single case, yet let me observe that this case, so far as it goes, entirely supports the view I have repeatedlv brought forward, that sulphurous acid is a remedy for cholera?a view warranted not by slender data but by a large series of observed facts. I would therefore beg my medical brethren to test and to try this remedy themselves, and if, by God's blessing, it should prove effectual in checking and subduing that terrible disease cholera, and in thus preserving human life, I shall indeed be
thankful. Let me add
a
few words
as
sulphur. The ordinary charcoal chatty
to my manner of
burning
the
used in cook-rooms in India is
well-known.
This fire should be fanned to a bright heat, and a small flat earthen chatty placed on it and thoroughly heated. When ready let the whole apparatus be brought into the sick room, and placed near (about a yard or so) from the patients' bed, then put into the flat chatty a few bits of bazaar sulphur, about an ounce in weight. If the chatty is hot enough, the sulphur will at once melt and spontaneously ignite ; if it should not do so, let the fire be fanned and the sulphur will soon burst into a flame. ViziANAGRAM. 3ls< July 1875.
for Q,uinine in Urine.?The urine to be tested rendered alkaline with ammonia, then shaken with ether, which dissolves out the quinine, the ether is poured off, a drop of hydrochloric acid is added and the ether evaporated. The minute residue is taken up in chlorine water, and on adding ammonia the characteristic green color appears.?The Thiladeljj/ua Medical Tunes. is
Testing
/
[October 1,
1875.
