The Sun.
London, England, 1848-10-19 00:00:00

TH

THE CHOLERA.
TO THE EDITOR OF THE SUN.

Sia,—The enclosed was drawn up for the us• of
my own private patients, but, as one part of the treat-
ment therein advocated I have not seen mentioned else-
where (I allude to the hot saline bath), and as I con-
sider it a point of very great importance, I have for-
warded it to you for the sake of publicity, should you
consider it worthy of insertion in your widely-ex-
tended paper. I have the honour to be, Sir,
Your most obedient servant,
A. TOULMIN.

" Asiatic or malignant cholera differs chi•fly from
the English malady of the same name in its intensity,
and in its assuming an epidemic rather than a sporadic
form. _ .

" The essential cause of the complaint consists in a
certain miasm, or malaria, which for the time being
pervades the atmosphere around the places it visits.
The poison is consequently in a gaseous form, and
possesses a certain density, which appears to be some-
what greater than atmospheric air, inasmuch as it
follows the course of rivers rather than passing over
higher ground.
" The disease is not contagious, and its infectious
character is denied by the majority of the profession.*
The inference is, that those who suffer from the com-
plaint have been exposed to its morhific influence, and
have not caught it by attendance at the bed-side of the
sick.

" Everything that tends to improve the general
health will likewise tend to render the individual less
susceptible to its influence. Hence, cleanliness,
temperance, and a regulated diet are most im-
portant.
" The first should be directed not only to the per-
son, but also to the house and surrounding locality.
The body should be spunged over with cold or tepid
water on rising in the morning, or in lieu of this, the
shower bath may be used. The house should be kept
perfectly clean and well ventilated—all drains and
cesspools shonld be emptied—all decaying or putrid
substances removed—and, if possible, all stagnant
waters in the neighbourhood be drawn off.
" The diet shauld be of a sustaining character,
consifting of bread and meat (roast rather than
boiled), milk, rice, and farinaceous food in general.
All vegetables, fruit, acids, salted meats, and pickles
being avoided. Spices of all kinds are useful and
should be taken freely. All light wines, and ill-
fermented beer avoided. If wine,be drunk, a glass of
sound sherry will be the best, and in constitutions of
lax fibre, a table-spoonful of French brandy in as
much water may be taken during dinner.
" Where habits of intemperance have been indulged
in the stimulus must not be wholly withdrawn, but
limited.

" Early hours, and the absence of all depressing
passions, will tend greatly to sustain the health.
" The cause of death in cholera arises from the
animal fluids being all drained off, in the continued
diarrhoea which takes place, until the blood is left of
the consistence of tar; in consequence of which the
circulation becomes greatly impeded, if not suspended,
and the blood black from being loaded with carbonic
acid. To this the coldness of the body necessarily
ensues, because the blood ceases to be arterialized, or,
in other words, heat ceases to be generated.
" The medical treatment must be left in the
hands of the profession ; but:as in this disease time is
most valuable, I would strongly recommend what
will be found to be a most important improve-
ment on the practice of applying dry heat—namely,
putting the patient at once into a hot saline
bath at 100 deg. F., in which two or three pounds
of common salt, of bicarbonate of soda, of phos-
phate of soda (the very salt of which the blood has
been robbed) may be dissolved. In this he may be
kept from the first moment of the attack until reaction is
fully established; and when in the bath, the heat may be
raised to 105 deg., or even higher, provided his feel-
ings will admit of it.
" Three important objects will be thus gained. A
degree of heat will be maintained over the whole sur-
face of the body higher than that of the blood, and,
therefore, the vital heat cannot be dissipated. A
quantity of fluid will also be absorbed, replacing that
which has been abstracted, and along with it the blood
will regain the alkali it has lost in the continued drain
from the system.
" In many cases diarrhoea will be the precursor for
days before. This ought never to be neglected. At
this time, half a wine glass of brandy, with twenty
drops of tincture of opium, may be taken ; but pro-
fessional assistance should be obtainod.

" Should the disease become fully established in
the interval that must elapse before such aid can
arrive, and of rhich time not a moment should be lost,
I would recommend the following medicine to be
kept in readiness in the house :

Take of—
Tincture of opium d. j
Tincture of cardamoms ... d. iv
Aromatic spirit of ammonia .. d. j
Compound spirit of sulphuric tether d. ij
Cajeput oil m viij
Oil of peppermint ... m ij
Best French brandy ... .. oz. iij
" Of this a fourth part may be taken every half-
hour, in as much hot water, until as.iistance arrives.
" A. TOULMIN, M.D., M.R.C.S.E.
" Wilton House, Blackheath, Oct., 1848.

" P.S. To render the bath more completely effective
it should be made for the purpose, for none of the
present make are intended for a long continuance in
them. One end should incline at such an angle as to
enable the patient to recline on it with perfect ease,
bearing in mind the utter prostration of strength that
occurs in cholera. It should be padded with vul-
canized India rubber, and be raised on a platform,
about a foot high, and supplied with a tap, so that,
when needed, the water may be drawn off and re-
tided, without the patient being disturbed. Every
perish should keep half-a-dozen of these baths in
readiness in case of need."

I confine the term contagion to its true meaning—
namely, to diseases induced by contact or inoculation;
and infection to such as where the miasm is generated in
the body of the patient suffering under the complaint,
and therefore may he imbibed or inhaled by those in at-
tendance. For example, the vaccine virus is simply con-
tagious—the small-pox both contagious and infectious—
while the measles and scarlet fever are infectious only.