Report on epidemic cholera and yellow fever in the Army of the United States, during the year 1867 / By Brevet Lieut. Col. J.J. Woodward.
- Joseph Janvier Woodward
- Date:
- 1868
Licence: Public Domain Mark
Credit: Report on epidemic cholera and yellow fever in the Army of the United States, during the year 1867 / By Brevet Lieut. Col. J.J. Woodward. Source: Wellcome Collection.
Provider: This material has been provided by London School of Hygiene & Tropical Medicine Library & Archives Service. The original may be consulted at London School of Hygiene & Tropical Medicine Library & Archives Service.
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![efficacy of the large doses of uncombined calomel ovei the reported results of tlie other modes of treatment recognized or recom- mended. There have been quite as many instances of recovery from collapse this year in proportion to the number of cases as the last, though the percentage of complete recovery is not so great as that reported last summer. I attribute the increased mor- tality this year, with perfect justice, I think, to the character of the patients attacked, a large pro|)ortion of them being recruits previously rejected for physical disability, and recently enlisted veteran reserve corps men, neither of which classes have sufficient vital force to recuperate from the terrible effects of such a disease, even after it has been completely checked. There have been two cases of death, apparently from uraemia, after complete reaction from the collapse of cholera; and one, as proved by an autopsy, from sudden invasion, after commencing convalescence from cholera, of capillary bronchitis. I can give no satisfactory explanation of the action of the large doses of calomel in relieving cholera. Perhaps as plausible a theory as any, is one which I have for some time entertained, that the calomel, from the absence of acid in the stomach in cholera, passes nearly unchanged into the intestinal canal and acts locally and mechanically as a remedial agent upon its mucus sur- fhces, denuded as they are known to be of epithelium. It is a well-known fact that dry calomel, applied to a chafed or abraded surface externally, will stop the exudation of serum and promote cicatrization more rapidly than any other known dressing. That the calomel passes through the stomach and intestines chemically unchanged seems to be also proven from the entire absence, in nearly all of these cases, of the constitutional eifects, salivation, etc., known in ordinary cases to follow the use of mercurials. In all of the cases, both last year and this, salivation has only occurred in three or four instances, and in those in so slight a degree as to occasion no inconvenience and scarcely to require attention. A certain and invariable result of the exhibi- tion of large doses of calomel in cholera is its immediate and powerful sedation. Vomiting is almost certainly stopped by one or two doses, and the patient remains in a state of immunity from suffering, except from thirst, as complete as could be effected by any safe hypodermic infection of morphia. My treatment of cholera and the preceding diarrhoea may be summed up briefly as follows: For the dian-hoea, drsichm doses, frequently repeated, of paregoric and aromatic spirits of ammonia, mixed in equal volumes, with rest in a horizontal position. Squibb's mixture we have found develops dysentery, though, for the moral effect in a frightened subject, nothing can be better than a single dose of Squibb's mixture, which the panic-stricken patient knows is taking hold of his complaint, for he can feel it. The paregoric and aromatic spirits of ammonia will suffice for nearly all cases of diarrhoea ; but should the case progress to, or be admitted with, rice-water evacuations, vomiting, etc., the characteristic symptoms of cholera, thirty grains of calomel, dry, are placed upon the patient's tongue, which is always sufficiently moist to enable him to swallow it without difficulty. If one dose does not stop the vomiting, it is to be repeated within a few minutes. The next dose is exhibited in thirty or forty minutes, and within the succeeding two or three hours one or two similar doses should be given. No other remedies are used, except friction to the cramped limbs, or firm grasping by the nurse's hands of the contracted muscles. Mus- tard paste, as soon as the struggles of the patient will allow it to remain in place, is also locally applied. Under the sedative powers of the calomel the patient soon becomes quiet, complaining of nothing but thirst. Small pieces of ice relieve this thirst as well as pints of water, and I have also invariably found that free draughts of water renew the whole train of symptoms; in fact, occasion a complete relapse of vomiting and purging, even in a convalescent. After the patient is.quiet, all remedies are sus- pended; he is occasionally supplied with a morsel of ice, cheering words are addressed to him, and sooner or later, in more than two-thirds of the cases treated here, reaction commences and progresses, if the patient were young and vigorous before the attack, to convalescence and recovery. The most intractable sequelfe we have had to contend with have been the effects of urajmic poisoning and dysentery. Autopsies have been made here, by Assistant Surgeon W. C. Minor, of several fatal cases of dj'-sentery following recovery from cholera, the invariable lesion appearing to be active inflammation and swelling of the solitary and agminated glands of the ileum, with great injection of the points of the solitary glands. The autopsies were made soon after death. Very respectfully, your obedient servant, JOSEPH B. BROWN, Surgeon, and Brevet Brig. Gen'I, U. S. A. Brevet Major General J. K. Barnes, Surgeon General. Proceedings of a board convened at Governor's island. New York harbor, by virtue of the following order: Headquarters General Recruiting Service, U. S. A., New Yo7-k City, September b, 1867. fEXTEACT.] II.. A board to consist of the following named officers will convene at Governor's island. New York harbor, this day at 3 p.m., viz: Brevet Brigadier General H. D. Wallen, U. S A., commanding depot; Brevet Brigadier General Jos. B. Brown, Surgeon, U. S. A.; Brevet Lieutenant Colonel Edw. P. Vollum, Surgeon, U. S. A.; Brevet Lieutenant Colonel John F. Randolph, Surgeon, U. S. A.; Brevet Captain W. C. Minor, Assistant Surgeon, U. S. A. The board will, after considering and informing themselves concerning the recent cases of cholera on Governor's island, and the present condition of the public health in New York, Brooklyn, and vicinity, also at the depot, report such regulations with regard to quarantine and other measures as they may consider necessary to prevent an increase of cholera at the depot, or its spread from thence elsewhere, or its importation to the island. They will also report whether, in their judgment, it is safe and Special Orders No. 175.](https://iiif.wellcomecollection.org/image/b21366044_0108.jp2/full/800%2C/0/default.jpg)
