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Page 11 of Account of spasmodic cholera as it appeared in the city of Lexington in June 1833 / by Lunsford P. Yandell, M.D.

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YANDELL on Spasmodic Cholera. The diarrhoea has scarcely made its appearance before spasms supervene, and the whole train of symptoms characterizing collapse are ushered in. In these cases, it is scarcely neces- sary to add, the issue is nearly always fatal. Treatment in the first stage. In this stage the only disorder of which the patient complains is disturbance of the bowels, with occasional nausea, and giddiness. This looseness of the bowels has been often mentioned by writers on cholera, as a premonitory symptom of the disease, which generally preceded it from one to five days. As the disease prevailed here, it constituted the initiatory stage, which was generally followed in a few hours, or at most a day, by the more une- qluivcacal symptoms. A premonition it was,so far as the mild stage of an affection may be considered as warning of the more aggravated stages which are about coming on. The treatment in this stage consisted, first, in confining the patient to his bed, and enjoining strict rest. This was an impor- tant preliminary. Dr. Rush has said, "the quickest and most effectual way of conquering fever, is by an early submission to it;" and the remark is equally true of cholera. With rest, and attention to keeping the skin warm, a single dose of calomel was, in most cases, sufficient to effect a cure. I gene- rally gave at the first dose 20 grains. If it was found that the looseness grew worse after the first dose, I repeated it in an hour or two, and then the dose was increased to 60 grains. I never considered it safe to trust to the first dose beyond two or three hours, if the watery discharges increased in frequency or became more copious, and when the access had been sudden and violent, I gave at once 60 grains of calomel, followed by 120 in a few hours, if the first did not check the discharges. This effect, I had the satisfaction to find, a large dose of calomel generally produced, and hence only in a few instances did I combine opium with it. In this way I seldom failed to relieve the patient in a few hours, when called in at this stage of the disease. The calomel promptly arrested the watery passages in most cases, and dark green, consistent matter followed in a short time. When this state 11