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Page 12 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. of things was brought about, the patient felt relieved, and was considered safe, and if he did not expose himself too soon to the sun, or commit some excess in eating, gave his physician no farther concern. To a number of my first patients I administered an emetic before giving calomel. I employed warm salt and water, with the addition, occasionally, of ipecac, or mustard, a tumrn bier full at a time, repeated every minute or two, until the effect was produced. It was always desirable that free vom- iting should take place in the course of fifteen minutes, and that the operation should be soon over. Slow, imperfect emesis produced not the desired effect. and the consequences of a large quantity of salt water being carried into the bowels, as they could hardly have failed to be injurious. were care- fully avoided. If the patient had just taken a meal the emetic had the effect of dislodging the undigested food; but the effect aimed at in the administration of this remedy was beyond this. It has been mentioned that the pulse was uni' formly below par, the skin cold, and bedewed with perspira- tion, and the countenance pale and haggard, all which symp- toms evidenced a deep-seated congestion. Whatever the original injury done to other organs, the heart seemed strug- gling with an unequal load. There was a disturbance in the balance of the circulation. The blood had retreated from the surface, and accumulated in the large veins of the interior. Such, at least, was the condition of the system, conveyed to my mind by the phenomena of the disease; and as there was usually no irritability of the stomach to forbid it, the emetic was given for the two-fold purpose of preparing the stomach for the reception of calomel, and giving a salu- tary impulse to the circulation. The skin generally grew warm under its operation, a profuse perspiration broke out, and the pulse became full and natural. When administered at a more advanced stage of the disease, I have seen emetics relieve the spasms promptly. I have given them with advan- tage, upon the occurrence of spasms, several hours after calo- inel had been taken, but before it had operated. I may 12