CII.—Cholera.
Spasmodic or pestilential cholera first appeared in England in 1831, and in France in 1832; great difference of opinion exists as to its cause, and hardly two practitioners agree as to the best way to effect a cure. Some persons think, as many would get well without medical aid as with it; and this conjecture is supported by what took place on its visitation in Dublin. The numbers attacked were so great, that for the humble class, large tents were erected outside the city, and the medical men were so harassed by their own connexions within it, that the poor were left very much to fate. On comparing notes of the mortality that took place, it was found, that the number of deaths of those who received medical aid, and those who were deprived of it, were about equal. Pages might be employed in enumerating instances related, in which the cholera was cured by cold water, though administered without reference to any hydropathic rules. In 1832, Cholera made great ravages in Silesia, when numbers at Freywaldau and the neighbourhood, fell victims. Priessnitz’s patients did not escape, though they avoided its fatal consequences. A friend of mine, who was at Gräfenberg at the time, assures me that in cholera, Priessnitz never lost a case, though seventeen of his patients, and many persons in the neighbourhood, were treated by him. My landlord at Freywaldau, confirmed the last of these statements, and said that his daughter fell a victim, who, he felt persuaded, would have recovered, had she been treated with water instead of drugs.
To ward off this disease, and place the system, if attacked, in the best condition to resist it, we ask the dispassionate reader, are not hydropathic rules in accordance with reason and common sense?
There are three different stages in cholera; the first is that of a common diarrhœa, accompanied with oppression of the chest, anxiety, and collapse of the face; if neglected, it assumes a more serious form, the pulse becomes weak, and there is a difficulty of respiration.
The second stage is ushered in by giddiness, great depression of pulse and of the vital energies, with spasms, accompanied by purging and vomitings.
In the third stage, the patient is suddenly laid prostrate, serous fluid, in large quantities, is discharged from the bowels and stomach, with cramps and spasms, hardly any pulse, and difficult respiration. Under ordinary treatment, this frequently terminates life in a few hours.
To those who have witnessed the wonderful results of the Water-cure treatment in cholic, diarrhœa, &c., it must be evident, that in the primary stages of this malady, the treatment resorted to in those complaints, would be perfectly effectual; and that cholera, in its worst and most fearful form, is to be successfully combated by no other than hydropathic means.
If, after visiting a contagious case, Mr. Priessnitz feels at all uncomfortable, he takes a packing-sheet and tepid-bath.
Asiatic Cholera.—On the first appearance of Cholera symptoms, which are generally those of languor and chilliness, do not wait for a development, but apply most vigorously a rubbing-sheet; then dry the body, and administer a clyster of cold water. In two or three minutes repeat the rubbing-sheet and clyster, wait five minutes and repeat the same a third time. Then a cold sitz-bath, letting two attendants rub the patient with hands dipped in water, particularly on the abdomen, the whole time; water should be drunk whilst in the sitz-bath, until patient vomits; when cramps in the stomach and vomiting have subsided, place a large bandage round the body, and put him to bed well covered up. After sleeping, apply a tepid-bath with friction for some time. If not cured, renew the whole operation.
If, after the sitz-bath, cholera appears on the advance, warm a blanket, and pack the patient as in the sweating process; if he remains therein several hours, and the symptoms do not decrease, renew the whole proceedings, and again try to produce perspiration; when effected, keep it up two or three hours. After this a tepid-bath 62° with friction. The success of the treatment very much depends upon drinking abundantly of water. The bandages used, should be doubled or trebled, and changed often. If patient is unable to stand or sit upright, lay him on a bed, and let several attendants rub him all over with wet hands.
Extract from a letter from Dr. Gibbs to the editor of the “Water-cure Journal.”
“You cannot have forgotten the consternation of the profession when this fearful disease invaded us in 1832. Neither can you be ignorant that the faculty, generally, are as ill prepared to contend with it now as they were in former years; but for the information of those who may not be as well acquainted with such matters as you must be, I beg to make an extract from the minutes of the proceedings at a meeting of the Western Medical and Surgical Association, as reported in the Lancet of September 19, 1846. In the course of a discussion on the treatment of cholera, Dr. Cahill said, that he ‘positively felt a creeping of the skin at the relation of the enormities which had been perpetrated by practitioners upon their patients. When he listened to the recital of practitioners who described the extravagant cases of mercury and of opium which they administered, he could not refrain from fancying that he was witnessing the orgies of so many Indian savages, whilst counting the scalps of their victims. He thought it a pity that the invention of such a system of torture should not experience the fate of the inventor of the brazen bull, and illustrate upon his own person the efficacy of his infernal ingenuity. He believed that in the majority of persons who died of Asiatic cholera, death was the consequence of the treatment rather than of the disease. He had seen above a thousand cases of Asiatic cholera; and in no instance had he seen any benefit from any mode of treatment. On the contrary, he had seen persons die of narcotism, who would have survived if left to the vis medicatrix naturæ. He had seen others die of absorption of air through the veins when the saline fluid was ejected; and he knew many who had had the extraordinary luck to escape both the doctor and the disease, yet rendered miserable for the remainder of life by the effects of the immense doses of mercury which had been given to them during the cholera paroxysms. In fact, it was afflicting to contemplate the sufferings which the rash and empirical practice of the profession in the management of this epidemic had created.’The learned gentleman likewise said ‘With respect to cholera, since nothing was known of its nature, and no treatment had any influence over it, the best plan was to do as little as possible: give carrara, soda, or pump-water, with a little laudanum, perhaps in the diarrhœal stage, and the patient would not be deprived of the chance which nature had given him.’
“It is to be presumed that the doctor had not seen this disease treated by the Water-cure, under the operation of which, if I am correctly informed, and as I can readily believe, results very different from those, which he witnessed, were obtained. It is stated that more than twenty cases were successfully treated by Priessnitz, and between thirty and forty at Breslau, by a clergyman, whose name I regret that I have forgotten; and it is added that neither practitioner lost a patient by death. The treatment adopted by each of them was nearly the same; the principal difference between them being, that the one employed the sitz-bath, and the other the shallow tepid-bath.
[“]If on the appearance of the premonitory symptoms, judicious treatment be promptly adopted, it seems not improbable that the disease may be cut short. Those symptoms may be any combination of the following:—shivering, dizziness, a ringing noise in the ears, a small quick pulse, accelerated respiration, languor, præcordial anxiety, a cold white tongue, nausea, vomiting, severe gripings, and watery diarrhœa. If it be not checked, the disease quickly passes into the second or algid stage; the circulation becomes feeble, the blood is drained of its fluid, the muscles are contracted and cramped, the tongue is colder and whiter, the thirst becomes burning, the lips livid; the features contracted, the extremities shrivelled, and the skin cold, clammy, and discoloured.
“Little is known respecting the nature of this disease; but the most rational opinion seems to be, that it owes its origin to a poison pervading the blood; deranging the balance between the arterial and venous circulation, impairing the nervous energy, and impeding all the functions of the various organs, excepting the secretions from the stomach and bowels; the preternatural excitement of which would seem to indicate an effort of nature to expel the disturbing causes from the system. This opinion obtains additional probability from the fact, which often has been observed, that the more profuse is the diarrhœa, the less fatal is the disease.
“Cholera may suddenly appear without manifesting any, or at least with very slight, premonitory symptoms; especially where the patient is labouring under any serious affection of the brain, lungs, or air-passages, when it will sometimes graft itself on the primary disease, and aggravate all its most various symptoms.
“On the first manifestation of premonitory symptoms, immediate recourse should be had to repeated friction in a wrung-out sheet, as in the earlier stages of fever. This will tend to stimulate the nervous energy, and to maintain or re-establish the balance of circulation between the arterial and venous systems; will counteract the disposition to internal congestion by promoting cuticular circulation; will aid the lungs by freeing the exhalants of the skin, and will forward the elimination of the virus through the same channels.
“But it will not be sufficient merely to attempt to resist the encroachments of the disease; the efforts of nature to expel the cause of it, also claim assistance. To this end cold or tepid water should be freely drunk to facilitate the vomiting, to dilute and weaken the action of the poison, to stimulate the kidneys, and to supply the waste of fluid in the blood. Dr. Rutty, in his synopsis, says, ‘It [the drinking of water] has also frequently been found efficacious in stopping violent vomitings and purgings, partly as a diluent, and partly as a bracer to the fibres; and in violent, deplorable choleras, cold water is recommended by the ancients, and at this time is ordered by Spanish physicians with good success, though Celsus orders it warm.’
“Enemata of pure water, tepid or cold, should likewise be freely administered; the quantity administered to an infant at one time should not exceed two ounces; four ounces would be sufficient for a child six years old; eight ounces for a youth of fifteen, and fifteen or sixteen ounces for an adult.
“But the principal process is long and entire friction, either in the shallow tepid-bath or in the sitz-bath. The latter seems to deserve the preference, inasmuch as it will more directly and powerfully aid nature in her efforts; its primary action being that of a purgative, while a less body of water will suffice, than could be made to fulfil the same intention in a vessel of the shape and size of the half bath; but, if the sitz-bath be employed, then friction with wet hands should be applied to the extremities. Cold water may be used in the sitz-bath, provided that there is nothing in the previous state of the patient to contra-indicate its use; in which case tepid water must be employed. Tepid water about 70° Fahr. may likewise be employed in the shallow bath, as the body of water therein must be greater than the sitz-bath; but warm applications are never indicated. Vapour-baths have been tried to recall the circulation to the surface, but without effect. On this point, Dr. Daun in his ‘Medical Reports on Cholera,’ says, ‘O’Brien lay on the steam couch for three hours before he expired, in a heat that I am convinced would have raised a lifeless body to a temperature nearly, if not equal, to that of a person in health; but his body preserved an icy coldness to the last.’ In this case friction in wrung-out sheets, or in the shallow bath, or perhaps the stimulus of the cold dash, would seem to be indicated.
“Cramps, in the extremities, should be combated with brisk friction, with wet hands to the parts affected. It is often necessary to draw off the urine with a catheter. Before the algid stage sets in, the heating bandage round the body may be very beneficial; but during the algid stage it should be omitted.
“The third stage or that of re-action, is marked by the following, among other symptoms; the pulse becomes fuller and harder, the skin becomes warm, and its livid discoloration disappears; the tongue becomes red and warm, the cramps cease, diarrhœa decreases and stops, and the kidneys begin to act. In this case it is well to encourage moderate diaphoresis in the dry blanket.
“The predisposing causes to cholera are any excess in eating or drinking, the habitual use of alcoholic liquors, unwholesome food, sitting with wet feet, a neglected cold, uncleanliness, impure air, deficient light or ventilation, and violent indulgence of the passions.”