Asiatic Cholera: A treatise on its origin, pathology, treatment, and cure

by Elijah Whitney; A. B. Whitney

M.——S.: ten drops every fifteen minutes, in a table-spoonful of water. An opiate may be given with the first and second dose, but should not be continued."

The learned author to whom we have referred, after detailing some of the various expedients employed in the treatment and cure of cholera, sums up the whole under the common term—failure—and, in effect, declares the most powerful remedial agents ineffective and useless in controlling and subduing this disease.

This declaration is made in reference to the general result of the remedies and the various expedients adopted mainly by one class of physicians, to which special reference has been made. It is therefore partial, and confined solely to what is erroneously termed the regular practice. In declaring all remedial agents a failure, does not the author himself commit a greater failure in omitting to survey the whole subject of treatment, and to trace out and to show from the application of the pathology of the disease the probable cause of such failure?

However formidable this disease may appear, on account of its rapidity and its firm, unyielding grasp upon the vital powers, the forbidding and almost hopeless prospect of relief, and the lamentable results which have attended some modes of treatment, it seems particularly unfortunate for the profession that there should have been a disposition on the part of this learned author to abandon all remedial agents as comparatively useless, without a more thorough investigation into the cause of failure. On this point no effort or inquiry even is made. This is the more remarkable and surprising after dwelling at length on the pathology of the disease. It would seem as if all the light and science derived from this source for nearly half a century had been overlooked, or the pathology of the disease, from some cause not satisfactorily explained, had been deemed unworthy at least in this instance to dictate the course of treatment. This should govern in cases of cholera as in all other forms of disease, or else all our efforts and remedies will prove abortive. Now, had the doctor carefully investigated the various modes of treatment and compared the results of each, he might have come to a different conclusion. But, being confined and limited in his investigations, he is unable to discover anything reliable or worthy his commendation, except the formulas above and the recommendation of Dr. Maclean. Among all the remedies and expedients named, there is only one tending to fulfil, the indications required, and that one, though prompt and magical in its effects, has been unequivocally condemned, without looking beyond the transient result for any light it might shed upon the subject. How it should have escaped his notice and passed so long unobserved by the numerous professional gentlemen who had often witnessed the effect, and were anxiously searching for light and the means of affording relief to the suffering patient, is a most singular circumstance which can only be accounted for on the principle that they all were anticipating some strange phenomenon, or development of cure as mysterious as the disease itself, which led them to overlook the simple and effective means of relief so clearly represented and shown in their numerous experiments for something more heroic and powerful than as yet the imagination ever conceived.

If we trace the action of calomel, the use of opium, the effect of cupping, bleeding, blistering, etc., etc., we shall obtain no very desirable information; nothing valuable tending to indicate a correct principle of practice. If we go still further, and examine the tendency and effects of the various baths exhibited at Scutari, the use of the flesh-brush, the bare hand, the heated sand, the embrocations, the turpentine and other irritants, the boiling water, or the burning alcohol, skinning and cooking the patient alive, we shall be shocked at the enormous cruelty and barbarity that have been pursued, and turn from the repulsive exhibition, without discovering one ray of light to guide us in the right direction. Disappointed and baffled in our inquiries, shall we here abandon our investigations and dismiss the whole subject, because our course is involved in difficulties? Would intelligence and reason justify the neglect to improve the means at command? We think not; but rather induce us to advance in search of truth if the elements of success are not quite exhausted. Let us be encouraged and stimulated to untiring perseverance so long as there remains any experiment untraced and uninvestigated in its bearing upon the direct action of the disease. Had Dr. Aiken, or those other eminent surgeons who took part in those numberless experiments, instituted on the Continent and in England, especially those who initiated the process of injecting into the veins a solution of soda raised to a temperature from 105° to 120° Fahr., continued their investigations patiently and assiduously, they might probably have discovered long ago the correct theory of practice for the treatment and cure of cholera.

But they failed to see, or, if they saw at all, rejected the feeble ray of light struck out by the experiments in which they had themselves participated, and like the celebrated Dr. Hunter, who refused to listen to the discoveries made by his pupil, the indefatigable Jenner, who traced the identity of the variola with the common disease affecting the kine; and thence extracted the vaccine lymph and established a principle by which that loathsome disease and often recurring epidemic has been nearly banished from the earth. Though they have thus failed, they have nevertheless left on record, in unmistakable language, the result of their bold experiments, which we may investigate, and appropriate the instruction drawn thence for our own and the advantage of our fellow-men.

What, then, are these results, regarded as shedding light on this intricate subject? We refer only to one the most obvious which we have already cited above. Let us repeat and analyze, and, if practicable, show the principle evolved. There was, on various occasions, the solution of soda injected into the veins at the temperature from 105° to 120° Fahr.: a higher temperature could not be borne. This process was performed slowly, thirty minutes being occupied in injecting the ten pints. Now mark the result as the operation proceeds. Says Dr. Aiken, "After the introduction of a few ounces, the pulse, which had ceased to be felt at the wrist, became perceptible, and the heat of the body returned." Mark the language: "only a few ounces" were required to arrest for the time being, the progress of the disease and restore warmth to the body; a very remarkable fact, replete with instruction, as will appear as we proceed. Again says the Dr., "by the time three or four pints had been injected the pulse was good, the cramps had ceased, the body, that could not be heated, had become warm, and instead of cold exudation on the surface, there was a general moisture. The voice, before hoarse and almost extinct, was now natural; the hollowness of the eye, the shrunken state of the features, the leaden hue of the face and body had disappeared; the expression had become animated, the mind cheerful, the restlessness and uneasy feelings had vanished; the vertigo and noises of the ear, the sense of oppression at the precordia, had given way to comfortable feelings; the thirst, however urgent before the operation, was assuaged, and the secretion of urine restored, though by no means constantly so." Such is the astonishing result obtained by this experiment, and this, too, when only three or four ounces had been injected—all the urgent symptoms mitigated and relieved. What, we ask, could have been more satisfactory, or better calculated to aid the discovery of an important truth? Every distinctive and fatal symptom for the time is relieved, and the normal condition and functions of the system restored; a result which could only have been obtained by the evolution of a principle of sufficient promptness and power and diffusibility to arrest and utterly suspend for a time the force of this disease.

What, then, was the principle evolved in this experiment, which gave immediate relief? Did it consist in the half ounce of muriate of soda alone, or in the four scruples of sesquicarbonate of soda alone, or in the ten pints of water alone, or in the whole combined, or more especially in the high temperature to which the solution was raised? It is a well-established fact that, in order to raise the temperature of cold water to blood heat and above, a large amount of free caloric must necessarily be absorbed, and exist mechanically in the fluid; and, in this condition, the solution was introduced into the veins, and there evolved its vast amount of free caloric, which immediately permeated every organ of the system, arresting disease, raising the temperature of the body, and restoring its normal functions. Of this there can be little doubt. For free caloric is one of the most prompt, effective and diffusive stimulants known, and was evidently in this case the remedial agent which produced the result. True, it may be said the effect was transitory, and passed off as soon as the caloric became eliminated. This, however, cannot alter the nature, character, or influence of the principle on which it was produced. It is usually admitted that a remedy that has power to control disease, will, by its continued action and influence, restore the normal condition of the system permanently, or at least aid Nature to repair her own work. By this we would not be understood as advising a repetition of the experiment under consideration, even under the most urgent circumstances; far otherwise would be our advice. We are arguing for the purpose of evolving and establishing a general principle of practice.

The great question, then, is, Did the principle evolved fulfill the indications required? and if so, is it available and consistent with the pathology and the peculiar phenomena, or symptoms of the disease? To settle this point, we need only turn to the law and the testimony, the very highest authority on the subject. The doctrine now universally accepted and prevailing regarding its pathology is, that a poison, virulent, and subtle, and unknown, has been absorbed and infects the blood, so that, after a longer or shorter time, a primary disease of this vital fluid is produced, by which the vital energy is impaired, and all other morbific changes induced. The term "Algide," first used by the French Pathologists, very accurately describes one of the most remarkable and constant symptoms, viz., the diminution of animal heat. On this depend the altered condition of the blood, the depression of the nervous power, the impaired functions of the respiratory and all the vital organs which are essentially involved by the disease. The icy coldness of the surface, the breath, the extremities and general loss of temperature, all show the character of the disease and the wants of the system.

Did, then, the principle evolved accord with the pathology and phenomena of disease? And did it fulfill the indications required? If not, we ask by what means was the disease arrested, and all the urgent symptoms mitigated and relieved, or by what were the good effects produced, and the normal action for a time restored? Can the result be reasonably accounted for on any other principle than the one assigned—the stimulating power of the free caloric? We think not; for it accords most perfectly with the pathology and the peculiar phenomena of the disease. It assuaged the more urgent symptoms, answered the imperious demand of the waning powers, revivified and reinvigorated the vital energies, and restored for the time the normal tone of the system. What more could be desired in any single agent than the result here obtained? That it accomplished all this, there can be no question, according to the statement of the learned professors who have repeatedly witnessed and described the results.