The question, however, will arise, Can this principle be rendered available? Most certainly it can; and though it may not be convenient to introduce free caloric into the stomach, we can, by combination, introduce a stimulant of equal potency which shall be equally as prompt, effective and diffusive in its action, similar in its influence, and similar in its results. It is the principle—not the precise element for which we contend.
It is universally admitted that in many instances we may learn much from observing the manner of death which, in a majority of these cases of cholera, may be described by the term asthenia—a death similar to that which occurs in congestive fevers, and in some cases of accidental poisoning. Perhaps the most striking fact observed in these cases is the perfect exhaustion attending the last moments of existence, and the quiet, undisturbed manner in which life terminates. This very clearly shows the exhausting nature and congestive character of the disease, and gives us an idea of the course of treatment necessary to be pursued. If, then, there is anything to be learned from this source relative to its treatment, it does most certainly corroborate and strengthen the position we have here taken.
Another feature of the case in aid of our position consists in its entire accordance with the modes of treatment which have been most successful in the cure of cholera. The two formulas cited above, and now most universally adopted in Europe and India, are based on a similar principle. So in this country 1832,-33 and 34, the successful modes of treatment consisted in the adoption of a principle essentially similar. Hence we infer from the teachings of this experiment, and from all the collateral facts on the subject, that the general principle to be observed in the treatment of this disease is a prompt and diffusive stimulant; and hence we deduce the doctrine already apparent, that every form of treatment, to be successful, must be based on a prompt and effective stimulant of sufficient power to meet as speedily the indications required, as did the free caloric in the experiment to which we have referred.
Here we might pause for a moment and examine the suggestion and doctrines advanced by the learned Drs. Bell, Johnson, and many other eminent practitioners in India and Europe. We might further investigate the principles and trace the practical philosophy of such eminent surgeons, as Drs. Mackintosh, Thompson, Wallis Maxwell, Massy, Hill and Brady, all of whom have had opportunity of investigating the nature and character of the disease and extensive experience in its treatment.
We might also, in a further examination of the subject, embrace a host of American authors whose works teem with every shade of doctrine, and almost every variety and description of practice, some evincing a degree of skepticism on the subject more wonderful and marvelous than is becoming the great apostles of medicine. It would seem as if the guiding light of science and experience had forsaken them in this, the hour of their need; that facts and arguments had failed to illumine their minds, or direct their inquiries in the proper course for the discovery of "the truth." Their conclusions on this subject are, therefore, marvelously inconsistent and conflicting. Over this mass of specious and conflicting testimony we might long ponder, without deriving any very valuable information worthy an elaborate effort, or making any discovery to aid in the establishment of a general principle of practice for the cure of cholera. But this investigation must be deferred to another occasion, when time may permit a more thorough and critical examination of their doctrines and practice than can be presented in this brief essay. We would, however, remark in passing, that in some instances their philosophy, doctrines, and results may lead us to the same conclusion to which we have arrived from other sources as above, and from our regard and belief in the progress of science, feel compelled to advocate the same, as offering the best hope of success in the treatment of this disease.
In the employment of an anti-miasmatic principle and remedial agent, we feel ourselves abundantly sustained, by the concurrent testimony, of those English surgeons connected with the Medical Bureau in the department of India, whose numerous experiments and carefully detailed clinic cases occurring in the recent irruption and prevalence of the disease in that section, exhibit its utility in such a striking contrast with all former practice, as to leave no doubt as to its direct and specific action in the cure of cholera. It is in allusion to these experiments, and in answer to the question, what is deemed the most successful mode of treatment, that the learned Professor Maclean unhesitatingly observes, "Alkalies in the effervescing form, free stimulation of the surface, and chloroform in small doses, offer the best hope of relief." As this opinion comes from such high authority, and is compatible with the pathology of the disease, we may, without fear of controversy, add in conclusion, in any and every form of medication for the cure of cholera, we must not forget that chloroform is our sheet-anchor; and must be so combined and administered as to meet promptly the indications required.
Section II.—Physiological Condition of the Blood.
ITS NON-AERATION—NON-OXYDATION.
In the preceding section we alluded to the suggestions and doctrines advanced by the learned Dr. C. W. Bell, Physician to the Manchester Infirmary, and late Physician to H. M. Embassy in Persia—and also to Dr. George Johnson, of Kings College, whose views and doctrines, relative to the Pathology, illustrative of the congestive character and non-aeration of the blood, coincide with those of Dr. Bell. A brief examination of their philosophy and doctrines will show very conclusively the first direct impression of the poison—the gradually altered condition of the blood, and the corresponding loss of nerve power—the impeded arterial circulation and the general tendency to congestion, as well as the altered condition and stagnation of the blood, especially during the stage of collapse.
The question is asked, "What is the pathological explanation of this remarkable train of symptoms?" and the answer is given, "The one great central fact is this, that during the stage of collapse, the passage of blood through the lungs, from the right to the left side of the heart, is in a greater or less degree impeded." Very conclusive evidence as to the existence of impeded pulmonary circulation during life is afforded by the appearances observed in the heart, blood-vessels, and lungs after death.
After adducing the evidence of this impediment from post-mortem examinations, and affirming that the blood does not flow freely through the lungs and pulmonary arteries, which are often filled and much distended with blood, it is observed—"The most interesting and conclusive evidence that arrest of blood in the lungs is the true key to the pathology of choleraic collapse, is to be found in the simple yet complete explanation which it affords of all the most striking chemical phenomena of the disease, the imperfect aeration of the blood, and the suppression of bile and urine."