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

by Elijah Whitney; A. B. Whitney

And again, says the learned author, "It is obvious that the stream of blood from the pulmonary capillaries to the left side of the heart is the channel by which the supply of oxygen is introduced into the system. One necessary consequence, then, of a great diminution in the volume of blood transmitted to the left side of the heart must be, that the supply of oxygen is lessened in a corresponding degree. This position, probably, will not be disputed by any one who will give the subject a moment's consideration. Nor, again, can it be denied or doubted that certain results must of necessity follow this limited supply of oxygen." * * *

"The blood in cholera is black and thick only during the stage of collapse; in other words, during the stage of pulmonary obstruction and defective aeration."

Again, in his explanation of the injection of the solution of soda into the veins of the suffering patient, it is affirmed, "The benefit, however, is of but short duration, for the primary cause of the impeded circulation, namely, the poisoned condition of the blood, being still in operation, * * * the stream of blood through the lungs will soon again be obstructed, and the patient thus passes into a state of collapse as profound as, and more hopeless than, before. It appears, therefore, that the hot saline injection into the veins and the operation of venesection, when it rapidly relieves, as it often has done, the symptoms of collapse, have this effect in common, that they facilitate the passage of the blood through the lungs, and thus lessen that embarrassment of the pulmonary circulation which is the essential cause of choleraic collapse. But whereas the hot injections act by removing the impediment which results from spasmodic contraction of the arteries; venesection acts by relieving over-distension of the right cavities of the heart, and thus increasing the contractile power of their walls."

Such are, in brief, the views of the learned Drs. Johnson and Bell, whose works are very highly commended by their American editor to the notice of the profession. These views, coming as they do from the highest authority, fully sustain the doctrine that the earliest impression of the disease is made upon the blood, and hence it becomes altered and changed in its most essential life-sustaining principle; for its oxygen becomes diminished, its consistency augmented, and its flow through the lungs impeded. Through this channel the effect of the poison soon makes an impression on the ganglionic mechanism, and the nerve-power becomes correspondingly diminished, and the action of the ganglionic nerves essentially deranged. But this is not all: they exhibit in the clearest manner the congestive character of the disease, and show the necessity of prompt and decided means to arrest this tendency. Hence, they urge, in the strongest terms, the importance of observing carefully this essential feature, and endeavor to exhibit fully the condition of this vital fluid at a particular stage of the disease, when bleeding, as recommended in their practice, is required, and may be performed to the best advantage for the relief of the partially congested blood-vessels, and to stimulate and give freedom to the circulation. The passage of the blood, they affirm, is impeded, clogged, and partially suspended. To remove this obstruction, relieve spasm, and secure the prompt aeration of the blood, in hope of arresting the progress of this disease, is ostensibly the object. However, they seem studiously to avoid the most logical conclusions of their explanations, and justify a practice that can give no hope of permanent relief, while every fact and symptom is ominously suggestive of the wants of the system, which imperiously demands the aid of electrified oxygen, ozone, or free caloric, for the oxydation of the blood.

Says Dr. Reid, "I believe the true explanation of the arrest of blood in the lungs to be this: The blood contains a poison, whose irritant action upon the muscular tissue is shown by the painful cramps which it occasions. The blood thus poisoned excites contraction of the muscular walls of the minute pulmonary arteries, the effect of which is to diminish, and, in fatal cases, entirely to arrest the flow of blood through the lungs."

Says Dr. Wallis, "The phenomena which are exhibited when the deleterious air has been drawn into the lungs are these: the great gastro-pulmonary nerve is either wholly or partially paralyzed; the consequences are the cessation of all its functions, either wholly or partially. This great nerve is a nerve of function, and performs the functions of digestion and respiration, and influences all secretions."

Dr. Maxwell, of Calcutta, uses the following language: "The development of the stages of fever entirely depends on the changes the leaven has effected. If this change has been such that the blood has become too thick to flow through the lungs, then, as a matter of course, the collapse stage is developed in excess; in other words, cholera asphyxia is exhibited. The blood, unable to pass through the middle passage into the arteries, collects and swells out the veins, giving that deadly or blue color to the skin. When the vomiting and spasms come on, this mass of blood in the veins is squeezed with great force, and hence the clammy moisture that is forced from every part during these fits. There is no pulse, because there is no blood in the arteries." "There are also lethargy and languor, and oppression in breathing, caused by the blood being collected in the veins. These make up the principal links in the chain of mechanical symptoms."

Dr. Bell, dwelling on this congestive character of the blood, and endeavoring to point out the best mode of relief, observes, "When this has reached to such a point as to oppress the action of the heart, yawning first and then shivering, or a sense of suffocation and pain in the precordia, are the indications of oppressed circulation, and of the commencing effort of the heart to overcome the mass of blood which is stifling it. If, by the application of tourniquets to the limbs, or by bleeding, part of the blood which is rushing from the extremities to increase this congestion is prevented from reaching the great veins, the heart, excited to increased action, is enabled, by this relief, more quickly to overcome the obstruction and restore the balance of the circulation, and the paroxysm passes off. If not thus mechanically aided, the heart, after a severe struggle to maintain the circulation during the period of constriction, is at length relieved by this nervous disturbance or spasm of the capillary circulation passing off of itself, and then the heart and arteries, so long excited by the struggle, maintain for a time their increased action after the obstruction in the capillaries is removed, and produce apparent febrile action. Presently this excitement subsides, the vessels become relaxed, and sweat succeeds. The vessels continue in this state for a longer or shorter period, according to circumstances, till they at length recover their ordinary tone and action in the intermission. This fever, however, is not fever properly so called, but reaction; and the sweating not critical, or essential, but relaxation. The cold stage is alone essential, and is the physiological cause of the subsequent stages."

From the passages we have cited, it is quite evident that Drs. Johnson, Bell, Parkes, Reid, Wallis, Maxwell, Massy, and many others, admit this congestive character and impeded circulation of the blood to be the result, or consequent of a primary affection of the blood, as we have already observed in a former paper. The term "Algide" is peculiarly expressive of the diminished animal heat, and, as Dr. Bell represents, it is the cold stage which is alone essential, and is the physiological cause of the subsequent stages. It is the specific disease-poison, so often referred to, that has been inhaled, the leaven that has effected such obvious changes in the blood. The poison, virulent, and subtle, and unknown, so marvelously active in its operations, that is exhibited so prominently in all the works we have perused as the one great, mysterious, and efficient cause which produces the disease called cholera, and all the phenomena of its development. To its direct and specific action, therefore, must be attributed all the phenomena of the disease as the resulting subsequent consequences.

It is also further evident, from the pathological facts and arguments adduced in support of this theory of congestion, that the abnormal condition or state of the blood-vessels is the result and the product of the activity of the primary or final cause, and must be regarded in relation to it as cause and effect. On this principle alone, the thickening of the blood, the contraction of the left ventricle of the heart, and of the capillary and pulmonary arteries, assigned by some as the cause of choleraic collapse, must be accounted for. These effects are not and cannot be from a process independent and outside of the primary disease action, but are the result of such primary action.