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

by Elijah Whitney; A. B. Whitney

Again, it is evident, from the views and doctrines cited above, that the disease is decidedly congestive in its tendency and character from its very commencement. The impeded flow of the blood—the comparative emptiness of the left ventricle of the heart and arteries—and the excessive loss of temperature, all indicate a rapid process of congestion attending the progress of disease. This is one of the peculiar and prominent features of cholera, and is strikingly exhibited in the morbid appearances observed in all those instances where death has occurred within a few minutes from the first indications of attack.

When the attack is violent, the process is rapid; when mild, it is slow; and even in the collapse stage progresses tardily. In either case it is the direct resulting consequent of the primary cause. How else can the violent attacks, suddenly terminating in death, be accounted for? To what other principle can this altered condition and stagnation of the blood be attributed? The evidence confirmatory of this position is abundant and conclusive. Many instances of the apparently rapid action of the cholera poison are related by Dr. Milroy, in a historical sketch of the epidemic of 1817; and at Kurrachee in 1855 and 6, it is said, that within little more than five minutes, hale and hearty men are seized, cramped, collapsed, and dead!!

When the disease broke out at Teheran, in May, 1846, Dr. Milroy states that those who were attacked dropped suddenly down in a state of lethargy, and at the end of two or three hours expired, without any convulsions or vomitings, but from a complete stagnation of the blood.

In the paper before us, it is stated, that "in a great majority of cases in which death has occurred during the stage of collapse, the right side of the heart and the pulmonary arteries are filled, and sometimes distended with blood; the auricle being partially, and the ventricle completely and firmly contracted. The tissue of the lungs is, in most cases, of pale color, dense in texture, and contains less than the usual amount of blood and air. There is something surprising in the contrast between the almost constant occurrence of this extremely anæmic condition of the lung, from which scarcely even a few drops of blood flow when the tissue is cut, and the hyperæmia of most of the other viscera." This impeded flow of the blood through the lungs, resulting, as it must, in a very scanty supply of blood to the arteries, in connection with the corresponding fact of the increased expansion of the veins, filled with black, and thick, and stagnant blood which, by the action of a powerful poison, or malignant disease, has become disorganized and unfitted for circulation, furnishes indubitable evidence of one prominent and characteristic feature of cholera which we term congestion, and to which we alluded in our remarks when the question under consideration was first introduced; in this view we are happy to find ourselves, on a more thorough examination of the subject, ably sustained by eminent pathologists and authors, who have arisen during the half century last past, and whose works are said to embrace all that is known and reliable on the character and treatment of Epidemic Cholera.

It is worthy of notice, before passing from this part of our subject, that according to Dr. Bell's views, the blood is forcibly sent into the great central veins, and there stopped in its course without any attempt to account satisfactorily for its singular arrest, at that point—Dr. Johnson comes to his relief, lifts the veil, and explains why it is kept there and cannot get any further. If the road, he tells us, had been clear and uninterrupted through the lungs, the blood would easily have got round to the left ventricle, and have again gone its round, but it is stopped by the spasmodic contraction of the minute branches of the pulmonary artery, which will not even allow the blood to enter the pulmonary capillaries, as shown by the remarkable anæmia of the texture of the lungs.

In this connection may be introduced an opinion as to the cause of the disease and some of its phenomena, which has obtained at least some celebrity, and attracted the attention, if not the careful consideration of the profession. It will account, in part, if founded in fact, for the physiological condition under consideration.

It is said, some have observed a chemical change in the constitution of the atmosphere, and have attributed the cause of the cholera to the loss or diminution of its ozone—a principle which is understood to represent what is very properly termed electrified oxygen. Ozone is, therefore, the vital element of the air. It is said that oxygen cannot be assimilated or combined with the blood except when it is in an electrified state constituting the peculiar property or state of ozone. In this state it produces vital electricity of the blood, which is the life. The brain is considered and represented as the reservoir of this vital electricity, and the nerves are the telegraphic wires or conductors of it. As a necessary consequence, all acts of material and intellectual life depend upon this double cause. The absence, then, it is affirmed, of this principle, termed ozone—or electrified oxygen—from the atmospheric air in certain localities and the consequent non-aeration or non-oxydation of the blood, may be considered as an efficient cause which will account for some of the most striking phenomena of the cholera.

Whether this electrified oxygen, or ozone, is identical with free caloric, it is unnecessary for our purpose at present to determine. It will be admitted that oxygen is the source of animal heat, and when introduced into the system generates its free caloric, which is an essential life-sustaining principle.

Dr. Massy, after describing a severe and advanced stage of cholera, observes, "The treatment of this case depends in the first instance on bleeding, and largely, if the patient's pulse is good, giving at the same time twenty grains of calomel with one of opium. This, he thinks, will be found the best practice. After twenty minutes, he gives ten grains more of calomel and half a grain of opium. He considers, however, a reliance on opium in this form of cholera most faulty—but observes, as you draw blood, stimulate, give punch, brandy, or wine and water, or carbonate of ammonia. Apply friction, with stimulating and hot liniments to the extremities, warm sand-bags to the feet, sinapisms to the calves of the legs and pit of the stomach; for, if you can once raise the pulse, the chances in favor of recovery will be vastly increased." The practice of bleeding and stimulating at the same time is deemed of vast importance. Dr. Bell coincides in this view, and devotes much space to the necessary instruction as to the time when and under what circumstances to bleed and to what extent, endeavoring to show the advantages arising from a strict observance of certain rules in carrying out this practice.

We have thus traced, in extenso, the views and doctrines of eminent surgeons and authors on the changes of the blood, and especially of the impeded circulation, to show, if practicable, the inconsistency of the more common and prevailing practice, and its utter inadaptation to the pathology and phenomena of disease. On the latter there seems to be little or no discrepancy—on the former there is a great diversity—as there has been no general principle established and laid down as the basis of treatment and cure of cholera. It has often been observed there is no disease on which so many different modes of practice have prevailed, some purely experimental, others empirical—and all without discovering an antidote to the poison, or any efficient mode of relief. The cause, or the poison producing the disease, still remains undiscovered. The direct mode of suspending and removing it, or counteracting its power and neutralizing its effect, and subsequently eliminating it from the system, remains still in doubt. What course, then, should the epidemic cholera again prevail in our midst, shall we pursue? Shall we rest satisfied with the diversified modes of treatment now prevailing? Or guided by the light of reason, science and experience, endeavor to adopt a general principle of practice, and exhibit and establish an efficient and judicious system, consistent with the pathology and the phenomena of the disease? Does then the practice, the prominent features of which are given above, accord with the indications required? In short, does the exhibition of bleeding and calomel and opium, accompanied with sinapisms, and hot, stimulating applications to the surface, meet the pathological condition and the phenomena of the disease? We have seen that the rapid changes in the blood, and the consequent direct tendency to congestion, are the proper and distinguishing features of the disease;—and hence the diminution of animal heat and general loss of temperature and their consequent effect, impeding the circulation, depressing and prostrating the nervous power—impairing and paralyzing the respiratory organs—suspending the functions of the liver and kidneys—enfeebling the action of the heart, and causing the capillary vessels of the mucous surfaces to pour off the serous fluid from the blood, and every muscle and tissue of the system with great rapidity, essentially constitute the phenomena of the cholera;—and that the constantly increasing augmentation of the poison and its intensified effects, measure the malignity, the violence, and the rapidity of the disease. Is there, then, any tendency in bleeding to arrest this rapid process of disease so disorganizing, depreciating, and enfeebling to the vital life-sustaining fluid, the blood? Can abstracting a portion of it, however large, suspend the poison, or its activity, or even check its progress in its rapid course and fatal termination? Can it have, under its depressing and depleting process, any tendency or power to relieve the congestion that is taking place, or change in any good degree the poisonous principle which is now generally admitted to exist in the blood, and to be the sole and efficient cause of its altered character and condition? The poison, once introduced into the blood, like the leaven hid in three measures of meal, will continue its activity, increasing its energy, and multiplying its forces, till the whole circulation becomes affected, and its life-sustaining power is destroyed and utterly lost, unless, by the exhibition of some remedial agent, it shall be promptly arrested in its progress, and suspended and eliminated. Again we ask, Will calomel fulfill any of the indications required? Has it any influence or power to arrest this disease, to quiet the nervous system, relieve the cramps, or restore warmth to the body? Its specific action, so far as known, can have no tendency whatever to relieve the system in any essential particular, or stay the progress of disease, or delay its inevitable result, if it remain unsubdued by the action of other remedies. Its action upon the liver, however prompt it may be, is only of a secondary importance. The primary cause must be overcome, its activity and energy suspended and the system generally relieved, or there is little hope in the case.