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

by Elijah Whitney; A. B. Whitney

Here we may ask, Will opium aid, or give the relief so urgently demanded? However serviceable as an astringent and anodyne in the premonitory stage of the disease, it cannot be exhibited in the second stage to so good an advantage, as its direct influence is to aid and promote congestion in those cases, where a tendency of this kind is already in existence. Hence, its continuance in the true or collapse stage of cholera is now generally considered faulty.

Once more: The auxiliaries employed in aid of the leading remedies already noticed may be summed up in the language of the celebrated Dr. Massy, in his instructions and directions on the subject of the treatment now under consideration. He observes, "But, 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."

To these directions there can be no special objections, except in the first instance in which he, indirectly, commends the use of means tending to deplete and depress the system, already brought by disease to the very verge of utter exhaustion. Remedies of this tendency are contra-indicated, and cannot, to say the least, be employed to advantage.

Depressing remedies generally, instead of checking, or counteracting the disease, will inevitably aid and hasten its fatal termination. Stimulants, such as are prompt and diffusive in their character, must be regarded as essential, and may be employed to great advantage. It will be found, however, exceedingly difficult in most cases, even where there is no depletion from bleeding, to keep up the waning powers, and carry the patient, through this formidable disease, to a favorable termination. Of the utility of warm applications to the surface generally, there can be no question; yet, our main reliance is on internal remedies, as has been already shown: the lost temperature of the body must be restored, the production and diffusion of heat, or caloric, must be internal through the administration of remedies, that will promptly and kindly produce this result.

What are, then, the remedies? We have ventured in this discussion to recommend the internal use of chloroform, and believe it will be found in combination with other prompt and diffusive stimulants, specially adapted to meet this condition. In this recommendation, we feel ourselves fully sustained by the result of various experiments heretofore made, and the recent trials of its use, as an internal remedy in the various stages of the disease.

The earliest record of the use of chloroform in cholera is probably to be found in the London Lancet for November, 1848, in which Dr. Hill reports a case of its successful use by inhalation. He placed the patient in bed, covered with warm blankets, and applied friction, stimulant liniments, and heated bags of bran to the surface, and kept the patient under the gentle influence of chloroform, till the more urgent symptoms entirely subsided. At intervals brandy-and-water, and thin arrow-root or milk was given. All other medicines were avoided. Though the urgent symptoms returned at first, as the effects of the chloroform passed off, they were easily controlled by the repetition of the inhalation. By persevering in its use, reaction set in, and the patient became convalescent.

Other cases, afterwards, were treated in the same way, with a similar result. Some, however, required the gentle use of chloroform by inhalation, at intervals, for twenty-four hours; after which, none seems to have been administered. For aught that appears these cases all recovered.

Another very interesting case is related by Mr. Brady, who observes that an elderly lady was seized with slight diarrhœa, which, on the following morning, had become very profuse: excessive vomiting supervened, accompanied by spasms in the calves of the legs, fingers and toes. Under these urgent symptoms, the usual remedy, brandy, was administered without avail; the dejections became incessant, and the spasms increased in intensity, presenting the features of a decided case of malignant cholera. In this condition, the physician was called in haste, as it was believed and affirmed the patient was dying. In describing this case, the physician observes: "On my arrival, I found the patient presenting all the symptoms of malignant Asiatic cholera, in an advanced stage; the features collapsed and ghastly; extremities and tongue cold; burning sensation in the stomach and œsophagus; pulse rapid and scarcely perceptible; voice diminished to a whisper; stomach exceedingly irritable, and the dejections from the bowels presenting the characteristic rice-water appearance; and all the voluntary muscles of the body were affected by spasm, so that the patient actually writhed in agony." Ordered the following: ℞. Chloroform ʒ j; Ol. Terebinth. ℥ j; aq. Dist. ʒ iij. M. And gave immediately a large tea-spoonful, in a wine-glass, of dilute brandy; and applied sinapisms to the calves of the legs and abdominal and thoracic surfaces. Thirst was relieved by drinking plentifully of water nearly cold. Though the stomach was irritable, the chloroform was retained, as well as the fluid drank after it, and was followed by no dejection. Half an hour after, two pills were administered, composed according to the following: ℞. Calomel gr. v; fellis. bov. inspis. gr. x; Ft. Pil. ij. Half an hour after these were given, vomiting ensued, but soon subsided; the diarrhœa had apparently ceased; the cramps had diminished in frequency and severity. A second dose of chloroform, now one hour after the first, was administered, and soon after this two more of the pills, both of which were retained, and gave decided relief. The pulse rose in power and became slower, the spasms less frequent, and, in an hour after the second dose, the patient was bathed from head to foot in a warm perspiration, and expressed herself comparatively free from all uneasy sensations. The attack had been completely subdued, leaving behind a good deal of pyrexia and debility, from which she rapidly recovered.

Here it is worthy of notice, that in this case, severe as it was, only two doses of the chloroform mixture were administered, each containing about six minims of chloroform and forty of turpentine; the pills would naturally tend to perpetuate rather than relieve the nausea and vomiting, and in one hour after the administration of the second dose, all the urgent symptoms were assuaged.

In another case, the attending physician reports that, after giving calomel, combined with opium, which was immediately rejected, the following mixture was ordered: ℞. Chloroform vj minims; brandy ʒ iij; water ℥ iijss, one-third of which was given immediately, and was thrown up in half an hour; a second dose was then given, and was retained. The vomiting and diarrhœa ceased; the spasms became less severe. In two hours after, gave the remaining third part; and during the next six hours, administered in two doses six minims more of the chloroform, with the most decided benefit, and the patient soon became convalescent. To the extreme tenderness over the region of the epigastrium flannel soaked in spirits of turpentine was applied; and as no urine was secreted, I am firmly of the opinion that the usual remedies would not have met this case. "I candidly confess," says the physician, "I had no hope of success from its severity; and, but for a knowledge of Mr. Brady's case, I believe I should have lost my patient."