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

by Elijah Whitney; A. B. Whitney

Dr. Davies reports a case in which he used chloroform fifteen hours after the seizure with relief, but not with success, and observes that, in a number of cases occurring in the hospital, there were 22 cases in which, as severe symptoms came on, the chief remedy was chloroform, administered internally, in doses of from seven to ten minims every hour, half hour, or quarter of an hour, according to the severity of the symptoms. Of these 22 cases, 8 terminated fatally, and 14 recovered.

Again: "Out of 9 cases of cholera, and 13 of the worst cases of diarrhœa occurring in my own practice, and treated with chloroform, one died. All these were in the better ranks of life. In some of them, the warm bath (salt water) was used as an auxiliary, and the diet consisted of nothing but cold milk and water, with some carbonate of soda, ad libitum. The fatal case was that of a drunkard, who, probably, did not take the remedy. These cases varied in severity, from sickness and diarrhœa, and mild collapse, to sickness, diarrhœa, severe cramps, and great collapse, with almost clear watery evacuations, passing away involuntarily * * * Of 14 cases of cholera treated by Mr. Towers, Medical Resident of the Infirmary, many of them under my own observation, one died. The fatal case was that of a woman aged 63, who was previously suffering great depression, consequent on extreme destitution."

Again, says Dr. Davies, "It will probably be remembered that, in my second report, I expressed a very favorable opinion of chloroform in this deadly malady. I considered I had strong grounds for so doing, after observing the large proportion of cases which recovered under its administration. From the history of this last visitation in the county prison, however, the fact turns out, that, under some uncertain circumstances, the use of chloroform will not prevent the proportion of deaths being considerable. I have reason to believe that it was, from over-anxiety, given in too frequent doses in some cases, and that it thus rather added to the coma, which is one of the characteristics of the malady.

At the commencement of the outbreak, the doses were repeated every hour, or every two hours, and it is to be noted that the first seven cases recovered.

As the cases multiplied, the remedy was given every half hour, and, in some instances, every quarter of an hour; the result was that the next six cases died. Whether these cases had anything in them inherently more fatal, it is difficult to tell. The symptoms at first were about equal, and the differences did not show themselves until towards the end. There was next a recovery of seven cases in succession; in these the remedy was administered less frequently, but subsequently two deaths occurred under the less frequent administration.

The chloroform was administered also by inhalation, in some of the more severe cases of cramps, with the effect of affording relief in every instance. The inhalation was not carried so far as to produce insensibility. Although I am still of the opinion that chloroform properly regulated is the remedy of all others hitherto tried to be depended on, yet it cannot be considered a specific for cholera."

Mr. Steadman reports a very interesting case treated by chloroform. He observes, "The spasms were universal and extremely violent, as if knots were being tied in the bowels, countenance livid and cold, voice feeble, and all medicines rejected. In this condition gave chloroform combined with 'aquæ vitæ' and distilled water. The first dose had a partial but most satisfactory effect. In two hours after, as the symptoms manifested a disposition to return, gave a second dose, which entirely controlled all spasms, vomiting and purging. The patient was ordered cold rice and mucilaginous drinks, and had the chalk mixture with nitric ether prescribed. A dose of oxgall (gr. x) was given in course of the day, which produced the desired effect. In two days the patient was declared convalescent." The daughter, who had nursed the mother in this case, was seized soon after in a similar manner, except the dejections were more abundant and frequent. The mother having some of the chloroform mixture left, gave it to the daughter without advice or hesitancy, and obtained the same magic results. The first dose was only partial in its effect, but the second completely subdued the disease.

Such are the results of some of the experiments which have been made by the administration of chloroform; and, so far as appears, the first cases treated by inhalation were severe malignant cholera in the advanced stage, all of which recovered. So, also, those treated by the remedy used internally, combined with a prompt and decided stimulant like the spirits of turpentine, or aquæ vitæ and brandy, recovered. In all these cases the remedy appeared to meet the urgent demand, to remove the impediment to the circulation, to relieve the nausea and vomiting, and purging and cramps, and restore, in a very short time, the general action and normal tone of the system. Still we must admit, that some cases, treated by its internal administration, and also by inhalation, proved, on some accounts not satisfactorily explained, unsuccessful. Were these cases given in detail, it would be much easier to detect the cause of failure, or its questionable use in such cases; but we have only the bare fact that they were thus treated, without the manner or character of the combination, if any were made, being given.

Hence Dr. Davies, under whose direction these cases occurred, remarks, in view of this result, "that no reliance could be placed on chloroform alone." The correctness of this opinion cannot be questioned, for the experiments we have cited all show the necessity of a prompt and diffusive stimulant in aid of its action, to render it sufficiently prompt and powerful to meet and overcome the disease in the more rapid and severe cases. Chloroform, properly combined, offers the best hope of relief, and is, without doubt, the most perfectly adapted of any remedy known to the pathology and phenomena of the disease. There is no remedy, when properly combined, so capable of meeting all the indications required as this, and none that can be administered with more certainty of success.

In conclusion, we may, with much propriety, refer again to the pathology suggested by the authors cited above, and inquire whether the action of chloroform as a remedy in these cases be consistent? and whether as such it has that curative influence, or direct controlling power, to arrest, suspend, and cure the disease, so imperiously demanded? We have seen that, according to the opinion generally prevailing, the first impression of the poison is made upon the blood, and through it upon the nerves, especially those which, from their anatomical position, bear the most intimate relation to the blood-vessels. Through this channel the first invasion appears to be made on the ganglionic, the nerves of circulation. These nerves are distributed chiefly to the viscera and blood-vessels, and are at least very early involved and essentially disturbed, for their healthful action depends in no small degree on the aeration or oxydation of the blood. Says an eminent author, "The action of every ganglionic mechanism depends on the existence of certain physical conditions, among which the most prominent and important is the due supply of arterialized blood. If this be stopped but for a moment the nerve mechanism loses its power, or, if diminished, the display of its characteristic phenomena correspondingly declines." Hence the loss of power in these nerves, and their deranged action, the contraction of the capillary and pulmonary arteries, the impaired and impeded circulation and all the phenomena arising therefrom.