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

by Elijah Whitney; A. B. Whitney

Again, the great pneumogastric nerve, which is composed of both motor and sensitive filaments, has a very extensive distribution in the upper part of the abdominal cavity. It supplies the organs of voice and respiration with motor and sensitive fibres, and the pharynx, œsophagus, stomach and heart with motor influence. This very important nerve, through the primary action and deteriorating process of the cholera poison, becomes early involved, and its functions greatly, and, in fatal cases, permanently deranged. The evidence of this disturbance and loss of nerve-power is too obvious to be overlooked or disregarded in the treatment of this disease.

In confirmation of this, we may, with great propriety, adduce the testimony of Dr. Wallis on the loss of nerve-power, and the process through which the result is produced, who observes, that "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."

Hence it appears the nervous power generally, as before observed, is very early and essentially impaired, and to such an extent that there can be no rational hope of relief, unless some remedial agent can be found that will exercise such a controlling influence and power, as shall be adequate to restore the tone of the nervous system.

Hence, we are forced to the conclusion that the prominent, leading, and most urgent symptoms requiring special attention, are "the Algide" or loss of temperature, the loss of nerve-power in the ganglionic and pneumogastric nerves and their branches, the altered or disorganized condition of the blood, the impaired or obstructed circulation, and the early and direct tendency to congestion. These are the prominent and essential features to be observed in the treatment. They are too intimate, dependent and inseparable, to warrant any attempt to mark the precise order of their development. They are the essential phenomena, proceeding equally and directly together from the primary cause and disease action, and strictly constitute the complex character of the cholera, and exhibit its main, distinguishing features, which must necessarily govern and dictate the maxims of rational practice in the treatment of this disease. The object, then, of first importance is to restore the lost temperature, the caloric already eliminated, and prevent its further depression; to restore, at the same time, the lost nerve-power to the nerves again; to arrest the process of disorganization of the blood, and equalize the circulation; to relieve and suspend the congestion; and then, according to all the experiments which have been made, the consequent and dependent phenomena of the cramps and the vomiting and the purging will disappear.

Section III.—Different Modes of Treatment.

After speaking of the various expedients resorted to for the cure of cholera, says Dr. Watson: "I believe that each, in some cases, did good, or seemed to do so; but I cannot doubt that some of them did sometimes do harm. I had not more than six severe cases under my own charge, and I congratulated myself that the mortality among them was not greater than the average mortality. Three died, and three, I will not say were cured, but recovered, * * * under large and repeated doses of calomel. Yet, as I said before, I do not venture to affirm that the calomel cured them." It seems that Dr. Latham commenced the treatment and Dr. Watson followed it up, repeating the half-drachm doses of calomel many times, as the patients seemed to rally after its administration. Again, he observes: "It was remarked of those who recovered, that some got well rapidly and at once, while others fell into a state of continued fever, which frequently proved fatal, some time after the violent and peculiar symptoms ceased. Some, after the vomiting and purging and cramps had departed, died comatose—over-drugged—sometimes, it is to be feared, by opium. The rude discipline to which they were subjected might account for some of the cases of fever." * * * "Never, certainly, was the artillery of medicine more vigorously plied, never were her troops, regular and volunteer, more meritoriously active. To many patients, no doubt, this busy interference made all the difference between life and death. But if the balance could be fairly struck and the exact truth ascertained, I question whether we should find that the aggregate mortality from cholera in this country was any way disturbed by our craft."

In a report by the acting physician to the Bellevue Hospital, made to then "Special Medical Council," August 2d, 1832, while the Epidemic Cholera was still prevailing there and in the city, the physician says: "The treatment I have divided into two kinds—the pathological and the mixed. The first having been determined on, after the careful examination of twenty-three persons dead of cholera; since then, ten more have been examined, which serve to confirm the conclusions first formed.

Pathological Treatment.—First Stage—This consisted in the administration of blue pill and opium with absolute diet. If pain was present, leeches to the epigastrium and arms, and when these could not be procured, cups to the epigastrium. This plan never failed to arrest the disease in the hands of those who diligently pursued it, where the mucous membrane of the gastrointestinal canal was not previously diseased.

Second Stage.—First, Blood-letting; second, diligent frictions with the ointment alluded to above, when persons could be procured to perform the duty; third, ice to allay the thirst; fourth, small doses of brandy and laudanum, if the vomiting continues; fifth, cups to the epigastrium, if there was pain and the brandy omitted.

Third Stage.—First, ice to allay the thirst, which is now, indeed, unquenchable; second, external heat; third, a continuation of the frictions; fourth, no opium, and, frequently, no brandy, especially among the children.