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

by Elijah Whitney; A. B. Whitney

Mr. Forward, an unprofessional gentleman of Kentucky, treated a large number of cases, during the prevalence of the disease among his employees, numbering over two hundred, without the occurrence of a single death. Another instance similar in principle is that of Dr. Browne, who reports a case treated by rectified oil of turpentine, with the most satisfactory and happy result. So, too, the late Dr. Sharp, of Paris, Ky., adopted a similar principle of practice, and became, thereby, eminently distinguished for the cure of cholera; his percentage of loss being very small indeed.

We might extend these statistics and references, and quote from the reports of many other distinguished physicians who have been very successful in the treatment of this disease; but these are sufficient for the purpose of directing our inquiries as to the utility and success of different modes of practice. It is immensely important to ascertain, if practicable, the general principle which has been most successful in the treatment of this disease, before it shall again make its appearance among us as a prevailing and fatal epidemic; especially when we realize and duly appreciate its vast mortality, as represented in the report now before us, that prior to its recent irruption and prevalence in India and Europe, nearly fifty millions of the earth's inhabitants have been swept away by this terrible scourge alone.

This estimate may, however, appear excessive and unworthy belief. Yet the general average for the forty-three years included is only a little over one million per annum, truly a vast number to be carried off by the prevalence of one disease alone. But, if we reduce this estimate within more reasonable limits, and take only two-fifths of it, or twenty millions, as an approximation to the truth, it would still be appalling, and imperatively demand, on account of the vast interests involved, the most rigid and thorough investigation as to both the direct and indirect cause of this vast sacrifice. It will also furnish us a sufficient apology for attempting a brief review and critical examination of the principles involved in the different modes of practice noticed above, in order to ascertain any failures or errors that may have, in some degree, operated as the indirect cause, in procuring this immense loss of life. All must admit that there are, in respect to the treatment of the cholera, great and palpable failures and errors which, though they have continued for nearly half a century, and have been sanctioned by high authority, as well as by long usage, ought nevertheless to be fully shown and exposed, so that they may henceforth be avoided. In our examination, there is but one rule to be observed, and one criterion of ultimate appeal by which to try each and every principle on which any mode of practice may be conducted. This universal and acknowledged rule is Pathology, the science which unfolds and exhibits the nature and character of disease, and "dictates the maxims of rational practice." It is the foundation and only base of rational medicine, which proceeds on the assumption that the nature and character of disease is fully known and appreciated. This knowledge is not only rational, but indispensable, in order to understand and apply the principles which ought to govern in the medication and cure of disease.

CHAPTER IV.

Section I.—General Principle of Rational Practice—Dictated by the Pathology of the Disease—Confirmed by Observation and Experience.

It has been observed that the essential characteristic, the leading and most prominent indications requiring special attention and permanent relief, 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; and that these prominent and essential features are correspondingly developed, and in their relation to each other are too intimate and dependent to admit the idea of priority and regular order of succession. The primary impression being on the blood, these proceeding, pari passu, together constitute the complex character of the disease, and suggest the general principle of rational practice. If our pathology be correct, it must be regarded as the foundation and only base for a successful mode of treatment, and must be allowed to dictate the maxims of rational practice in the prevention and cure of this singular disease. The neglect to apply to the treatment of the cholera the science of its peculiar and established pathology and phenomena, or to give heed to its teachings, has no doubt led to the errors and failures in practice, which, from their too general occurrence, induced the learned and celebrated Dr. Velpeau to declare, before the Academy of Medicine in Paris, that "we know nothing more of the treatment of cholera now, than on its first appearance in 1832. All our remedies and modes of practice have failed."

By observing the fundamental principles of the science of medicine, and adopting a mode of practice suggested by the pathology and phenomena of the cholera, these errors and failures, which have justly brought odium upon the so-called regular profession, will probably result in saving nine-tenths of those attacked, instead of losing that appalling proportion, as has been the case in some instances in years past.

What, then, is the principle which, for nearly half a century, has been strangely overlooked, and utterly disregarded by the so-called regular profession, so far as the maxims of rational practice are concerned in the treatment of this disease? We unhesitatingly affirm the principle suggested by the pathology of the disease is, and must be, one that will reproduce and resupply the lost caloric, or restore warmth to the body; one that will restore promptly the lost nerve-power to the ganglionic nerves especially; one that will arrest and remove the tendency to congestion, equalize the circulation and relieve the oppressed respiration, and thus mitigate the long train of dependent symptoms. For this purpose, a prompt and diffusive stimulant is required of sufficient power to meet these urgent demands, and suspend promptly any further depressing influence or action of the cholera poison. A stimulant, essentially different from alcohol in any of its forms, is required. Alcohol, except so far as it necessarily enters into the composition of medicines, is inadmissible. So, too, are all those stimulants whose action is violent, or tends to induce constitutional derangement, or impairs in any way the subsequent health of the patient. It must be one prompt, kind and diffusive in its nature, and peculiarly adapted to meet and relieve the essential urgent symptoms on which the whole train of non-essential symptoms depend. In short, it must be one possessing the singular properties of a stimulant, sedative and astringent, especially an arterial stimulant and antispasmodic.

In confirmation of this doctrine, we may refer to the general principle exhibited in the most successful modes of practice. During the prevalence of the cholera in 1832, the physician having charge of the Tenth Ward in this city, in which more than a thousand cases occurred, adopted as the principle of general practice in that ward a prompt and diffusive stimulant, which was, at that early day, regarded by him as based on the pathology of the disease. This principle was strictly observed and fully carried out in practice by all his assistants. The result, embracing the different stages of the disease, and some of the most malignant cases, was the curing and saving of more than nine-tenths of those attacked.

Another instance directly in point is the course pursued by Mr. Forward, an unprofessional gentleman, who had over two hundred laborers in his employ, among whom the cholera prevailed in 1832 with its accustomed severity. On its first appearance, Mr. Forward, unadvised, and depending on ordinary domestic remedies, adopted as the base of practice in the emergency a prompt and diffusive stimulant, which proved perfectly successful. Being advised to continue the same course, should any more cases occur, the result was, in treating a large number of cases, including thirteen in his own family, that all were cured. Again, on the reappearance of the cholera in 1835, the same practice was pursued, with the same uniform success. Can anything be more satisfactory or more conclusive as to the adaptation of a principle of practice to the pathology of the disease, or furnish better evidence of the correctness of the doctrine we have advanced?