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

by Elijah Whitney; A. B. Whitney

In collapse, which is simply a more advanced stage of the disease, indicating the gradual failing of all the powers of life, our main reliance is on enemata, as noticed above, often repeated, and continued as occasion may require.

Rev. Dr. Hamlin, of Constantinople, observes, "It is difficult to say when a cure has become hopeless. The blue color, the cold extremities, the deeply sunken eye, the vanishing pulse, are no signs that the case is hopeless. Scores of such cases in the recent epidemic have recovered."

Here it may be proper to add, that a cure, even with the most efficient remedies, cannot be easily effected without placing the patient at the commencement in a recumbent position. This appears indispensable. The patient should be placed in bed and kept there in the horizontal position, comfortably covered with blankets, and with warm applications to the feet. Every necessary convenience should be at once provided to prevent, if possible, the patient from rising to, or standing upon, his feet, for the erect posture, before relief is fully obtained, will inevitably hasten the unfavorable termination of the disease. On this direction, therefore, the physician must insist if he would save his patient. Says an eminent physician, perfectly familiar with the disease, "This direction faithfully observed, and good nursing, will save very many patients even without medicine."

Of the auxiliary aids, consisting of various external applications, we cannot speak in very flattering terms. To the mind of the practitioner the more important are readily suggested, and are promptly employed by nurses in the earlier stages of the disease. It is impossible for any person to attend on a case of true cholera without being instinctively moved to apply heat friction, and warm stimulants to the surface for the relief of the suffering patient. Any attempt to prevent these kind offices and apparently beneficial appliances would be unwise, and most certainly, in private practice, unavailing. It becomes, therefore, necessary to direct the use of those which are most agreeable to the patient and tend to preserve and sustain the recuperative power; those which tend to weaken and depress the system are the most objectionable. Among the number that seem to do good, we may mention bottles of hot water to the feet and calves of the legs, hot bricks dipped in water and wrapped in flannel and applied to different parts of the body; blankets wet in water as hot as can be borne, and wrung out so as not to drip, and applied to the whole surface, and changed at short intervals, so as to keep up a steady and permanent temperature of the surface; flannels moistened with spirits of turpentine, or other stimulant embrocation, and laid over the stomach and bowels, may be employed, as these all, in some instances, seemed to be beneficial. Their necessity and use, however, must be governed by circumstances. As we have before said, our main reliance is on a prompt and diffusive stimulant internally; other means, at best, are very uncertain.

Such are some of the remedies evidently suggested by the pathology and phenomena of the disease, and adapted to meet and remove the more urgent, essential symptoms. They are not entirely new. They have been employed to some extent in former epidemics of cholera, and have sustained a good reputation as useful and curative agents in the treatment of this disease. The combinations here suggested are the result of observation and experience, and are intended to present the form in which these remedies can be exhibited to the best advantage. They are simple, prompt, and reliable, such as will leave the system, when the disease is subdued, in its ordinary condition, without any injury whatever to prevent its immediate return to its normal state of health. Let them be employed, and their utility thoroughly tested. They will bear the strictest scrutiny, and sustain their reputation untarnished under the most trying circumstances. Should the cholera appear again in our midst in its epidemic form, and these remedies be generally employed and properly administered, we venture to predict their efficacy will be abundantly proved in the successful result of saving more than nine-tenths of those attacked.

Section III.—Prophylaxis—or Means of Prevention.

In presenting a course of preventive treatment consistent with the origin and general character of the disease, we are necessarily limited to the means of sustaining the normal action of the system, and suppressing the operation of those causes which, by reducing the general health, tend to generate, foster, and develop the cholera. Of the former so much has been written and published, inculcating the general principles of hygiene, that it seems quite unnecessary to dwell on a subject so familiar to the great mass of community; yet, there are occasions when the most familiar truths have to be impressed upon the mind, by constant repetition, to prevent threatened dangers, and obviate the most serious consequences. In no instance is this more important than in time of prevailing epidemics; for it is an undeniable fact, that multitudes will neglect the most obvious principles of hygiene, and tolerate, with utter indifference, the most offensive nuisance, in and around their dwellings, and if attacked by disease, will often wonder why they, more than others, should be visited by a malignant disease, or become the victims of a prevailing epidemic. Hence the necessity of urging the observance of some of the most obvious principles of hygiene, in the preventive treatment of Asiatic cholera.

Pure air, pure water, and a frugal nutritious diet are Nature's great preventives for the thousand ills of life. These are the great essentials in sustaining the healthful and normal condition of the system, always of primary importance in preserving its tone and energy, and rendering it impervious to any miasmatic or epidemic influences. Therefore, the tone of the system should, more especially when epidemics are prevailing, be kept fully up to its normal standard. This cannot be accomplished without pure air,—whether our dwellings be located in the city or in the country; free ventilation of all apartments is of the first importance. Kitchens, sitting-rooms, dressing-rooms, and especially sleeping-rooms, should be kept constantly and thoroughly ventilated; cellars and vaults, too, should receive attention, and be kept free from a deteriorated or foul atmosphere. Everything within and without our dwellings, tending to impregnate the atmosphere with noxious effluvia, should be removed, and the foul air promptly purified by the use of appropriate disinfectants.

Pure water for drinking and culinary purposes is another preventive remedy, whose employment cannot be safely omitted. It is a well-known fact that, in various localities, wells only a few feet deep, which are mainly supplied by drainage or surface water, have proved a fruitful source, and in some instances a direct and efficient cause of epidemic cholera.

The water from rivers flowing past large cities and villages is often so impure as to render its use decidedly deleterious, if not an actual source of disease. In some cases they have been literally so filled with portions of fish, and other animal matter, that all city supplies were made endurable only by long-continued filtration. The waters of many of our Southern and Western rivers are rendered impure from the lime and surface drainage with which they are so highly impregnated that they often become a direct source of diarrhœa and cholera. Pure water, free from the impregnation of vegetable, animal and mineral substances, should be sought and obtained for domestic use.