Of 37 cases admitted 12 terminated in death, the remainder in complete recovery. [9]
All the cases in the above number were considered to belong strictly to the epidemic cholera of the season, characterized chiefly by depression of vital power, suppression of biliary and urinary secretion, and great tendency to death. Pains were taken to exclude from it allied affections, especially bilious, or as it is sometimes called, English cholera, of which there were many, and some grave cases. Want of care in this respect renders useless comparisons of the respective value of different modes of treatment; and it is suspected that it is more to such carelessness, to use no strange word, than to superior skill in the practitioner, that the high proportion of cures claimed in some instances should be ascribed. This is said without meaning to insinuate that one method of management is not better than another, or wishing to damp the inquiry in which so many men are now anxiously engaged, as to how more may be done than has yet been effected for choleral patients. In attempting to balance the respective merits of different lines of practice, it is also necessary, in order to render the comparison fair or instructive, to know whether as a whole, the cases treated by each were equally severe.
Of the 12 fatal cases which occurred here, eight of the subjects were in a state of complete collapse—cold livid and pulseless—on admission; in another collapse was nearly complete, and death speedily followed in all, without the slightest sign of re-action. In one of the remaining three cases, there were slight and transient periods of re-action, alternations of promise and discouragement for fifty hours, when fatal sinking came on. In the other two, the first danger was past, but severe re-actionary fever followed. In one there was restoration of the biliary secretion; in the other, during the last eighteen hours the subject had the complete appearance of a patient in West Indian fever, discharging largely from the stomach, and more sparingly from the bowels, a fluid exactly resembling black vomit.
In the cases, which terminated in recovery, the impression was severe, though not equally so; and in each the symptoms, as already stated, were considered clearly characteristic of the prevailing epidemic. In some of them no hope was entertained for a time; especially in two cases, where there was in excess, lividity of surface, cold sweats, corrugated skin, bent fingers and toes, and failure of pulse.
In considering the probability of recovery from cholera, there is reason to think that the manner of attack should be taken into account, jointly with the severity of subsequent symptoms. From what was observed here, it appeared that when there had been precedent diarrhœa, or when there had been—though sudden—a gradual progress to the collapsed state, there was a much better chance for the patient than when the disease, in overwhelming force, fell upon him at once. When, soon after eating a hearty meal, in perfect health, the subject is obliged to be relieved from duty in the ranks, or on deck, becoming in an instant faint and giddy, with a rush of fluid from the stomach and bowels, shrinking of features, fluttering pulse, coldness of surface tongue and breath—struck down, as it were, by electricity—to which soon followed the up-turned ecchymosed eye and whispering voice—when the disease thus sets in, it is doubtful whether art has any power to arrest, or materially modify its fatal career. Such, at least, is the impression from what was observed here; and such, without questioning what has been alleged to have been done by others, or disparaging the means they employed, it is apprehended will be the conclusion of most observers elsewhere.
The practice pursued in Haslar Hospital is submitted to the profession, not because it had any very eminent success, nor on account of its including new remedies, but because the proportion of recoveries was at least fully as large as that which has followed other modes of treatment; because there was some novelty in the combination of the means employed; and because it is thought that any contribution to the therapeutics of cholera will be acceptable.
Among the diseases allied to cholera which have been treated in Hospital during the last two months, should, it is believed, be included grave cases of fever, with striking predominance of gastric symptoms, and excessive discharges from the alimentary mucous surface, as well as the following:—
Forty-three cases of febrile diarrhœa, with rice water digestions, and strong choleral tendency.
Ten cases of colic, with spasms of extremities.
Twenty cases of bilious cholera, making a total, exclusive of fever, of 73 cases of allied affections, all of which have ended in cure, or are making favorable progress. Some consideration of these cases, and of the various appellations applied to cholera, have led to the following remarks on