“Little is known respecting the nature of this disease; but the most rational opinion seems to be, that it owes its origin to a poison pervading the blood; deranging the balance between the arterial and venous circulation, impairing the nervous energy, and impeding all the functions of the various organs, excepting the secretions from the stomach and bowels; the preternatural excitement of which would seem to indicate an effort of nature to expel the disturbing causes from the system. This opinion obtains additional probability from the fact, which often has been observed, that the more profuse is the diarrhœa, the less fatal is the disease.
“Cholera may suddenly appear without manifesting any, or at least with very slight, premonitory symptoms; especially where the patient is labouring under any serious affection of the brain, lungs, or air-passages, when it will sometimes graft itself on the primary disease, and aggravate all its most various symptoms.
“On the first manifestation of premonitory symptoms, immediate recourse should be had to repeated friction in a wrung-out sheet, as in the earlier stages of fever. This will tend to stimulate the nervous energy, and to maintain or re-establish the balance of circulation between the arterial and venous systems; will counteract the disposition to internal congestion by promoting cuticular circulation; will aid the lungs by freeing the exhalants of the skin, and will forward the elimination of the virus through the same channels.
“But it will not be sufficient merely to attempt to resist the encroachments of the disease; the efforts of nature to expel the cause of it, also claim assistance. To this end cold or tepid water should be freely drunk to facilitate the vomiting, to dilute and weaken the action of the poison, to stimulate the kidneys, and to supply the waste of fluid in the blood. Dr. Rutty, in his synopsis, says, ‘It [the drinking of water] has also frequently been found efficacious in stopping violent vomitings and purgings, partly as a diluent, and partly as a bracer to the fibres; and in violent, deplorable choleras, cold water is recommended by the ancients, and at this time is ordered by Spanish physicians with good success, though Celsus orders it warm.’
“Enemata of pure water, tepid or cold, should likewise be freely administered; the quantity administered to an infant at one time should not exceed two ounces; four ounces would be sufficient for a child six years old; eight ounces for a youth of fifteen, and fifteen or sixteen ounces for an adult.
“But the principal process is long and entire friction, either in the shallow tepid-bath or in the sitz-bath. The latter seems to deserve the preference, inasmuch as it will more directly and powerfully aid nature in her efforts; its primary action being that of a purgative, while a less body of water will suffice, than could be made to fulfil the same intention in a vessel of the shape and size of the half bath; but, if the sitz-bath be employed, then friction with wet hands should be applied to the extremities. Cold water may be used in the sitz-bath, provided that there is nothing in the previous state of the patient to contra-indicate its use; in which case tepid water must be employed. Tepid water about 70° Fahr. may likewise be employed in the shallow bath, as the body of water therein must be greater than the sitz-bath; but warm applications are never indicated. Vapour-baths have been tried to recall the circulation to the surface, but without effect. On this point, Dr. Daun in his ‘Medical Reports on Cholera,’ says, ‘O’Brien lay on the steam couch for three hours before he expired, in a heat that I am convinced would have raised a lifeless body to a temperature nearly, if not equal, to that of a person in health; but his body preserved an icy coldness to the last.’ In this case friction in wrung-out sheets, or in the shallow bath, or perhaps the stimulus of the cold dash, would seem to be indicated.
“Cramps, in the extremities, should be combated with brisk friction, with wet hands to the parts affected. It is often necessary to draw off the urine with a catheter. Before the algid stage sets in, the heating bandage round the body may be very beneficial; but during the algid stage it should be omitted.
“The third stage or that of re-action, is marked by the following, among other symptoms; the pulse becomes fuller and harder, the skin becomes warm, and its livid discoloration disappears; the tongue becomes red and warm, the cramps cease, diarrhœa decreases and stops, and the kidneys begin to act. In this case it is well to encourage moderate diaphoresis in the dry blanket.
“The predisposing causes to cholera are any excess in eating or drinking, the habitual use of alcoholic liquors, unwholesome food, sitting with wet feet, a neglected cold, uncleanliness, impure air, deficient light or ventilation, and violent indulgence of the passions.”