ROBERT LEWINS, M. D.
To W. Maclean, Esq. &c. &c.
In the hands of a man of ordinary dexterity, the common injecting apparatus alluded to in my last will be found to answer the purpose perfectly well; but if the practice I recommend is, as I hope it will be, generally adopted, it will, I conceive, be expedient to advise that a regular and perfect transfusion apparatus be used; at all events, to warn those who inject to beware of allowing air to get into the vein. The tubes, of course, must be filled with fluid, as well as the pipe in the vein, before commencing, and considerably more fluid than it is intended to use ought to be in the vessel from which it is pumped.
R. L.
No. 3.
Leith, May 23d, 1832.
Sir,—My friend, Dr. Lewins, has communicated to me your wish for a detailed account of my method of treating cholera by saline injection into the veins, with which I now most willingly comply. My scope for observation, since I commenced this treatment, has been too limited to allow me to be very copious on the subject, but I think I can adduce sufficient proof to the unprejudiced, not only of its safety, but of its unquestionable utility. I have never yet seen one bad symptom attributable to it, and I have no doubt that it will be found, when judiciously applied, to be one of the most powerful, and one of the safest remedies yet used in the second stage of cholera, or that hopeless state of collapse to which the system is reduced.
Before entering into particulars, I beg leave to premise, that the plan which I have put in practice was suggested to me on reading in The Lancet, the review of Dr. O’Shaughnessy’s report on the chemical pathology of malignant cholera, by which it appears that in that disease there is a very great deficiency both of the water and saline matter of the blood. On which deficiency, the thick, black, cold state of the vital fluid depends, which evidently produces most of the distressing symptoms of that very fearful complaint, and is, doubtless, often the cause of death. In this opinion I am abundantly borne out by the phenomena produced on repletion by venous injection.
So soon as I learnt the result of Dr. O’Shaughnessy’s analysis, I attempted to restore the blood to its natural state, by injecting copiously into the larger intestines, warm water, holding in solution the requisite salts, and also administered quantities from time to time by the mouth, trusting that the power of absorption might not be altogether lost; but by these means I produced, in no case, any permanent benefit; but, on the contrary, I thought the tormina, vomiting, and purging, were much aggravated thereby, to the further reduction of the little remaining strength of the patient; finding thus, that such, in common with all the ordinary means in use, was either useless or hurtful, I at length resolved to throw the fluid immediately into the circulation. In this, having no precedent to direct me, I proceeded with much caution. The first subject of experiment was an aged female, on whom all the usual remedies had been fully tried, without producing one good symptom; the disease, uninterrupted, holding steadily on its course. She had apparently reached the last moments of her earthly existence, and now nothing could injure her—indeed, so entirely was she reduced, that I feared I should be unable to get my apparatus ready ere she expired. Having inserted a tube into the basilic vein, cautiously—anxiously I watched the effects; ounce after ounce was injected, but no visible change was produced. Still persevering, I thought she began to breathe less laboriously; soon the sharpened features, and sunken eye, and fallen jaw, pale and cold, bearing the manifest impress of death’s signet, began to glow with returning animation; the pulse, which had long ceased, returned to the wrist; at first small and quick, by degrees it became more and more distinct, fuller, slower, and firmer, and in the short space of half an hour, when six pints had been injected, she expressed in a firm voice that she was free from all uneasiness, actually became jocular, and fancied all she needed was a little sleep; her extremities were warm, and every feature bore the aspect of comfort and health. This being my first case, I fancied my patient secure, and from my great need of a little repose, left her in charge of the hospital surgeon; but I had not been long gone, ere the vomiting and purging recurring, soon reduced her to her former state of debility. I was not apprised of the event, and she sunk in five and a half hours after I left her. As she had previously been of a sound constitution, I have no doubt the case would have issued in complete reaction, had the remedy, which had already produced such effect, been repeated.
Not having by me the number of The Lancet containing Dr. O’Shaughnessy’s analyses, I adopted that of Dr. Marcet, only allowing a smaller proportion of saline ingredients. This I now find to be considerably less than natural, according to the more recent analyses. I dissolved from two to three drachms of muriate of soda, and two scruples of the sub-carbonate of soda in six pints of water, and injected it at temperature 112° Fah. If the temperature is so low as a hundred, it produces an extreme sense of cold, with rigors; and if it reaches 115°, it suddenly excites the heart, the countenance becomes flushed, and the patient complains of great weakness. At first there is but little felt by the patient, and symptoms continue unaltered, until the blood, mingled with the injected liquid, becomes warm and fluid; the improvement in the pulse and countenance is almost simultaneous; the cadaverous expression gradually gives place to appearances of returning animation, the horrid oppression at the præcordia goes off, the sunken turned up eye, half covered by the palpebræ, becomes gradually fuller, till it sparkles with the brilliancy of health, the livid hue disappears, the warmth of the body returns, and it regains its natural colour—words are no more uttered in whispers, the voice first acquires its true cholera tone, and ultimately its wonted energy, and the poor patient, who but a few minutes before was oppressed with sickness, vomiting, and burning thirst, is suddenly relieved from every distressing symptom; blood now drawn exhibits on exposure to air its natural florid hue.