Analyses OF WORKS AND SUGGESTIONS ON CHOLERA.

451

nearly in contact with the atmospheric air, on hand, and the tissues to be nourished, on the other, as Analyses OF possible. The parietes they do possess (if any) are of the thinnest and most permeable kind. ON CHOLERA. AND WORKS SUGGESTIONS These methæmatous channels present, as I have said, the all field circulation are on which the of the objects grand WE can no longer devote a separate review to each book or accomplished. As the arteries and veins are mere conduits, so the heart itself is but a forcing pump, or wonderful piece of pamphlet which reaches us on the subject of cholera; for the living machinery. The detection and the demonstration of name of these is legion. The most we can promise is, to give this machinery, in all its relations, a valve being the hiero- a brief sketch of the features of those which have glyphic, were the achievement of the great Harvey, and will lately reached us. Theleading titles &c. of the several works on end of time. honoured down to the his name carry But to return to my proper subject--the Law of Life. In which our remarks are made, have already appeared in our proportion to the surface of the lung on which the methsema- list of books received. tous channels are spread, in proportion therefore to the complexity of the structure of the lung, is the quantity of respiraDr. HENRIQUES, who states that he has practised in various tion, and, inversely, that of the irritability of the muscular parts of the world, insists upon a resemblance between cholera fibre; in proportion to the complexity of the lung is the and miasmatic congestive fever in their intrinsic nature, and activity of the animal. he presents his readers with a parallel of those diseases in a The fish has a mere gill, the batrachian has a mere vesicle, tabular form. He divides cholera into three stages, and rewith, or even without, subdivisions or sections. The lung of commends bark or quinine as the remedy most to be depended the triton is a mere vesicle; that of the frog and of the toad, upon, so soon as any of the prominent symptoms are devea vesicle with its surface somewhat augmented by partitions loped. It then, he says, carried slightly towards the centre. The lung of the serpent, "becomes imperative to suspend, that very instant, every the tortoise, the tribes of the mammalia and birds becomes of animal alimentation, as well as every class of vinouff, species In the insect and bird more and more complex and extended. and malt drinks, and ten grains of sulph. quinine spirituous, the extends over the general system, not tribes, respiration is to be given immediately. The diet should consist entirely being limited to one organ: in the insect, indeed, each articulate of to which should be added a sufficient quantity segment is furnished with an analogue of the medulla ob- of rice-water, table salt to make it palatable. Tea might be drank with longata, the central nervous organ of the reflex function of

placed the

as

one

,

____

I

the smallest quantity of sugar, but without milk." He adds, in " decided cases of miasmatic fevers, of whatever form or degree of this influence required to manifest the peculiar modification, that the Peruvian bark is the most efficacious irrito-contractile property of the muscle, the greater the de- and successful remedy; hence, by analogy and induction, we have been led to the administration of quinine in cases of £ gree of irritability of the latter. The degree of simplicity in the structure of the lung, and cholera throughout all its stages; when, however, there does the slight galvanic power required to manifest the property not exist any contra-indication, (those exceptional cases are peculiar to muscle, coincide, and are, together, exemplifications of very rare occurrence,) and throughout the whole course of£ of the Law of Life-that the degree of stimulus and the our experience, in no instance have we had to regret its employment." degree of nervous and muscular susceptibility are inverse. Frictions over the epigastric and abdominal regions, with Whatever the ratio between the quantity of respiration or of food, and the degree of excitability of the nerve and stimulating embrocations; tepid baths in the earliest stage, of the muscular fibre, in any animal, it gives us but not afterwards; perfect rest, a blister on the epigastrium, irritability the precise force of galvanism which is adapted for experi- injections per anum of decoction of bark, and friction of the ments on the nervous and muscular tissues of that animal, if extremities in the ensuing stage; and in the third, or reactional we would confine ourselves within the limits of physiology. This stage, the continued administration of bark with an unstimuprinciple, then, must be our guide in such researches, a point lating diet, are the remedies on which he mainly depends. not attended to by Signor Matteucci and others, who have Depletion and purgatives he abjures; mercury he has never therefore mingled pathological with physiological results. employed, except in conjunction with quinine; opium he conThe same law should guide us in experiments on other siders contra-indicated as "injurious, by narcotizing the physical agents. In the late Mr. Edwards’s beautiful work, system, and so diminishing the generation of heat." As proto ward off the disease, he recommends we may observe the same inaccuracy, in regard to the limits phylactics, " of temperature. Asphyxia is the more prompt as the tempera- , A generous and slightly-stimulating regimen; a regular, ture of the water in which the batrachia (the frog, for ex- temperate, and sober mode of living; daily exercise; tepid ample) are immersed is more elevated. But at a certain baths two or three times a week; damp clothing to be partielevation of temperature, the very heat itself acts positively cularly guarded against; two grains of sulphate of quinine to and, I need not say, pathologically, and the question is no I be taken every morning for six or seven days, then to be suslonger one in relation to mere asphyxia, but of a widely pended during as many days, and recommenced, and this plan different nature. Instead of being a question of the effects to be continued as long as the epidemic lasts." of exclusion of atmospheric air, it becomes a question of the positive effects of heat as a stimulus. The limits of physioDr. KENNEDY, of Woodhouse, Leicestershire, who is now logy are passed, and the region of pathology is entered. Such is the value, in physiological investigations, of an engaged in a gigantic undertaking connected with the " History of Medicine," published for private circulation, in 1832, intimate and accurate knowledge of this Law of Life. In our experiments with galvanism on the batrachian tribes, a Lecture on Asiatic Cholera, delivered by him in the same an apparatus consisting of the " couronne de tasses" is the year, and with a copy of which we have been favoured by a. most convenient. The power of this apparatus may be reduced valued correspondent. The pamphlet contains a learned and so as to be within the physiological limit, however great the interesting account of the history of the disease. The treatrecommended in it is mostly of a prophylactic nature: excitability and irritability may be; and our results will be so ment too. We may augment that power, and trace its effects, too, but on the invasion of the attack, camphor and laudanum in but we must consider them as belonging to the domain of small doses, fumigations of vinegar, camphor, and fragrant antiseptic substances; an anti-spasmodic poultice over the pathology. stomach, frictions of the extremities, with a liniment, of£ the direct current tetanoid the Physiologically, produces state on the nerves of the electrogenic frog; pathologically, which the blistering fly is an ingredient, &c., are recommended. it may perhaps be said not to do so. Such is the view to be The inconsistency of practising venesection is inveighed taken of Signor Matteucci’s results, and those of another phy- against: the immission of arterial blood is considered "a more feasible expedient." siologist. The " couronne de tasses," properly employed, may become Mr. MICHAEL THOMAS SADLER, of Barnsley, has produced a the test and the measure of the excitability and irritability in an animal, and so afford the means of comparing these with pamphlet, the most striking feature in which is the attempt to show that the source of the disease is terrestrial, or, in his the structure of the lung or the quantity of respiration. This view of the subject has never been pursued by any own words; " That we have, from facts, very strong evidence to lead us experimentalist. The first step in the inquiry has not been to taken. assign the specific cause of malignant cholera to some

respiration. Uf galvanism as the test of irritability, the other element the problem, I need not speak at any length. The less

in

the

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452 secret emanation from the lower parts of the earth, and that it is probably some agent analogous to electricity." He says," If there are magnetic storms, why should there not be choleric storms ? To be able to account for the irregularity of earthquakes, volcanoes, or the motions of the magnet, science must pierce to the depths below, and be able to watch the mighty operations there going on. This, however, is beyond its reach; but amongst other conjectures, if we suppose there is, as Humboldt suggests, a molten mass of nearly eight thousand miles in diameter, within twenty-one miles below our feet, (put in motion, it may be, by the influence of the sun and moon,) we may then suppose an agent generated by some action of those perhaps perfectly-unknown materials, that may account for the dreadful malady which is the subject of my paper; and the varying nature of the strata of which the earth is composed may conduct it in an irregular form and manner to its surface." The idea has been entertained by other persons, who have, however, not canvassed the subject at such length as Mr. Sadler; and doubtless in investigations into the still mysterious origin of cholera, and circumstances predisposing certain localities to its advent, geological as well as atmospheric conditions must be taken into account. In the endeavours to prove" that malignant cholera is infectious," and that simple diluents are amongst the most important accessories of the treatment, we conceive that Mr. Sadler is less happy. He

timid be dismayed at this assertion: a false dependence on specifics has brought many to the grave: a sound confidence in the skill and judgment of those whose life is spent in the study of disease and its treatment, has, under the Divine blessing, saved many. " In confirmed cases of malignant cholera, the treatment found most beneficial by the writer was the following:-Large doses of calomel at the commencement, followed by smaller doses of calomel and opium at short intervals; bleeding, if early, and indicated by circumstances; large mustard poultices to the spine and pit of the stomach; friction of the abdomen with hot flannel, or the application of flannel dipped in turpentine; friction of the extremities; artificial heat; alkaline mixtures, with small quantities of ether or brandy; soda water, or plain water in moderation, to allay thirst, (which, by-the-by, is unquenchable;) injections of hot salt and water, or of turpentine in salted gruel. Sometimes, if the skin was insensible to the mustard poultice, a small piece of linen dipped in strong liquid ammonia was applied to the pit of the stomach, and covered with flannel till the skin was affected. Emetics did not appear serviceable unless given very early. Astringents in this stage were of no permanent benefit. Quinine sometimes did good."

Mr. GREENHow, of Newcastle, reiterates many of the hints and the advice which have been given and urged with the view of warding off attacks of the cholera; and which, as he says, remarks,though perhaps very trite and very true, are trite truisms of " It is evident that in cholera the blood must lose a great too practical a nature to be omitted." He considers that the part of its serous element; and pathological facts show, in ex- influence of cholera, like the carbonic acid of the Grotto del amining the body after death, that the blood isof an oily or Cane, gravitates to the lowest situations. ropy consistence, very closely resembling tar or treacle;’ this " One fact connected with the history of cholera is most being the case, it requires but a very superficial knowledge of important to be kept constantly in mind-cholera is not a conanatomy to convince any one, that blood approaching to this tagious disease. It is incapable of being communicated from one state cannot possibly circulate through the fine capillary ves- human being to another, neither can it be communicated from sels of the system, and if it does not circulate through these, the dead to the living. Ample opportunities of careful obthe blood cannot undergo its proper changes in the lungs; all servation and in 1831 and 32, convinced us of this investigation secretions must be suspended, and death the result." great truth-truly great, as regards our conduct in reference But it is equally evident that " simple diluents, as water," to another visitation of this formidable disease..... The will not replace the "serous element" of the blood, even if the danger is not from the persons of the sick, but from the stomach can be got to receive and retain them. The advo- localities in which they have been seized with the disease, the cates of the saline treatment, applied to the system by the efficient cause of which, for the most part, settles down into various modes which have been adopted, will argue, and with hollows, the beds and margins of streams, and dirty recesses, some reason, that the fluids they aim to introduce into the into which a pure and wholesome atmosphere can scarcely at system, contain more of the constituents of the wanting serum any time find its way..... Such places, in a philosophical than pure water, and are therefore more analogous to the point of view, havea near resemblance to the celebrated Cave materials demanded to replace the loss suffered by the cir- of Dogs in Italy, so fatal to the canine race, while man enters culating fluids. Mr. Sadler is quite right in adding, imme- unharmed-simply, because his superior stature enables him diately after the passage last quoted, " Diluents may not save to breathe an atmosphere untainted by the deadly vapour the patient in such a state of the blood." which, lurking in the lower part of the cave, is sure to kill his dog. As in this instance, so in the endemic cholera, there is Mr. ALLEN, of Oxford, has written a very methodical, trite, a certain line of altitude, beneath which disease will certainly and, as we consider, excellent pamphlet of "Plain Directions take place, in degrees proportioned to the predisposition or for the Prevention and Treatment of Cholera,"* which we re- susceptibility of the inhabitants, which, in its turn,is dependent commend for perusal by both medical and lay readers. We upon conditions already referred to; above this line, on the extract from it the following passages:contrary, disease will either be entirely absent, or its occur"Put no faith in nostrums, specifics, or antidotes. In 1832 rence extremely rare..... Experience has proved that this eajeput oil had a great reputation as a cure for cholera: it noxious condition of the air cannot be purified by any artificial or chemical means that have been devised; and it is was found to be no more efficacious than other essential oils as cordial adjuncts to valid remedies. Opium was vaunted as an only by removing to a more healthy situation, on a higher antidote; it proved to be only serviceable in moderate and level than the endemic line already referred to, that the injudicious combination. Calomel was pronounced to be a spe- habitants can be saved from disease and death. The manner cific ; and, assisted by other means, it almost deserved the of effecting this migration, or the removal, en masse, of the name. Acetate of lead (sugar of lead) was extolled as a sure inhabitants of a locality so contaminated, whether by preand efficient check to the tlraining diarrhoea: yet fatal cases paring beforehand temporary houses in an airy situation, occurred under its administration. Saline solutions were reo beyond the boundaries of the town, or by pitching tents in garded by Dr. Stevens as a certain cure; yet, as Dr. Watson such a situation, on the spur of the necessity, must be detersaid, human beings were not so easily cured by salt as her- mined by committees of health and town councils, or other rings ; no doubt it was a valuable auxiliary. Tartar-emetic, authorized bodies .... Whatever might be the cost, it would doubtless be greatly exceeded by that of providing for many nitrate of silver, bismuth, croton oil, musk, nitrous acid, &c. &c., have had their several advocates. Latterly, naphtha has sick persons, and for the burial of not a few of the dead. gained a reputation for success in Russia; yet twelveout of It may safely be laid down as a good practical rule, that the every twenty cases at St. Petersburgh have been fatal; it has prevention of a great calamity is less costly than the loss sus. not been tried in this country, though recommended sixteen tained by its actual occurrence." years ago. Carbon and carbonic acid are strongly advocated by recent writers; experience must decide their merits." Mr. GowER, of Hampstead, in a MS. communication to us, " In 1832 people bought large bottles of cajeput oil, large bottles of laudanum, and large bottles of brandy: these were says-" I would suggest that effervescing mixtures (if admishould be made with lemon-juice, or citric acid, and carefully locked up in a cupboard, as charms against cholera: nistered) of tartaric acid and soda. In common with all instead potass, the in Faith were all untouched-except brandy. speci- neutral they salts, tartrate of soda increases the fluidity of the fics gave way before the test of experience, which proves no antidote has yet been discovered for cholera. Let not the blood, doubtless, but acts on, and passes away through, the bowels more freely than many other salts, a quality which warrants suspicion of its appropriateness in cholera..... In * Oxford : Vincent. London : Renshaw. Pp. 40.

that

453 degrees of intensity in contagion, so (and we speak from an experience of upwards of twenty-five years in respect of fever) this infectious property of cholera, (for we have witnessed it also,) assuming it to be contagious, is very feeble, indeed, contrasted with that of typhus, or the common continued fever of It will be recollected that in The Times of September 14 Mi, I that country." there was a letter from an Indian officer, who stated, that when in the Bengal territories, he became acquainted with a The recommendations of Dr. M’CANN, which were so highly Hindoo prescription for the cholera, consisting of assafostida, lauded by Mr. Hodgson, of Birmingham, in his evidence beopium, and the powdred root of the asclepias-gigantea, two fore the sanitary commission, (THE LANCET, for Oct. 7th, grains of each for a dose. Pills of this composition were kept p. 411,) may be summed up in the following extracts :in closely-stoppered phials, and when required for use, were For Prevention.-I recommend comfortable and nutritious bruised and administered, moistened with brandy-and-water, animal food of the solid kind, warm clothing, and attention to every half or three-quarters of an hour, and, as it would apregular hours, free ventilation and cleanliness; also limepear, with eminent success,-in India, at least,-since from the dwellings of the poor. I advise abstinence from three to five doses generally succeeded in checking the ur- washing spirituous liquors, from all fruit and raw vegetables, from all gent symptoms. Dr. Wise, of Dacca, to whom we are in- salt fish and oysters-the latter especially,-from all excesses debted for most of our knowledge of native Hindoo medithat debilitate the constitution; and, above all things, 1 deof to have these and cine, appears approved highly opium precate the strong purgativemedicines .... When sickness, assafcetida pills, for he states, in a letter dated April, 1847"When the patients are brought to the hospital, or when I with derangement of the bowels is felt, the patient (if an adult) should mix a tablespoonful of mustard, or double that see them first in a collapsed state of cholera, I give a pill of common salt, in half a pint of warm water, a broken down, (bruised in a spoonful of brandy-and-water,) and quantity third part of either to be taken every ten minutes until free repeat it; and I apply the tourniquet to the four extremities. vomiting be produced; after the stomach has been well cleared This throws several pounds of blood into the trunk, and disout with more warm water, thirty drops of tincture of opium turbs and removes the morbid action; and thus patients are should be given in a glass of brandy-and-water, to be followed cured when there is no chance with any other remedies." with a pill composed of five grains of calomel and two The tourniquet is an application to which Dr. Wise (wisely) np of opium; for an adult, small doses of these in the prograins attributes considerable influence. of three grains of calomel and half a grain of opium In the absence of the asclepias-gigantea, black pepper or portion to be taken at intervals of every two hours until bile is obis to have been with capsicum reported employed equal served to pass in the evacuation :’ mciency. Embrocations of heated turpentine, hot water in bottles or A practitioner whose letter appeared in The Times a few bandage tightly placed around the seat of pain, and " from days subsequently, remarked,-" Having for many years wit- jars, two to five drops of chloroform, in a little ginger tea or any nessed the uniform efficacy of a combination of capsicum and warm fluid, as one of the most efficient agents in removing in numerous cases of sporadic cholera, I adopted its opium choleric spasm," are the other principal remedial means on use in Asiatic cholera, with confident hope of success. I rewhich Dr. M’Cann places trust; and his treatment in the stage peatedly used assafaetida in the combination; I was, however, of collapse its as nearly allied as possible to that of the early in tried all the remedies the result. disappointed Having 23rd. science could suggest, with average success, I adopted the free stage."—CeM’OM Sentinel, Sept. use of calomel, from the suggestions of the practitioners in India. I found that, used in combination with opium and pepper, I had greater success than with any other remedy. I Medical Socíetíes. administered five grains every half-hour, with one grain and a half of opium and one grain of Cayenne popper (black pepper MEDICAL SOCIETY OF LONDON.

far as this salt irritates the intestinal canal it does mischief; besides that, in so far as it increases the secretion from the bowels, its action is diverted away from the kidneys and skin :’ so

-

in a fuller dose will

no

doubt

answer as

gradually diminished as reaction

well.

The dose

was

on, and the rice-water

MONDAY, OCTOBER 9, 1848.—MR. HANCOCK, PRESIDENT. ejections abated." CHOLERA. Capsicum, indeed, appears to be a useful remedy, or adjunct to more powerful remedies, in all climates. It is probable that Dr. said he had been informed by Dr. Pereim CLUTTERBUCK the malady might be checked on Indian soil by stimulant that a decided case of cholera had occurred in the London would unless in which combined Europe prove powerless drugs he therefore did not question that the disease now with a new and more active drug, such as calomel; for we can Hospital, existed in London. He should be glad to hear the opinion of to remain unaltered in the its wholly epidemic hardly suppose as to the best mode of treatment: he characters when transplanted into so different a clime. It is fellows of the Society had himself seen many plans tried, but had never satisfied far more effiwell known that cubebs, sarsaparilla, &c., prove himself of their success. He was inclined to take a common eient in their several uses, when employed in the countries sense view of the subject and palliate the symptoms, and where they are indigenous. trust to time for the result; as to any remedies being specific he was sceptical. If the patient were cold, he should apply Dr. W. REID, of Edinburgh, in a letter he lately addressed heat, and give stimulants, as brandy, ammonia, &c.; if there came

to Lord Morpeth, and in which he advocates that cholera may was vascular excitement, he should treat it on a moderate in certain cases become contagious, as yellow fever, erysipelas, antiphlogistic plan; if there was pain, he should give opium, and some other diseases are reputed to have become, has the as under other circumstances. As to attempting to cure the i following remarks:disease by calomel and opium, by oil of turpentine, naphtha, "It may have one character in the tropics, and display &c., he should not be inclined to resort to them, as no pathoanother within the temperate circles, yet continue still the logical view was given as a reason for their use. He was insame affection. It not being contagious in one district is no clined to think cholera was not contagious, as scarlatina or guarantee that it will not become so in another; for in the small-pox, but caused by an atmospheric influence. The first many concurring causes might not exist, which crowd organs principally affected were those connected with the dense and frequent in the latter. One man puts on the clothes spinal nervous system ; the effect was something like that of and sleeps in the bed from which another has been recently strychnine, appearing to affect the spinal, in contradistinction removed, a corpse from the yellow fever, (this is not an imagi- to the central nervous system. native case; we know, personally, it has actually been done,) Dr. LEONARD STEWART said the most staggering objection to and does not fall ill of that fever. His case does not prove it the non-contagion of cholera was, that it always appeared first is not contagious: the very buoyancy of spirits, and daring in seaports, although, at the same time, local circumstances hardiness which inspire his mind, assure the body against the might occur to cause it in seaports as well as in other places. poison of the fever..... We do not rush precipitately to a He had seen one plan of treatment successful, which was conclusion when we assert that we have no positive evidence suggested to him by a friend who had been long in the East that the cholera is invariably a non-contagious disorder; and Indies; he tried it in one decided case. Six grains of tartarized also, that onthe other hand, we have most satisfactory and antimony were dissolved in warm water, and half given, and undisputed grounds for saying, that it has almost, in its first repeated in half an hour; the first dose increased the sympvisitation of this country, uniformly affected the very same toms, the second threw the patient into a violent heat and localities and tracts which are the undisputed haunts of perspiration, and in ten minutes he was a changed man, and got quite well without further treatment. This was the only typhus." 11 This, further, however, we would subjoin, that as there are case he had treated on this plan, but his friend had used it