56
REPLIES TO QUERIES ON THE TREATMENT OF EPIDEMIC CHOLERA. [Appendix
Query No. 9,—continued.
Thorp, E. C., Surgeon, Ben. I.—I believe the origin of cholera to be a loss of the energy
and temporary vitality of the sympathetic nervous system, or a morbid and exhausting irrita-
bility of the same system. I have seen amongst natives two or more cases where the patient
has been brought to the hospital in a state of syncope, not coma. The cases had neither
diarrhœa nor vomitting or cramps, but the sunken hollow eyes and cheeks, and signs of im-
perfect, if not suspended, aeration of blood were present, as in the most severe cases of ab-
dominal cholera. Nothing removed the intensity of these manifestations, and the patients died.
Thring, G. B., Deputy Inspector General, Ben. I—This may be so, but it is not an esta-
blished fact. If it is so, I do not think the poison could be eliminated by the secretions
from the particular organs under the control of the sympathetic and ganglionic nerves.
Tousdell, W. G., Surgeon Major, Bom. B.—Such is the correct idea.
Tarner, J., Surgeon Major, Bom. I—Most certainly, nervous depression is primary.
Van Someren, W. J., Surgeon Major, Mad: I.—When, in correspondence with this patho-
logical observation, we strike upon some medicine specially operative, and perhaps stimulant,
on these nerves, we may find treatment less empirical and more successful.
Wilson, R., Assistant Surgeon, Mad. I.—The primary action of cholera poison is to para-
tyze the sympathetic and ganglionic nerves ; and as these preside over secretions, the secretory
functions are suspended until this nervous system recovers its suspended action.
Wood, D., Surgeon, Ben. B.—The diminution or suppression of the secretions is an
evident fact ; but as to whether or not it be caused by the special action of the poison on the
ganglionic and sympathetic system, I am not prepared to offer an opinion. I think the poison
is swallowed. In certain states of the mucous membrane the germs increase rapidly ; in others,
this is not the case, and the poison is thrown off after the primary action, which is eccentric
and local.
Young, H., Surgeon Major, Mad. I.—I entirely concur in this opinion.
IV.—FIRST STAGE OR MALAISE.
Query No. 1—Indications.—To eliminate the poison through the secretions of the liver,
kidneys, and skin.—To avoid exhaustion or exposure.
Ellis, W. J., Civil Surgeon, Humeerpore, Ben. I.—A convict, young, hale and hearty, came
up to me one morning during an epidemic of cholera at Maunbhoom ; his countenance spoke
alarm and anxiety, and he wished to be removed or transferred during the crisis. I tried to
reassure him by telling him not to think of the matter and to attend to his task. Within
12 hours that man was no more. This no doubt was a case of fright or fear, and I Have
known of other cases ; but this struck me at the time most forcibly.
DcFabeck, F. W. A., Assistant Burgeon, Ben. I.—The disorder here introduced as the first
stage of cholera, I cannot recognise as being cholera at all. There is a combination of two
symptoms without which I consider there is no cholera, viz. (1st) rice-water evacuations,
with (2nd) suppression of urine. All the other symptoms may, and do, occur under other
conditions ; and conversely, were they all absent in a case presenting the combination of
symptoms above mentioned, I should regard such a case as one of true cholera. That diarrhœa
frequently merges into cholera, I cannot but admit ; but diarrhœa is no more cholera than a
combination of one equivalent of chlorine with one of mercury is corrosive sublimate. Under
this view, I treat cases of diarrhœa during cholera time very nearly as I would treat them at
another ; combining of course such precautions as may be indicated to prevent their running
on into cholera. But when once rice-water evacuations and suppression of urine occur, I
change my treatment entirely, just as, to pursue the above simile, a chemist would change
his treatment of a preparation of calomel to which another equivalent of chlorine had acci-
dentally been added.
Eteson, A., Surgeon, Ben. I.—I have not seen any marked line which could divide this
the first stage of cholera. During the occurrence of an epidemic I believe that every living
soul within its influence must be infected : and all experienced medical men are familiar with
a premonitory train of symptoms, which assumes greater or less severity according as the
individual has in his system that which favors the development of the contagion or
otherwise.
·
Fayrer, J., Surgeon, Ben. I.—Allay irritation, check purging, give calomel, grs. 10, opium
gr. 1 ; some mild astringent for relaxation ; counter-irritation to the abdomen.
Hunter, W, G., Surgeon, Bom. I.—I have not recognised this stage. I should call what is
here described as the second "stage or the stage of choleraic diarrhœa the first stage ; though at
the same time, I would observe that, the diarrhœa, though generally present, is not invari-
ably so.
McDermott, P. A., Surgeon, Bom. B.—-None that I know of. I have given calomel, Dover's
powder, and capsicum, with some success ; and phosphite of soda in good beef-tea at short
intervals ; also a mixture of ale and gin to allay thirst, and promote the action of the kidneys.