50
REPLIES TO QUERIES ON THE TREATMENT OF EPIDEMIC CHOLERA. [Appendix
III.—THE TREATMENT.
Query No. 1.—General Indications—To remove the poison of the cholera from the body.
Bateson, R. S., Surgeon, Ben. I.—The poison manifestation is such that it requires sub-
duing rather than assisting by use of purgatives and so called poison-eliminating agents.
Donaldson, J., Surgeon, Mad. I.—We cannot eliminate the poison, I am convinced, by any
evacuatory processes which we can employ. Nature will do the work, and save life where it is
possible to do so, if we aid her and support the strength.
Duckworth, F., Assistant Surgeon, Mad. I.—As there is very little doubt that cholera is
caused by the absorption of some subtle but material poison, which is rapidly circulated and
quickly pervades every part and tissue of the body, the first indication points to the necessity
of assisting nature in its effort to eliminate this poison through the natural channels of the
human frame.
Gibbons, J., Surgeon, Mad. B.—I look on the prominent symptoms of a choleraic seizure,
vomitting and purging, as already fulfilling the indication of ridding the body of the poison.
These being in excess may prove fatally exhaustive ; but from a large and sad experience, I
think I have observed that in the cases where vomitting and purging have both been present,
there was active and violent re-action, and recovery often ensued. On the contrary, cases
marked by the absence of the effort of nature at elimination are most surely and rapidly fatal.
This leads one to speculate in the first instance whether a small dose of the poison or one
insufficient to prove fatal to the individual has been imbibed, and whether the effort of nature
ejected the poison ; or whether in the second instance, the dose has been an overwhelming one,
or the power of resistance in the individual less. Such a theory sufficiently accounts for the
fatality of the disease and its proved intractability to remedial measures. But although the
indications of treatment have been carried out with all the resources of science and skill, no
impression has as yet been made on the death-rate of the disease.
Gordon, A., Inspector General, Bom. B.—So far as my opinion is concerned, I believe that
we are as ignorant of the pathology of cholera as when the disease first occupied the attention of
medical practitioners in 1817, and that a successful or rational mode of treatment has yet to
be discovered. The remedies which have hitherto been proposed for the cure of cholera I
believe to be utterly valueless, and I am inclined to think that patients treated without medicine
have as good a chance of recovery as those who are drugged.
Irving, J., Surgeon Major, Ben. I.—Of only one thing do I feel certain; and that is
that it is only in the premonitory and first stage that medicine is of any use at all, and that
much, if not all, of the physic given in the latter stages of the malady might, with equal
advantage, be thrown into the close stool at once, rather than allowed to pass there by the
more tedious route of the intestines ; for where there is no power of absorption, medicine must
and does pass unaltered.
Lord, R. G., Surgeon Major, Bom. I.—The treatment by éliminants in the earlier stages of
the disease is not one that would seem to be supported either by reason or results. In the
third or re-actionary stage if the vomitting and purging have ceased, and the urinary excretion
has not been re-established and the escape of the urea thus effected, then what may be called
the elimination treatment may be appropriately resorted to ; the object being not to eliminate
the cholera poison from the system, but to produce such a discharge as shall afford a means of
escape for the agency which is producing the coma. The accumulation of urea in the blood
is provided against by the watery evacuations, and when these cease, its poisonous effects
become manifest by a tendency to coma ; the blood is rendered unfit for the proper support of
the large nervous centres, and so death results from the failure of their influence.
McDowall, C., Surgeon, Bom. I.—The watery purging in cholera does not void the "poison,"
but only the "germ" of the poison of cholera ; it is only after this has been for some time out
of the body, and after fermentation or decomposition has taken place, that the stools become an
irritant poison. Pettenkoffer, the Cholera Conference, and almost all physicians unanimously
recognize the fact that, as harmless fresh grape juice contains the germ of the poison alcohol,
so the recent cholera evacuations contain the germ of the poison of cholera. This is proved by
the success of stopping preliminary diarrhoea.
Seeing that, according to the above theory, the stools are not properly poisonous till after
they have been some time out of the body and decomposed, and that stopping of preliminary
diarrhoea has universally been acknowledged to be the most successful mode of treatment ; and
seeing also that the watery and saline purging renders the blood thick, poisonous, and in-
capable of circulating, and brings the secreting and absorbing organs to a dead stand still, and
almost infallibly causes death either in collapse or by uræmic after-poisoning ; seeing all this,
it is advisable to moderate the watery purging both in preliminary diarrhœa and even in
collapse.
Astringents, opium, &c., properly guarded by cholagogues and diuretics are of great use
when cautiously given. In cholera especially, medicines should be injected under the skin.
The cold douche (first tried by the Surgeon of the 72nd Regiment) is a grateful remedy and a
powerful stimulant. The moderating of the rice-water purging of choleraic diarrhœa and
cholera is a powerful mode also of preventing the spread of infection.