52
REPLIES TO QUERIES ON THE TREATMENT OF EPIDEMIC CHOLERA. [Appendix
Query No. 9,—continued.
the cholera poison ; for vomitting and purging seldom come on before the circulation is some-
what impeded.
Barnard, G., Surgeon, Ben. I.—It produces, or in its essence it is an inflammation,
specific or non-specific, no matter which, of the mucous membrane of the stomach and small
intestines.
Blackclock, A., Surgeon Major, Mad. I.—It excites the ganglia at first. The excite-
ment endures during the cold stage. Ganglionic debility may be paralysis following the
over-excitement,
Chalmers, C. B., Deputy Inspector General, Ben. I.—I am inclined to this opinion. Cases
are constantly seen where a patient vomits a meal which he has eaten, say, on the day
before the morning of the seizure, without any trace of assimilation having taken place ;
and all the symptoms of the disease point to this.
Clementson, F. L., Surgeon Major, Mad. I.—Very probably there is depression or
paralysis of the sympathetic and ganglionic system ; but whether the secretions are dimi-
nished, suppressed, or only suspended, remains an open question.
Daly, G. H, Surgeon, Ben. I.—My belief is that the primary action, or direct action
of the cholera poison, is on the blood, after being introduced either by the respiratory,
digestive, or integumentary apparatus ; and secondarily only on the sympathetic or gang-
lionic system, which it depresses or paralyses, causing diminution or suppression of the
secretions of the organs supplied by it.
Davis, W. F., Assistant Surgeon, Mad. I.—I believe it must be so, as there seems no
other way of accounting for the intense depression.
DeFabeck, F. W. A., Assistant Surgeon, Ben. I.—Pathological indications do not appear
to me to support this view :—
1st.—There is no proof that secretion is suppressed from want of nervous force, but
much to show that this condition is due to the deficiency of the circulating fluid from
which that secretion is derived.
2nd.—Post mortem examination shows, that the larger blood-vessels supplying the
lungs, the liver, and generally all parts of the system, are distended with accumulated blood,
while the capillaries are almost empty ; there, therefore, appears to be reason to conclude
that there exists a spasmic condition of the muscular fibres of the minor arteries and veins,
which form the connexion between the main trunks and the capillaries, and that hence arises
an exalted, rather than a diminished, activity of the vascular branches of the ganglionic nerves.
3rd.—It is more probable that the excited condition of the sensory-motor nerves, which
produces the cramps usually complained of by cholera patients, should be reciprocated by
the sympathetic system, than that this latter should assume a state of paralysis. This view
seems to be strengthened by the following considerations—
(a).—Vomitting is one of the urgent symptoms of cholera. A necessary condition for the
production of vomitting is obstruction at the pylorus. In this disease there can be no
other cause for such obstruction, than spasmodic contraction of the muscular fibres of the
lower third of the stomach.
(b).—The pain and uneasiness felt in the epigastric and pericordial regions can only, as
far as I know, be satisfactorily accounted for by this increased contraction of the stomach,
and probably also of the diaphragm.
(c).—The intestinal canal is almost entirely dependent, for its nervous supply, on the
sympathetic. If this supply were arrested, as it would be in paralysis, we should have this
depression and the interrupted discharge of bile into the intestines operating as powerful
causes to produce constipation. Thus there is nothing to show that the peristaltic action of
the intestines is any way impaired, and if it be granted that there is no positive proof to
indicate that action is exalted, there is none to establish that it is not as free as at any period
during health.
4th.—If cholera were associated with a paralysed condition of the sympathetic system
of nerves, injury, or impairment of function of this system under other conditions, would
produce results similar to those observed in cholera ; but this, it is well known, is very far
from being the case.
I should, therefore, rather say that the primary action of the choleraic influence is to
exalt the action of the whole or portions of the sympathetic system of nerves (notably their
ganglionic branches distributed throughout the vascular system), producing a condition of
spasm of the muscular fibres of the smaller arterial branches, of the ductus communis chole-
dochus and of the ureters, and that in consequence of this, circulation is impeded and secre-
tion and excretion impaired.
Donaldson, J., Surgeon, Mad. I.—-The suppression is owing, I think, also to failure of the
supply of healthy blood, the circulation partaking of the depression, and labouring on in a
much impeded or almost suspended state.