No. II.]
VI.—THIRD
STAGE—COLLAPSE.
75
Query No. 6,—continued.
some degree of animal heat. Under circumstances of great difficulty, for there was no suitable
apparatus at hand, I have injected into the circulation large quantities of weak saline fluids
heated to 100° F., with no other than a transient improvement, and often not even that. Again,
before profound collapse, I have injected from four to six ounces of spirits of wine and water
heated to 100° F., and I have repeated it several times at short intervals without any appre-
ciable effects. In one instance, however, the patient, a native woman, became at once
maniacally delirious; she started up in bed with glittering eyes, and after violent struggles,
sank down exhausted. She ultimately recovered but was attacked during re-action with double
pneumonia, and after this warning I made no further trial.
I remarked that the effects were hardly noticeable in Europeans, while all the natives
were excited to a greater or less degree. Perhaps the brain tissue of the one was less accus-
tomed to such a stimulus than that of the other class, and responded to it in the case I have
alluded to, with wild exaltation of function. I did not attempt the injection of alcohol during
deep collapse, believing that its oxidation could not possibly take place while the capillary
circulation was entirely arrested.
Carter, II. V.., Assistant Surgeon, Bom. I.—Despite the transient effects of transfusion, there
are grounds for more fully trying the operation in a complete manner. Do not give alcohol.
Callen, P., Assistant Surgeon, Ben. I.—For a short time I followed Dr. Honigberger's
suggestion on his theory of a cholera mite in the blood, and I cut my patients and rubbed
them with quassia, but only to see them die without the least apparent benefit.
Fasson, S. IL, Surgeon Major, Mad. B.—I have found the functions of the kidney restored
to action best by counter-irritation over the loins in the form of mustard sinapisms or blisters.
When relieved from its state of congestion, the organ returns to its duty.
Greenhow, H. M., Surgeon, Ben. I.—For feeble action of the heart, the best remedy is
bleeding, repeated several times. Spirits are worse than useless in this as well as in the
following stages.
Hadaway, J. M., Inspector General, Mad. B.—The effect of transfusion is quite evanes-
cent. I have seen camphor in powder given with the same object. The action of the heart
and the color in the face were restored, but only for a few seconds, leaving the patient if
anything more debilitated.
Hunter, W. G., Surgeon, Bom. I.—I never saw any benefit from saline transfusion.
Alcohol is, I believe, powerless.
Joseph, J. M., Surgeon, Mad. I.—In thirty-one cases where transfusion of saline fluid into
the veins was practised by me in the year 1848, the action of the heart was immediately
restored in a very remarkable manner. The pulse returned to the extremities after the third
or fourth stroke of the piston ; the cholera voice began in a short time to change into a more
natural tone ; the body hegan to get warm, and the whole aspect of the patient soon changed
for the better. But these improvements were of short duration, and the effects lasted only
for a period varying from 30 to 50 minutes. Twenty-nine cases proved fatal and two recovered.
I did not attribute these recoveries to the transfusion.
MacLeod, A. C., Surgeon Major, Mad. I.—I regret that my experience does not afford any
information respecting the effects of transfusion. I cannot agree that alcohol is powerless
as a stimulant. Used at intervals, I think it a valuable remedy, especially in extreme collapse.
Even when discharged by vomitting, a little is probably retained, which finds its way into the
fluids and acts as a stimulant.
The spontaneous rising of the action of the heart is indeed the most welcome of all
indications ; at the same time, I hope I shall not be thought paradoxical in asserting that even
this might, by artificial means, be brought about too soon. On this point I venture to quote
from my work on Acholie Diseases, page 178 :—" It only remains to be noted in addition
that even the stagnation of the circulation, whilst the work of elimination is going on, is
another indispensable element of the defensive process. So long as any of that subtle
poison pervades the blood, this cannot flow too slowly ; the more quickly it passes through
the parts it supplies, the more, it is evident, must they be subjected to the injurious influence
it contains. The machinery of life cannot go on beneficially till this be expelled. It is
therefore all but suspended, and carried on at the lowest possible rate compatible with life."
The "stagnation of circulation;" the universal congestion of the viscera ; the heat and
blood of the body all drawn from the surface to the interior ; the suspension of all glandular
secretions, hepatic, renal, pancreatic and salivary ; the subsequent watery evacuations ; these
and all the "symptoms" of cholera I regard as but parts of a great functional convulsion for
the ejectment of a poison whose presence is incompatible with life, and by this view of the
pathology of the disease I am influenced in the. treatment.
Miles, H. L., Surgeon, Bom. B.—Alcohol is not only powerless, but pernicious, in this stage.
Mills, J., Surgeon Major, Bom. I.—The only stimulants I have found of much use in this
stage are ammonia and ether, and specially the formula 10 grains, of the sesquicarbonate
repeated every 15 or 20 minutes with camphor.
20