REPORT
ON
THE TREATMENT OF EPIDEMIC CHOLERA
BY
JOHN MURRAY, M. D.,
INSPECTOR-GENERAL OF HOSPITALS, INDIAN MEDICAL DEPARTMENT.
Cholera is a specific disease marked by characteristic symptoms which run
a defined course, varying according to the intensity of the attack and the stage
of the disease. It spreads and multiplies. It is reproduced, and therefore it
belongs to the vital or animated kingdom; but whether vegetable or animal is
uncertain. It has recently been reported as having been detected as a fungus,
by the microscope, and again this fungus has been considered as merely one
of the signs of decomposition on which the germ, of the disease flourishes.
Practically the most important point, viz., the circumstances which promote
or restrict the propagation of the germ, apply equally to specimens from either
kingdom.
The object of this investigation is to discover what facilitates its dissemi-
nation, and increases its reproductive power, and what practical means have
proved useful to enable the human body to avoid or resist the action of the
poison, and remedy its injurious effects. The action of the choleraic poison
on the system will be most clearly defined by tracing the disease from its most
intense form, through milder forms and various stages, where there has been
time for the development of secondary symptoms. It is only from a clear
understanding on this point that a rational system of treatment can be founded,
and the action of the remedies explained. In no disease has there been such
diversity of opinion as of cholera, and in none has such a multiplicity of op-
posite remedies been so strongly urged.
The urgency of the danger, the calls of the patient and friends for the
remedies usually useful in exhaustion in other diseases, combined with the
desire to rescue the patient from imminent danger, naturally leads the inex-
perienced physician to employ increased doses or stronger remedies, or even in
despair, to the use of any violent remedies which may have a chance of success.
This is a natural impulse, but liable to lead to danger in this peculiar disease.
This is one of the most important points in the treatment of cholera, in which
the accumulated opinions of so large a number of independent witnesses, as
are collected in the present investigation, are peculiarly valuable.
The great and sudden changes which follow the different stages of the
disease, have led to the conclusion that the remedies simultaneously employed
caused the changes; whilst possibly they were merely insufficient to prevent
their taking place. In ague, alcoholic stimuli do not materially shorten the
cold, and they are unquestionably injurious in the subsequent hot stage. In
cholera alcoholic stimuli in large quantities often prevent re-action taking
place; or should it arise they cause violent or dangerous symptoms to supervene.
Cholera in its most intense form is rarely seen. I have heard it called
ground or earth cholera in the European barracks, and kalla murees (black
death) by the natives. The patient is suddenly struck down with extreme
prostration or collapse, without pain or prominent symptom, only an uneasy sink-
ing or heat in the stomach, with thirst or a desire for water,—the countenance is
livid,—the eyes congested and sunken,—the voice broken,—the skin cold, blue
and covered with clammy perspiration,—the pulse feeble or imperceptible,—the
breathing slow labored and intermitting,—the intervals gradually become longer,
till breathing at last ceases and death ensues. Sometimes these cases prove
fatal within two or three hours of the attack. In less intense attacks the feeling
of prostration is followed by one or more watery congee-like discharges, with
burning pain in the epigastrium, cramps of the extremities, and profuse cold
perspiration. This congee vomiting and purging often ceases whilst restlessness
comes on. The heart flutters feebly, the breathing becomes slower, with longer
intervals, and at last ceases.