54
REPLIES TO QUERIES ON THE TREATMENT OP EPIDEMIC CHOLERA. [Appendix
Query No. 9,—continued.
Mackenzie, M. M., Surgeon, Bom. I.—Although feeling well at the time, while stooping
over the death bed of a poor European woman suffering from cholera at Sattara, I was suddenly
seized with abdominal pains and desire to go to stool. Before I got home (300 yards), these
symptoms had increased and vomitting had set in, bub by judicious measures the symptoms
were arrested.
MacLeod, A. C., Surgeon Major, Mad. I.—I cannot concur in the opinion that this is a
primary action of the cholera poison. A remarkable depression of the whole nervous system
does indeed take place, by which the vitality of the secreting organs h proportionately
lowered ; but I conceive that this depression of the nervous system is itself a secondary effect,
consequent on the blood poisoning which precedes.
The secreting powers of the liver and kidneys are thus influenced by the state of the
nervous system. But the blood is at the same time poisoned, no longer furnishing that
pabulum on which the secreting powers can he exerted with advantage. This may well be
another cause, co-operating with that of diminished nerve stimulus, in producing arrest of
secretion.
I believe that in cholera the blood is poisoned (only through the medium of the lungs),
much in the same way that it is poisoned by the venom of a serpent. Indeed, if we consider
one of those rarer and worst cases of cholera, in which the victim is suddenly stricken and
as rapidly sinks, without either purging or cramps, the analogy is not a little striking, and may
be instructive.
There is the same sudden prostration of the powers of life, with faintness, sickness,
giddiness ; the same stupor (without delirium, lethargy, and indifference), vomiting, coldness
of surface, clammy perspiration, livid hue, faltering pulse, and viscid tarry blood correspond-
ing to the surface coldness, there is the same sense of internal heat indicative of that uni-
versal visceral congestion which, in both cases alike, death reveals ; lastly, the same suspen-
sion of the hepatic and renal functions.
The pathological phenomena then of an attack of cholera (according to my views), may
be summarized as follows, in their order of succession : —
In the first place, when the lungs have no longer the power of restoring, presumably by
neutralization, the poison of cholera, that poison produces, through the lungs, a three-fold and
simultaneous effect, namely, insufficient oxygénation, loss of temperature, and great nervous
depression. The patient feels suddenly faint and giddy ; the skin becomes deadly cold,
clammy, and wrinkled ; with an universal leaden tinge, especially of the lips and conjunctiva ;
the breath issues cold from the mouth : the tongue too is cold, and of the same general leaden
hue. If a vein or artery be opened, even at this early stage, the blood trickles slowly, thick
and dark, and the pulse is scarcely to be felt. The shock to the whole nervous system is
visibly of the most intense character.
Next in order succeed the proper or pathognomonic symptoms, in consequence of the
presence of venous blood in the arteries, and of loss of power in the nervous, and especially
the ganglionic system ; the secreting powers of all the glandular organs, including the liver,
kidneys, and salivary glands are arrested, and there is no bile and no urine ; and the tongue
"cleaves to the roof of the
mouth."
Whilst the surface and extremities are cold and bloodless, the viscera become hot and
gorged with blood, and all the heat remaining and all the blood are rallied to the strongholds of
the body ; they are wanted there for present life, for the death struggle at hand, and for re-
action. The patient, whilst his very nails are blue with cold, complains of intolerable heat,
especially about the epigastrium. With a failing circulation, irregular muscular action is a
familiar physiological effect ; hence cramps are excited. By another familiar law of the econo-
my, the suppression of one or more secretions is compensated for by an increase of others ;
accordingly, there are, lastly, frequent and copious dejections of a thin serous fluid, partly
by stool, and partly from the stomach by vomitting, and at the same time the skin is bedewed
with a cold sweat.
Morton, G. Έ., Deputy Inspector General, Ben. I.—The effect of the poison is certainly to
diminish or suppress the secretions, probably through the ganglionic nerves.
Muuro, W., Deputy Inspector General, Ben. Β.—I have thought so since 1862. The fol-
lowing is an extract from my report of cholera in the 93rd Highlanders :—" How heat, or dif-
ferent degrees of heat, and moisture act so as to produce disease, I do not know ; whether by
the production of malaria poisonous to human life, or by direct influence on the nervous
system, I cannot understand."
Murray, T., Surgeon Major, Bom. I.—Primarily on the sympathetic and ganglionic
nervous centres, and secondly on the blood.
Naismith, J., Deputy Inspector General, Ben. I.—The only point which has occurred to me
is, whether the paralysis of the ganglionic system, caused by the action of the choleraic poison,
is not of itself sufficient to affect the life of the blood, and cause changes in its constitution
without supposing that the poison actually enters the blood. In cases of death from light-
ning, the life of the blood is at once destroyed, and its constitution altered by the deadly