No.
II.]
III.—THE TREATMENT.
53
Query No. 9,—continued.
Duckworth, F., Assistant Surgeon, Mad. I.—There can be no doubt that the shock to the
nervous system is very great, and that the depression exerts a paralyzing effect on the sym-
pathetic and ganglionic nerves, which may have a decided influence in diminishing or suppress-
ing glandular secretions ; but the state of inertia of the secreting organs can also be satis-
factorily accounted for by the stagnation and engorgement of the glands, and perhaps, also,
by the peculiarity of the action of the poison on the constituents of the blood and secreting
cells.
Eteson, A., Surgeon, Ben. I.—I apprehend there is great obscurity, not only as regards
the precise functions of the sympathetic nerves, but chiefly because, admitting the suspension
of the sensitive powers, it is not yet shown whether such an effect is due to loss of nervous
power, primarily or coincidently. Undoubtedly, the organs chiefly affected are those supplied
by the sympathetic nerves, but who can say that these results are due to "paralysis" or
"depression," except in so far as it may be surmised that the chemical balance of the blood
being deranged, the nerve centres are not susceptible to its influence.
Farquhar, T., Surgeon Major, Ben. I.—Or what is perhaps more likely, causes a state
of tonic spasm of the nervous system in part ; at least, this is the most likely action.
Fraser, A. H, Surgeon, Ben. B.—I am inclined to believe that it is the secondary in-
fluence, such as uræmic poisoning, and the mal-nutrition of nerve centres from change in the
blood, which paralyses by the morbid action set up by the primary effect.
Furnell, M. C., Surgeon, Mad. I.—It would seem so. One often sees a man, looking as
if about to be attacked by cholera when cholera is prevalent, shake off his malaise by drinking
a good stiff tumbler of any stimulant, such as brandy and water.
Gibbons, J., Surgeon, Mad. B.—Yes, and also the great nervous centre.
Greenhow, H. Μ., Surgeon, Ben. I.—Primarily, the poison depresses the ganglionic nervous
system, and suppresses the action of organs supplied by it.
Jackson, J. R., Surgeon, Ben. I.—The action of cholera poison is of the nature of a
ferment in the blood, and if the blood or the fermentable material of the blood can be
charged with the sulphites,, it is to be reasonably expected that the poison may be counteract-
ed in its lethal effects.
Jardine, J., Surgeon, Ben. B.—These are very early symptoms of the poison, but I
suspect that the poison of the blood is as early, if not antecedent, to the shock of the nervous
system. This possibility should not be omitted in future experiments and enquiry.
Lidderdale, R., Assistant Surgeon, Ben. I.—The poison in its primary action seems to
depress the organic nervous system, in some cases proving fatal with little vomitting and
purging, acting so powerfully through the sympathetic as to destroy the action of the heart,
lungs, liver, and kidneys, and so to cause death.
Lowe, T., Surgeon, Mad. I.—My opinion is that the primary action of the poison is upon
the blood ; then, that paralysis of the great ganglia and sympathetic ensues, and that this
paralysis causes the suppression of the various glandular secretions.
McDowall, C., Surgeon, Bom. I.—It remains to be discovered whether or not the cholera
poison being absorbed into the blood and acting on the sympathetic (chiefly vaso-motor
nerves), primarily causes embarrassment (by spasm?) in the circulation, and arrest of secre-
tion, absorption, and depuration, and then, only as a consequence to this, exudation of water,
&c., through the gastro-intestinal mucous membrane, which exudation by thickening the
blood also further prevents the heart, kidneys, liver, &c., from acting, and helps collapse. The
alternative lies in considering whether this, the cholera poison, acts primarily (by simple
contact, or most probably after circulating in the blood) on the mucous membrane of the
stomach and bowels as an irritant, and by simply draining the watery and saline portions of
the blood, thus and thus only prevents circulation, secretion, depuration and absorption.
2. In accordance with the first view, the true remedy to he sought is one which will
counteract the depression and spasm (?) of the circulating and depurating organs, and enable
absorption to take place, without our caring too much for the loss by the bowels. It is easy
to propose many such remedies : subcutaneous injection of morphia as a stimulant and re-
mover of spasm, atropine, calabar been, hyoscyamus, &c., &c., with diuretics and chologogues.
Until a remedy suited to the case be found, we are logical in cautiously moderating the
almost certainly fatal loss of fluid, and thus, and more directly by stimulating chologogues,
diuretics and aromatics enabling the circulating and depurating organs to act. I have often
wished to give an extended trial to turpentine as being an astringent to the bowels, and at
the same time a diuretic.
3. As our knowledge of the poison, its mode of absorption, its situation, whether in the
general circulation or merely on the surface of the mucous membrane of the stomach and
bowels, its peculiar field of action, whether the cardiac pulmonary on solar plexuses, or merely
the periphery of these last, the surface of mucous membranes, or any particular organs, as
our knowledge of this, and of the different states of the poison in its germ-stage or fully
developed stage, increases, the above conclusions may have to be modified ; but these are the
true subjects for long and careful study.