The Press.
London, England, 1854-09-09 00:00:00

THE PRESS.

It first appeared in the zillah of Jessoro,
about a hundred miles N.E. of Calcutta, in
August, 1817, and then, travelling across the
peninsula against the prevailing winds, which
are westerly, reached the Bombay coast exactly
in one year, having committed frightful
ravages in its progress. Thus early its move-
ments were remarked as singularly capricious.
" Sometimes," said the Bengal report, "it
" would take a circle round a village, and,
" leaving it untouched, pass on, as if it were
" about to depart from the district ; then, after
" a lapse of weeks or months, it would suddenly
" return, and, scarcely touching the parts which
" had lately undergone its ravages, would
" almost depopulate the spot which had con-
" gratulated itself on its escape." Following
one shore of the Ganges, it would suddenly
stop, take a rapid sweep across the river, lay
all waste before it, and then return to continue
its direct line of travel. The natives regarded
it as an evil deity, to be kept at distance by
charms or propitiated by prayers and sacrifice.
The medical boards in India paid more
minute attention to its nature and symptoms
than they have perhaps received since. The
general conclusion arrived at was that stated
by the Bombay board :—" There is a somewhat
" which presses heavily and suddenly upon the
" vital functions, and in many cases resembles
" the effect of a poison taken into the stomach
" or applied to the blood ; but whether it acts
" more immediately upon the circulating or
" the nervous system we cannot determine.'
The point remains to this day unsettled, but,
in many cases of post-mortem examination,
when the brain was exposed it was found sur-
charged with blood; and hence Dr. HARTI.EY
KENNEDY, Physician-General at Bombay, in-
ferred that in cases of cholera some such de-
rangement of the nervous system takes place
as in concussion of the brain. The dizziness
and stupor which are the first symptoms in
the most fatal cases support this view. When
the disease first appeared in Punderpoor the
people tumbled over each other by hundreds
lifeless in the public streets.

But theories as to the cause of cholera are
of less importance than rules for its treatment.
Mr. CRAW, an eminent surgeon, was one of the
first to perceive that the disease was not
a mere bowel complaint. In the course of his
practice he found that bleeding afforded the
best chance of relief, and, as his experience
established the benefit of this treatment, he
lamented that he should have been prevented
from employing it earlier "by the scarecrow
"of imaginary debility." Dr. JUKES, and
many other eminent India surgeons, came to
the like conclusion. They bled freely to
remove the congestion of the internal vessels,
and then administered stimulants to rouse the
vital powers. Dr. KENNEDY, in his work on
" Epidemic Cholera," had no doubt whatever
that bleeding, followed by an emetic or cathar-
tic, was the system most plausible in theory
and safest in practice.

But a distinction was drawn between the
real exhaustion caused by long-continued
purging and vomiting, and the apparent de-
bility which was merely symptomatic of the
disease. If native strength was inherent, and
only prostrated by sudden attack, then bleed-
ing was often found to alleviate spasms,
relieve congestion, and promote animal
warmth. " When I cannot bleed," writes Dr.
KENNEDY, "it is to my mind next to signing
" the patient's death warrant. The venous
" evacuation is always less exhausting than
" the unnatural visceral secretion it inter-
" rupts." The subsequent remedies were
commonly castor oil, to excite the bowels to
action, and laudanum to soothe the irritability
of the stomach.

How far this mode of treatment might prove
successful in our clime it is for the medical
profession to decide. In the worst cases here
the symptoms are the same as in India—stupor,
dizziness, prostration, cramps. Desperate
disorders justify extreme remedies. Com-
monly we are afraid our practitioners give up
the worst cases as soon as seen, hut any course
is better than hopelessly to abandon the
patient to the rigour of this mcst rapid and
fatal disorder, or to order formularies to
maintain professional etiquette. The re-
sources of medicine are not exhausted till the

843

practitioner believes them to be so. The
mystery which surrounds tl•is terrible scourge
should stimulate his invention, and lead him
to try conclusions with it by new modes of
practice, when satisfied of the inefficiency of
the old. It is satisfactory to find that exertions
are being used to dispel the vulgar prejudice
that the efforts which nature makes to throw off
the choleraic poison by the stomach or bowels
should be abruptly checked by opiates. This,
indeed, as SYDENHAM remarks, is "to shut up
"an enemy in the bowels." From the medical
commission which has been nominated we
may hope at least for a clear and intelligible
view of the general character of the disease,
and rules of treatment adapted to its several
stages, and to the widely-different forms under
which it appears.