Chapter III · (continued 2)

To remove the cramps, hot bricks, or bottles of hot water, etc., should be kept applied to the feet, legs and arms, and cloths wet in water as hot as can be borne, must be applied over the abdomen and changed every few minutes; this should be perseveringly pursued until relief is obtained. Sometimes advantage will ensue from stimulant applications along the whole length of the spine. Cramps of the muscles of the limbs may be overcome by bathing with the compound cajeput mixture,[VI] either alone or in combination with chloroform, and applying friction at the same time. This course usually checks the further progress of the disease, and the patient is saved; however, should it fail and the stage of collapse come on, in addition to the above treatment energetically pursued, the patient should be enveloped in blankets, wet with water as hot as can be borne, which should be renewed every ten or twenty minutes, and stimulants may likewise be given; the saturated tincture of prickly-ash berries will here be found beneficial, both by mouth and enema."

Dr. Morrow observes, that "to fulfill the most prominent indication, the production of an equilibrium in the circulation, and excitability, the compound tincture of guaiac[VII] may be given." This is prepared by adding gum guaiacum, cinnamon and cloves—each, one ounce to a quart of best brandy, and is administered in tea-spoonful doses in hot, sweetened water and brandy, every fifteen or twenty minutes till relief is obtained. As a general remedy, its exhibition is most salutary. In some cases where excessive nausea is the most prominent symptom, it may be advisable to administer an emetic to relieve the gastric irritability, to equalize the circulation and check the spasms. For this purpose, the acetous tincture of lobelia and sanguinaria,[VIII] with the addition of one-third spirituous tincture of aralia spinosa,[IX] is preferred. This is given in doses from a tea-spoonful to a table-spoonful every ten minutes in warm catnip-tea, sweetened. In very urgent cases, it may be given in larger doses and frequently repeated.

In most cases, the saturated tincture of xanthoxylum fraxinifolium bac. may be used with great advantage. It is a reliable, excellent and prompt remedy. When given in the early stages, it will frequently relieve in from ten to twenty minutes. In combination with the fluid extract of rhubarb and potassa,[X] it has generally proved very prompt and efficient. In cases of partial collapse, when the patient is suffering from severe cramps, Hunn's Antispasmodic Mixture[XI] is an excellent remedy. In cases of violent spasms, it has been administered every ten minutes in doses of from one to two tea-spoonsful in hot brandy-and-water sweetened, with great advantage, and it is peculiarly applicable in such cases where there is not too great irritability of the stomach. In many cases, camphor is very beneficially prepared, by adding one drachm of camphorated spirits to a half-pint of cold water and the mixture given in tea-spoonful doses every three or four minutes.

Dr. King states that in the early stage he has used very extensively the following preparation:

℞. Ox Gall, ℥ j.

Capsicum, āā., ℈ iv.

Gum Guaiac,

Leptandrin, ʒ iv.—Mix.

This was given in doses of one grain, and repeated two or three times a day. He had also succeeded in some cases with a mixture composed as follows:

℞. Sulphur Sub., grs. iv.

Gum Guaiac, grs. ij.

Charcoal, grs. ij.

Camphor, gr. j.

Opium, grs. ss.—Mix.

Dose, one to ten grains, repeated every ten minutes until relief is obtained. In some cases, however, this compound did not appear to exercise any beneficial influence. In cases of excessive irritability of the stomach, oat-meal cake coffee was given, for the purpose of allaying its irritability, with admirable effect. The saturated tincture of prickly-ash berries,[XII] combined with tincture of opium, was used in some cases as an injection, with very good effect.

Dr. R. S. Newton observes that he had also used a preparation composed of equal parts tannin, capsicum, camphor and kino, with considerable success, to be given in doses of four grains, and repeated at short intervals until the discharges were checked.

He considered the saturated tincture of xanthoxylum fraxinifolium bac.[XIII] the most valuable of all the remedies for the cholera which he had tested. When the stomach would not retain it, he gave it as an injection. It had a peculiar influence on the system, and having taken the remedy, he could speak from experience of its effects. When given as an injection, the effect produced was almost instantaneous; the sensation was as if he had received an electric shock; its use was very soon followed by a copious perspiration. He had more confidence in this than any other one remedy with which he was acquainted.

Dr. Wright observes that he had also used the neutralizing extract, saturated tinc. xanthox. fraxi. bac., and the compound tincture of guaiac.[XIV] He had succeeded best with a mixture of equal parts tincture of prickly-ash berries and neutralizing extract.[XV]

He had always found it necessary to attend strictly to the surface. The best external application he found was equal parts of capsicum, salt and mustard.

Dr. Chase states that, "in the early period of the disease, he had used the leptandrin, combined with neutralizing extract,[XVI] very successfully. He thinks opium can be dispensed with in the treatment of cholera altogether. In typhoid cases, he pursued an entirely different course, and remarked that many cholera cases presented symptoms similar to those described in Wood's Practice, as belonging to pernicious fever, which must be treated according to their peculiar character."

Such, it is said, is the more general and successful practice in the Mississippi Valley, where the disease has several times prevailed in its most malignant form. For its curative efficiency much is claimed. Its utility, however, must be measured, as in all other cases, by the unerring rule, the actual results sustained by incontrovertible facts. The nearer any mode of practice accords with the general principle of pathology, the greater must necessarily be its success, for it is not in this disease, or in any other, that the bold, energetic and heroic practice, which is inconsistent and incompatible with this principle, cures, however extensively adopted and rigidly pursued. For this principle must direct and govern the practice, or else it becomes necessarily experimental or empirical, and must be inevitably attended with the most lamentable results.

Section IV.—Statistics—Percentage of Loss—Variable Results—Their Cause.

The results of the different modes of practice which we have briefly noticed will aid materially our effort to discover and establish some general principle for the successful treatment and cure of cholera. For all modes, whatever be their merits or demerits, are supposed to be founded on the pathology of the disease. To treat any disease successfully, its pathology must be observed, and so applied in the arrangement and adoption of a mode of practice as to secure not only entire harmony, but a complete and perfect adaptation of the treatment to its pathological character. The nearer any mode approaches to an exact conformity to this principle the greater will be its success. The neglect to conform, in the treatment of the epidemic cholera, to this acknowledged and universal law, has, no doubt, been the prolific cause of the sacrifice of thousands of valuable lives. For this principle is the key to unlock the mystery of disease, unfold the process of diseased action, and, as an unfailing and definite rule, must govern all correct theories as well as all rational practice of medicine, under whatever name it may be conducted. All practice, then, deviating from, opposed, or contrary to, this principle must be purely empirical, and unworthy the confidence of an intelligent community. Hence we may refer to statistics rather than argument on the subject, to ascertain how far and to what extent each of the different modes of practice conform to the general principle; and on the other hand, to show what modes may be at fault, being deficient in the application of science, opposed to the established laws of practice, and contrary to observation and experience, and therefore utterly and hopelessly empirical.

The statistics collected from the most reliable sources, and here presented, may be regarded as a fair representation of the general average of loss by the different modes of practice. In a report now before us, it is stated, "The average proportion of deaths in Paris from cholera, treated under the allopathic practice, was 49 per cent.; while that under the homœopathic was only 7¹/₄ per cent." "In Vienna, (Aus.,) under the former, the deaths are reported at 31 per cent.; while under the latter it was only 8 per cent. In Bordeaux, death occurred under allopathic treatment at the rate of 67 per cent., and under homœopathic, 17 per cent. only. The general average in the places last mentioned will stand thus: Allopathic, 49 per cent.; homœopathic, 10¹/₄ per cent." The record of mortality in twenty-one hospitals in Europe shows the average deaths under allopathic treatment to be 65¹/₈ per cent., while in ten hospitals where the cholera patients were under homœopathic treatment, the average deaths from that disease was 11³/₄ only. In a report "published by the authorities of Pischnowitz (in Prussia), it will be seen that 680 cases were treated as follows: 278 treated homœopathically, of which 27 died; 381 treated allopathically, of which 102 died."

In St. Louis, during the prevalence of cholera in 1849, the number treated by three homœopathic doctors, to July 13th, was 1,567, of which 51 died—a loss of 3¹/₄ per cent.

In Cincinnati, during the month of May, there were treated by the eclectic physicians 330 cases of cholera and 198 cases of cholerine, of which only five died.

In the same city, during the same time, there were treated by the allopathic physicians 432 cases of cholera, of which 116 died.

Again, during the month of June there were treated by the eclectic physicians, when the disease had reached its maximum intensity, and many of the patients being reached by the physicians only in the collapsed stage, 764 cases of cholera, with a large number of choleroid diseases not fully reported. During this month, the mortality with all physicians was necessarily greater than either in the preceding or subsequent month. Including then the month of May, the aggregate to July 1st is 1,094 cases, with a loss of only 36, which is considerably less than four per cent. (being 3.28); while the mortality of the old school cholera practice being 26 per cent. in May, must have risen to at least 50 per cent. in June, when the ratio of mortality was more than doubled with all physicians. The Western Lancet for July, 1849, issued while the cholera was still raging, and speaking in behalf of the allopathic physicians, observes, "that of the cases of true cholera, with rice-water discharges, at least one-half the cases in this city, as everywhere else, proved fatal." This confession of the Lancet, edited by a thoroughgoing allopathic physician, advocating the interests of that school, must be regarded below rather than above the actual allopathic loss. Now, admitting the Lancet's correctness, and taking into account the aggregate loss of only 36 by the eclectic physicians in treating 1,094 cases of "true cholera," we ask what must have been the loss by the allopathic school of practice to have brought the average percentage of all schools up to 50 per cent., as affirmed by the Western Lancet? If the cholera hospitals be included in exhibiting the results of the different modes of practice, it will appear from the reports that the total number of deaths, compared to the admissions, was, under the eclectic treatment, 23¹/₃ per cent.; under the allopathic treatment, 60 per cent. This percentage is confined exclusively to the three cholera hospitals reported.

In the report of 1832, by Dr. Atkins, it appears "that the total number of cases" of cholera in this city, New York, "including those in the hospitals, as well as those reported to the Board of Health, had been 5,835 on the 1st of September. The total number of deaths by cholera to September 1st was 2,996." More than one-half died. "Dr. Buell reports the success," says Professor Clark, "of sixty-grain doses of calomel in one of the New York hospitals, as 93 deaths in 100 cases;" very remarkable success! the largest mortality in the city.

As like causes produce like effects, we need not be surprised at this high rate of mortality, for, says Professor Aikin, "taking the whole number attacked, it is said that the number of deaths in Astrakan were as one to three; in that of Nizhni Novgorod, as one to two; in Moscow and Kazan, as three to five; and in Penza, in the country of the Don Cossacks, as two to three. In the summer of 1831 the mortality at Riga, St. Petersburg, Mittan, Limburg, and Brody, according to the Berlin Gazette, was about one-half, while at Dantzic, Elbing, and Posen it was about two-thirds of the whole number attacked. The period of the epidemic, however, greatly influenced the mortality; for on the first onset, nine-tenths of all those attacked perished, then seven-eighths; and the proportion of deaths forms a gradually decreasing series of five-sixths, three-fourths, one-half, one-third, till, towards the close, a large proportion of those attacked recovered. The uniformity of this law in every country affected with cholera, whether Europe, America, India, or China, is extremely remarkable." This high rate of mortality is truly and peculiarly illustrative of the inadaptation of the general mode of the so-called regular practice to the pathology of the disease. This, no doubt, is the main cause of its failure, and justly exposes it to the unenviable distinction of being empirical.

The practice of Dr. Beach, the physician of the Tenth Ward of this city, during the prevalence of the cholera in 1832, embraced about one thousand cases, of which only a small percentage was lost. One of his associates, Dr. Hopkins, reported 157 cases, of which only 6 died, being less than 4 per cent., which probably is not much below the general average of the other districts in that ward at that time.

Mr. Forward, an unprofessional gentleman of Kentucky, treated a large number of cases, during the prevalence of the disease among his employees, numbering over two hundred, without the occurrence of a single death. Another instance similar in principle is that of Dr. Browne, who reports a case treated by rectified oil of turpentine, with the most satisfactory and happy result. So, too, the late Dr. Sharp, of Paris, Ky., adopted a similar principle of practice, and became, thereby, eminently distinguished for the cure of cholera; his percentage of loss being very small indeed.

We might extend these statistics and references, and quote from the reports of many other distinguished physicians who have been very successful in the treatment of this disease; but these are sufficient for the purpose of directing our inquiries as to the utility and success of different modes of practice. It is immensely important to ascertain, if practicable, the general principle which has been most successful in the treatment of this disease, before it shall again make its appearance among us as a prevailing and fatal epidemic; especially when we realize and duly appreciate its vast mortality, as represented in the report now before us, that prior to its recent irruption and prevalence in India and Europe, nearly fifty millions of the earth's inhabitants have been swept away by this terrible scourge alone.

This estimate may, however, appear excessive and unworthy belief. Yet the general average for the forty-three years included is only a little over one million per annum, truly a vast number to be carried off by the prevalence of one disease alone. But, if we reduce this estimate within more reasonable limits, and take only two-fifths of it, or twenty millions, as an approximation to the truth, it would still be appalling, and imperatively demand, on account of the vast interests involved, the most rigid and thorough investigation as to both the direct and indirect cause of this vast sacrifice. It will also furnish us a sufficient apology for attempting a brief review and critical examination of the principles involved in the different modes of practice noticed above, in order to ascertain any failures or errors that may have, in some degree, operated as the indirect cause, in procuring this immense loss of life. All must admit that there are, in respect to the treatment of the cholera, great and palpable failures and errors which, though they have continued for nearly half a century, and have been sanctioned by high authority, as well as by long usage, ought nevertheless to be fully shown and exposed, so that they may henceforth be avoided. In our examination, there is but one rule to be observed, and one criterion of ultimate appeal by which to try each and every principle on which any mode of practice may be conducted. This universal and acknowledged rule is Pathology, the science which unfolds and exhibits the nature and character of disease, and "dictates the maxims of rational practice." It is the foundation and only base of rational medicine, which proceeds on the assumption that the nature and character of disease is fully known and appreciated. This knowledge is not only rational, but indispensable, in order to understand and apply the principles which ought to govern in the medication and cure of disease.