CHAPTER IV.

SECTION I.--GENERAL PRINCIPLE OF RATIONAL PRACTICE--DICTATED BY THE PATHOLOGY OF THE DISEASE--CONFIRMED BY OBSERVATION AND EXPERIENCE.

It has been observed that the essential characteristic, the leading and most prominent indications requiring special attention and permanent relief, are the "Algide," or loss of temperature; the loss of nerve-power in the ganglionic and pneumogastric nerves and their branches; the altered or disorganized condition of the blood; the impaired or obstructed circulation, and the early and direct tendency to congestion; and that these prominent and essential features are correspondingly developed, and in their relation to each other are too intimate and dependent to admit the idea of priority and regular order of succession. The primary impression being on the blood, these proceeding, pari passu, together constitute the complex character of the disease, and suggest the general principle of rational practice. If our pathology be correct, it must be regarded as the foundation and only base for a successful mode of treatment, and must be allowed to dictate the maxims of rational practice in the prevention and cure of this singular disease. The neglect to apply to the treatment of the cholera the science of its peculiar and established pathology and phenomena, or to give heed to its teachings, has no doubt led to the errors and failures in practice, which, from their too general occurrence, induced the learned and celebrated Dr. Velpeau to declare, before the Academy of Medicine in Paris, that "we know nothing more of the treatment of cholera now, than on its first appearance in 1832. All our remedies and modes of practice have failed."

By observing the fundamental principles of the science of medicine, and adopting a mode of practice suggested by the pathology and phenomena of the cholera, these errors and failures, which have justly brought odium upon the so-called regular profession, will probably result in saving nine-tenths of those attacked, instead of losing that appalling proportion, as has been the case in some instances in years past.

What, then, is the principle which, for nearly half a century, has been strangely overlooked, and utterly disregarded by the so-called regular profession, so far as the maxims of rational practice are concerned in the treatment of this disease? We unhesitatingly affirm the principle suggested by the pathology of the disease is, and must be, one that will reproduce and resupply the lost caloric, or restore warmth to the body; one that will restore promptly the lost nerve-power to the ganglionic nerves especially; one that will arrest and remove the tendency to congestion, equalize the circulation and relieve the oppressed respiration, and thus mitigate the long train of dependent symptoms. For this purpose, a prompt and diffusive stimulant is required of sufficient power to meet these urgent demands, and suspend promptly any further depressing influence or action of the cholera poison. A stimulant, essentially different from alcohol in any of its forms, is required. Alcohol, except so far as it necessarily enters into the composition of medicines, is inadmissible. So, too, are all those stimulants whose action is violent, or tends to induce constitutional derangement, or impairs in any way the subsequent health of the patient. It must be one prompt, kind and diffusive in its nature, and peculiarly adapted to meet and relieve the essential urgent symptoms on which the whole train of non-essential symptoms depend. In short, it must be one possessing the singular properties of a stimulant, sedative and astringent, especially an arterial stimulant and antispasmodic.

In confirmation of this doctrine, we may refer to the general principle exhibited in the most successful modes of practice. During the prevalence of the cholera in 1832, the physician having charge of the Tenth Ward in this city, in which more than a thousand cases occurred, adopted as the principle of general practice in that ward a prompt and diffusive stimulant, which was, at that early day, regarded by him as based on the pathology of the disease. This principle was strictly observed and fully carried out in practice by all his assistants. The result, embracing the different stages of the disease, and some of the most malignant cases, was the curing and saving of more than nine-tenths of those attacked.

Another instance directly in point is the course pursued by Mr. Forward, an unprofessional gentleman, who had over two hundred laborers in his employ, among whom the cholera prevailed in 1832 with its accustomed severity. On its first appearance, Mr. Forward, unadvised, and depending on ordinary domestic remedies, adopted as the base of practice in the emergency a prompt and diffusive stimulant, which proved perfectly successful. Being advised to continue the same course, should any more cases occur, the result was, in treating a large number of cases, including thirteen in his own family, that all were cured. Again, on the reappearance of the cholera in 1835, the same practice was pursued, with the same uniform success. Can anything be more satisfactory or more conclusive as to the adaptation of a principle of practice to the pathology of the disease, or furnish better evidence of the correctness of the doctrine we have advanced?

Richard Brown, Esq., surgeon, Cobham, Surrey, November, 1848, reports a case treated successfully by rectified oil of turpentine, the therapeutic character of which is unquestionable.

Dr. Massie, of Texas, adopted a similar principle of practice, and highly commended the same to his professional brethren, as the safest, best, and most efficient in the treatment of the cholera. He affirms, that of all the modes devised for the prevention and cure of this disease, none is so simple and efficacious as the one exhibited in his practice.

The homoeopathic treatment, which claims to be a complete and perfect system, arranged and adopted by its originator and all his disciples, confirms the correctness of the doctrine we have advanced. Its curative principle in the treatment of cholera is based on a prompt and diffusive stimulant, peculiarly adapted, so far as it has any power, to meet and relieve the essential symptoms of this disease. Hence its success and favorable results, which show a saving of nearly nine-tenths of all the cases treated.

Again, the eclectic physicians, who now, including all of the reform school, constitute a majority of the practitioners of medicine in this country, adopted a principle essentially similar, which has governed their practice in the treatment of this disease from its first appearance in 1832. Their system seems to have been more strictly conformed to the pathology of the cholera than that of any other school. Hence, their unparalleled success furnishes the most substantial and conclusive evidence, sustaining the correctness of the doctrine we have adduced, and the general principle of rational practice suggested and imperatively demanded by the pathology of the disease. Their treatment, directed mainly to the relief of the essential symptoms, has been based on a prompt and diffusive stimulant, which, fulfilling to some extent the indications required, has enabled them to meet the disease on each occasion of its reappearance with some assurance of success, and more generally to arrest its progress or subdue its power as exhibited in its several stages, and even in many instances to restore the patient and save life in the last stage of the almost hopeless collapse. This is clearly shown in the actual results which fully exhibit the incomparable fact that in private practice considerably more than nine-tenths of the cases of "true cholera" are cured, and the constitution and health of their patients saved unimpaired.

Again, this doctrine is substantially confirmed by the results of the experiments made by Drs. Hill and Davies, in the exhibition of chloroform, either alone or combined with other stimulants. In the carefully detailed account of its exhibition in the various stages of the disease, it is clearly shown that its direct action tends to arrest and suspend the depressing influence of the primary cause, and when properly combined with other stimulants, affords very prompt relief. The favorable results thus obtained encourage the hope that it may prove a successful remedy and lead to the adoption of a more consistent mode of practice in the treatment of epidemic cholera. In India, in Europe, and in America, it is now regarded as a very important remedy, and especially indicated in this disease. As an antidote to miasmatic poison, and as a prompt and diffusive stimulant when properly combined, it is admirably calculated to meet and suspend the most urgent symptoms. In short, it may be considered, in relation to this disease, an excellent therapeutic agent, and well calculated to form the base of the principle for which we contend.

But again, our doctrine is confirmed by the experiment usually termed "venous transfusion." The solution of soda, when raised to a temperature from 105° to 120° Fahr., and injected into the veins of the suffering patient, gave temporarily prompt and immediate relief; but, when injected at a lower temperature, failed. In this experiment, the sole and only agent contributing to the result was, as before explained, the free caloric which immediately permeated every tissue, supplied warmth to the body, relieved the depressed nerve-power, equalized the circulation, and restored generally the normal action of the system. Of this result, and of the diffusive and prompt stimulating power of free caloric, there can be no question. The principle here evolved, which answered so perfectly the imperious demand and so immediately suspended the power of the disease, is the very principle dictated by its pathology. Stronger and better evidence of the utility of a prompt and diffusive stimulant, permanent in its character and influence, cannot be furnished; one that will act kindly, without violence and without any disturbance to any organ or tissue, to injure or delay the return of immediate and perfect health after the disease is subdued. Such we affirm to be the principle demanded in the successful treatment of the epidemic cholera.