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 homoeopathic was only 7-1/4 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 homoeopathic, 17 per cent. only. The general average in the places last mentioned will stand thus: Allopathic, 49 per cent.; homoeopathic, 10-1/4 per cent." The record of mortality in twenty-one hospitals in Europe shows the average deaths under allopathic treatment to be 65-1/8 per cent., while in ten hospitals where the cholera patients were under homoeopathic treatment, the average deaths from that disease was 11-3/4 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 homoeopathically, 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 homoeopathic doctors, to July 13th, was 1,567, of which 51 died--a loss of 3-1/4 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, 23-1/3 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.