CIILLOCK AND XACLA HEN ON CHOLERA..
De. Wee-Linen is Assistant Surgeon to the Second Life Guards, and Mr. Maclaren appears to have been Surgeon to the Union of Plympton St. Mary, Devonshire. In each position these practi- tioners have haAl opportunities of personally observing, cholera ; Dr. M'Culloch, when it prevailed last year in the regiment ; Mr. Maelaren, in the Union of Plympton, among whose poor and pre- judiced population its ravages were much more fatal than in the fine-constitutioned, regularly fed, and more health-controlled men of the Household troops. Besides deductions from actual disease as . witnessed by these authors, their treatise contains some speculations and suggestions. There is a logical view of the cause of cholera, founded more on general possibilities, or at best on arguments of a general kind, than on anatomical or medical facts ; which last come to closer proof than reasoning can attain, if they do not altogether establish the conclusion. There is an hypothesis as to the conta- gious nature of cholera, in part based on the idea of its origin, and which is even less consequential. There is a speculation as to the cyclycal character of epidemic disease ; its possible use or ne- cessity; the change in the character of epidemics, that evidently takes place in the course of successive generations ; the probability that this change is not owing merely to hygienic causes, but to something deeper, something in the system of nature or scheme of Providence ; and that possibly epidemics are too much complained of, as they may only kill•rapidly those whom other diseases would destroy slowly, fine weather and good harvests keeping up lives that might drop under average circumstances and would certainl perish in adverse. Lastly, considering that the facts .are ins ment to form a certain judgment as to the nature and causes of nholerar or any other epidemic, the authors throw out a; euggestion for an elaborate collection of statistics, medical, geographical, Sic. throughout the world,—which at present is not very likely to be , accomplished. As the book is thin, and some portion occupied as an appendix with • specific reports, there is little room for looseness of composition or 'diffuseness of manner; but there is rather too much of the formal logical in style and of merlins] pe- dantry in diction. Of the various topics in the book, the most important and prac- tical are the probable cause of cholera, with its treatment and pre- vention. In their -views of the last subject, our authors do not greatly differ from those most generally acted on in practice. In the two first grades, or, properly speaking, in the more or less violent state of diarrhcea that frequently but not always precedes malig- nant cholera,, they prescribe opium, or some similar drug, to check the abnormal secretions) especially from the bowels ; calomel, to restore the secretions to their normal condition. • and some com- forting restoratives to support the strength of the patient shaken in the struggle. restoratives, principles of practice, with attention to .natural indiealions according to circumstances, comprise the treat-, , ment of the premonitory symptoms, and will generally subdue the , disease, according to our authors, and, we believe, to the fact. When the malignant grade has been reached, -whether by neglected diarrhora or by sudden attack, the case is nearly hopeless as re- gard.s art. But though the doctors can make little of the last stage, the writer may; and we quote the account, as the best bit of medical description of the subject we have seen. "The third grade of attack—Algide or Val-neat Cholera—may announce itself suddenly, without any of the usual premonitory symptoms of gastro- eholersic irritation or premonitory diarrhcea. At once the victim may be seized with pain in the bowels, and suddenly profusely purged ; or, if in bed asleep, he awakes with feelings of faintness and sickness, accompanied with severe griping. of the bowels, when they are moved immediately, copiously, and are watery : again, in a few minutes, there is urgent call, and the bowels are emptied by a gash, with a squashing sound into the vessel, as water from the pump. Feelings of prostration are extreme and instant. The patient resigns himself to the issue as an inevitable fatality—expressing himself, that he feels it 'to be nothing but death.' The features are pinched, starved- hire, and cold ; cramps, more or less, have now supervened, and frequently there is vomiting, which may be with every dejection, or incessantly. The fluids ejected are seroid [serum, a yellowish liquid] or frothy and slimy, as water beaten with white of eggs; not unfretntently they are tinged greenish with bile • sometimes the matters, whether by stool or vomited, are of identi- cal character, The breathing soon is panting, rapid, and shallow, or scarcely perceptible. Though *ale and intelligent, the patient is indifferent to anything, and to all around him. Thirst is distressing; urine is entirely suppressed.; cold sweats exude. If when in usual health the patient is florid, now, under this grade of attack, the malar surface of the cheeks, the tips of the nose, and around the mouth, the colour is a purplish blue. In the na- turally pale, or in women, frequently the avidity is only around the eyelids; but the whole appearance is that of a wretched one, starved, dying by hun- ger and cold. Deep, dark, congestive areolat, surround the eyes ; these are sunken, withdrawn into the sockets, are expressionless, vacant, and waxy- bite ; the comae are dull, irregular, and shrivelled. The line of reflection
• The Phamomena of Pestilential Cholera in relation to the grade of Attack and the Treatment: its Pathology; Origin and Spread; and the Means of Prevention. By George 31•Culloch, F.B.C.S. (Dub.); and A. C. Madmen, 31.R.C.8. Ed. Published by Churchill,
of the conjunctiva), from the ocular to the palpebml surface is much coil- gested ; the sclerotic coats are paler than usual—timy are blanched. Alto- gether the aspect là ghastly. The tongue is cool, of leaden colour, dull and pale as if exsanguineous; in others, it i9 thinly and tenaciously coated. The breath is cold, and the voice whisperons. Hiccough frequently ia trouble- some. The pulse, scarcely felt, is soon imperceptible. There is now extreme restlessness—jactitation from anhelation. The clothes in the lightest degree cannot be borne—the oppression upon the cheat being evidently the most distressing feeling.
"Though all means be resorted to to restore general heat, the exposed surface- of the face remains deadly cold ; the tips of the fingers and nulls are livid and blue the backs of the hand*, the palms and fingers, are shrunken and corrugated, incurvated and exsanguineous, they are like to washer- women's. The assemblage of these symptoms constitutes the stateof collapse, and the tendency is to death. "In extreme caws, or before death in fatal cases, vomiting and purging generally cease for some time; in the latter' often for hours previously, a stillness, almost of death, obtains ; broken by occasional jaotitations, or an audible sigh : a glow of life, of colour, and heat, will sometimes lighten the countenance—but transiently; for suddenly it is darkened—quenched, as if all power had gone out in the returning effort. In the more exquisite states of collapse there is no cure ; and all recoveries thence must be accounted au- prises. In the leaser degrees of collapse, or indeed in every degree after li- vidity, feebleness, and coldness of breath have set in, not more than half can be expected to recover. Death,. as it were of the system, has already hap- pened, and hope alone remains of its reanimation from connexion with a still unexpired central power. "In this state of collapse the power of remedies is but email—it is, at least, difficult to estimate their influence. Perhaps complete rest, and care- ful nursing to restore and retain animal heat, by medicated or ordinary means, and to prevent the patient 'To ;:ng himself, to let well alone, or limit interference to cordial restorative assistance, are the most of any help that can be given ; hope being entertained rather from the inherent power of life—its resistent or recuperative energy. "Sometimes the invasion of Algide Cholera progresses more gradually.— the point of departure may be from.any stage of the other grades, as by ac- cession from mild to severe premonitory diarrhoea; or sometimes it may be preceded by the more general condition of choleraic irritation for days pre- vious. But whether by exreerbation of gentler and neglected diurrhuca, or of the general condition of gastro-chokric irritation, the invasion of the true .Algide Cholera is always declared by marked deterioration of all the graver symptoms, and a rapid progress to the inost serious phomornena. The point of transition is abrupt, as if an extra force had suddenly entered into operation. In some wises the pluenomena of invasion have been described as first coming on in a sort of aura : the victim, feels something gradually to creep from his feet, up, all over him ' ; sometimes it is described LIA3 'something' that he has felt come all over him at once'; when suddenly he feels giddy, and is seized with pain in the bowels, and immediately they are moved. Thenceforth, the procession of phrenomena is in the usual manner- In other cases, disagreeable smells are first complained of, and are believed to mark the moment of invasion ; again, it is a choking feeling, whieh.they afterwards explain. as when they swallowed it,'—meaning the infect*. Around the victim of cholera, an odour, mawkish and sickly, ca- daverous and earthy, or sometimes urinous, is often perceived. The urinmis odour, however, is more perceptible in the state of reaction. "Recovery from the Algide state is always doubtfuL Results prove that leas than a half recover, and certainly in the more extreme cases a amall free- tion only escape death."
The opinion of the writers on the cause of cholera, and by cou- sequence of many other epidemics, is, so far as we know, novel: it is to this effect. Conditions of the atmosphere that may be called. pestiferous take place, and originate partly in itself, partly from earthly causes—as denying animal and vegetable matter, or excretions. This quality, however, is latent, or at least imper- fectly developed, until it meets not only with a constitution adapted to receive it but a species of animal whose nature can re- ceive it all ; some creatures, in the view of these writers, being in- capable of receiving certain diseases, and vice versa ;—though this is no proof of any specific difference in the virus itself, sham what produces cholera or plague in man may produce another dis- ease in cattle. To create pestilence, therefore, two things are needed —a miasm, and a body obnoxious to its influence; from which conjunction there results a tertium quid, which is, for example, the choleraic virus. In its origin this pestilence may be geogra- phical, as cholera really seems to be ; that is, it can only origmate in a region suited to it. Thence, however, it ma.y be dissipated contagiously by means of man or fomites (substances imbued. with contagion); though the contagion depends upon the twofold cir- cumstance of a state of the air and other concomitants and the aptness of the constitution to receive it. The theoretical conclu- sion therefore is, that but for India, cholera would not have ap- peared in Europe, since it could not have originated here : on the other hand, had not the atmosphere been deranged by a miasm favourable to the reception of cholera contagion, it would not have spread through Europe.
Perhaps the strongest argument in favour of this view is the length of time the disease took to reach Europe and the apparently i
capricus routes by which it travelled. Little peculiar weight can be attached to the argument for contagion derived from the sudden access, and the feelings of patients, as mentioned in the extract ; for something like this occurs in many disorders where contagion is not dreamt of. The sudden chill which introduces "the cold" is frequently remembered by the patient ; in many diseases peculiar sensations, or hopelessness from the first, are spoken of
patients, and seem, to owe their origin to extreme sensibility. We need not, however, enter further into the question since little
direct practical result would flow from these writeriviews, how- ever worthy they may be of theoretical discussion. The treat- ment they recommend in the earlier stages is followed, we believe, by the bulk of the profession; the inutility of remedies in the last stage all are compelled tcr admit; their principle of prevention is simply the " tend.ency to the benign extreme," cleanliness,. good air, good living, and good spirits. Not much is even built upon contagion, beyond an advice to avoid needless communication,— to which few need much urging; and the retention of the present quarantine-laws in obvious- cases.
Previous page
