DR. RUSSELL ON EPIDEMIC CHOLERA. * Tree wonderful part of cholera
is the extent of its range, which surpasses Juvenal's limits of the ancient world—" a Gadibus usque Anroram et Gangem," and all but realizes Johnson's extension, " from China to Pert"; the steady but gradual way in which it continues its march, from Hindostan to England, and across the Atlantic to America ; perhaps the rapidity and certainty with which death generally ensues after seizure. As for its obscurity, what do we know of the causes of any disease? Even where the case is obvious to the eye, as in wounds, we know the cause and the object of the fever and inflammation—that they arise from violence, and that if Nature does not produce them to effect a cure, the parts will mortify and the patient probably die : but h,orn she does it we do not know. " Servile to all the skyey influences," they "hourly afflict" us in some form or other. Now it is simple cold or
disorder; then it takes the epidemic form, and we suffer from influenza, diarrhoea, typhus, or what not. In certain regions, these forms of disease are aggravated into yellow fever, putrid fever, or plague; and within the last half century may be added cholera, which as regards existence and virulence seems independent of climate, though limited in its ravages either by weather or by the food and condition of the people.
To the class of disorders we have mentioned may be added others ad- mitted to be contagions,—as smallpox, measles,—but which all seem de- pendent upon the atmosphere; that is, they sometimes are " very much about," sometimes are scarcely heard of, although the social conditions shall be much the same. We may therefore readily admit the atmo- sphere to be the cause of these, and indeed of all diseases not constitu- tional or dependent upon function or lesion. When we consider the in- stantaneous effects of foal air upon life, and the malaise—the disorder— very quickly induced by a vitiated atmosphere, the mischief that may arise from continually inhaling tainted air, however small the quantity of the taint, can readily be imagined; nor is it surprising that chemical art cannot detect the poison, even in the worst malaria. The wonderful matter is the variety of its effects. Now influenza, now scarlet or other fevers, now cholera, and now something else, would seem to argue a variety of specific poisons. It is easy enough to admit that a bad state of the atmosphere inducing a bad state of blood should excite a complaint of which the seeds were in us, or by deranging the digestion should pro- duce diarrhoea, (not to mention that hot days, cool nights, want of pre- caution, and vegetable diet, may often produce what is called an epi- demic). Bat why cholera ? why fever? why some of the varieties of fever ? why plague ? It is palpable enough that care, proper diet, good air and exercise, even without a good constitution, may resist an evil influence that overpowers persona obnoxious to the contraries of these things. But why should the bowel complaints now so prevalent seem to "do instead " of cholera ? or why should they go on to cholera ?—see-
ing that there is no very obvious connexion between the symptoms of the two disorders, and none at all between the post-mortem appearances. It
is possible that the following descriptions of cholera, from examinations in India and Russia, might have been modified by the climate; but they point to the heart and lungs as primary seats. This is on the authority
of Mr. Scot.
" The lungs have not 'infrequently been found in a natural state, even in cases where much oppression of respiration had existed previously to death. Much more generally, however, they have been found either to be gorged with dark blood, so that they have lost their characteristic appearance, and have assumed more that of liver or spleen; or they have been found to be in the opposite state— that is, collapsed into an extremely small bulk, and lying in the hollow on each side of the spine, leaving the cavity of the thorax nearly empty. * * * The blood found in the lungs has been always very black. The heart and its larger vessels have been found to be distended with blood, but not so generally as the apparent feebleness of their propelling power, and the evident retreat of the blood to the centre, would have led us to expect The right auricle and ventricle being • A Treatise on Epidemic Cholera. By Z. Rutheribrd Russell, M.D. With an Ap- pendix of Cases treated in the Edinburgh Homeopathic Dispensary, 1848-49, and a Map showing the course of the Cholera from India to Britain. Published by Bailliere. gorged with blood, is nothing peculiar to cholera; bet some dissections have shown the left cavities to be even filled with dark or black blood, which we may reckon as a morbid appearance more peculiar to it In the abdominal cavity, the peritonial coverings of the viscera, being serous membranes, present in general but little deviation from the healthy state; occasionally, indeed, the morbid rte. cumulation of blood in the vessels of the viscera, imparting an appearance of tur. gidity and blueness, is evident on their exterior surfaces. We also find them bear. ing marks of inflammation, especially where the patient may have lingered long before death. In other cases, the whole tube has had a blanched appearance, both externally and internally. The stomach and intestines generally preserve their ordinary volume. The appearance of the omentum is not sensibly affected in cholera. The stomach is found to be so variously affected as to destroy all grounds for pathological reasoning."
Dr. Muller thus describes the appearances at St. Petersburg.
" Heart—Full of fluid blood, or else black unctuous clots (generally) ; also id many cases tough fibrinous coagula; very often larger or smaller spots of why_ mosis on the pericardium; besides which there was nothing remarkable, except e great flabbiness of the muscular substance. Lungs—Remarkable anairnia of the capillary system in the substance of the lungs, while black thick blood poured in greater or less quantity out of the larger vessels. The lungs are pale and whitish, and very dry to the touch. When pa. tients die after reaction has set in, those dark spots may be already observed, scattered through the anremic lung, though in a very slight degree, which ars observed in the beginning of hypostatic pneumonia or acute cedema. When death occurs later, there is very often more extensively diffused (-edema of the hinge, or completely developed hypostatic, and for the most part lobular pneumonia, with soft red hepatization."
But be the cause of the disease or of death what it may, the proba- bility of its fatal termination when once it has reached a certain stage is undoubted. No matter what style of practice or class of medicines is adopted, the great proportion of the patients, perhaps all that have reached the true stage of Asiatic cholera, die. Dr. Russell, an homoeo- pathic practitioner, claims for homoeopathy a success over allopathy, at Edinburgh, in these proportions— Cases. Recoveries. Deaths. Per mat.
Allopathic treatment ...... 876 271 546 62
Hommopathic 236 179 57 25 Such partial statistics, however, prove little, unless we knew the na- ture of each particular case. It is possible that the cases taken to the general hospital might be of a worse kind, and among a worse class of patients, than those attended by the homceopathista. It is more than probable that these last practitioners, with the proverbial zeal of a new sect, might hunt up their patients at an earlier stage, and attend their 236 cases with more zealous care than was displayed by their rivals over their 876. If there is in the statistics any real approximation to a true comparison, the conclusion would seem to be in favour of abstinence and the least interference with Nature. This is Dr. Russell's mode of treating the second stage, or confirmed cholera. "Beyond the administration of the specific medicine, [camphor] the first stage requires no peculiar management, except that quiet and abstinence be strictly enjoined. In the second stage, however, it is advisable to adopt auxiliary mea- sures to aid the struggle of the restorative powers of the system. The object of treatment is to induce a slow, steady reaction. Let this be borne in mind. Too rapid a reaction is dangerous, and frequently terminates the patient's life suddenly, or induces the consecutive fever. From experience, we should recommend the following steps : let there be a general warmth in the apartment, by means of a fire, if the weather be cold ; let the patient be covered with two or three blankets, not more; let bottles of hot water be put at his feet and sides, if the body is cold; if there are cramps, gentle and continual stroking of the affected parts gives relief; the intense thirst must be allayed by frequent moderate draughts of cold water. In some cases we tried large draughts of hot water, but we cannot report very favourably on the result. There is no objection to their trial, however. They were recommended as conducing to supply the want of animal heat. Neither can we recommend embrocation of any kind, whether camphor or turpentine. It is very doubtful if they do any good, and they probably interfere with the action of the medicines. Another thing of great importance to attend to is, that the patient abstain from all food. Not nnfrequently, when the reaction sets in, there is a crav- ing appetite ; and as everything seems going on favourably, the physician is apt to indulge the patient's desire for something to eat. In repeated instances we have seen sudden relapse follow upon eating and, in our opinion, it is of the great- est consequence to give no food at all—nothing but cold water, till the second and third stages of the disease be past. They seldom last above forty-eight hours, and the patient runs no risk from being kept upon a water diet for that time; and after the recovery has begun, the most extreme care is necessary in diet. Nothing but arrow-root, sago, very well boiled rice, and such like things—and even these m very small quantities—ought to be given. A person affected with cholera requires unremitting attention till he is convalescent. He should be seen every few hours, and the most rigid cleanliness of bed and person enforced, when possible. There is no disease that exacts so much care ; and even if this care fail to prolong lye, at all events it mitigates the sufferings of the most painful and terrible death."
We need not enumerate the list of medicines made use of in the later stages of the disease, as they would only be intelligible to the practitioner or available to the homoeopathist. The dose of camphor (the alleged specific in the earlier stage) may be given as a matter of record; though it should be observed that Dr. Russell differs from the Board of Health in considering diarrhoea the first stage of cholera; nor does he assign it a prominent place among the symptoms.
"In the first stage camphor gives rapid relief; but the patient's friends must themselves employ it, as the stage soon ends either in death or in the second stage, which is more difficult to be cured, and not with camphor. In the first stage, accordingly, the patient must get as often as possible, at least every five minutes, a drop of spirit of camphor, (from one ounce of camphor to twelve of spirit of wine,) on a lump of sugar, or in a spoonful of water."
Dr. Russell's volume contains an account of the history and charac- teristics of cholera; some discussions as to the probable causes of it, in opposition to the opinions of the Board of Health ; a view of the statis- tics of allopathic and homoeopathic treatment, with a full account of the practice he has himself adopted ; and a selection of cases treated at the Edinburgh Homoeopathic Dispensary. His historical and general account is a fair and judicious compilation ; though he is not always free from a fanciful or crotchety manner, which is often a characteristic of men who quit the beaten path without rising to philosophic originality. His rea- sonings on the subject of cholera are shrewd, but sometimes urged in the spirit of a partisan, as if the faculty had almost committed a crime; rather than merely made a mistake in their views—assuming them to be wrong. The superiority of the homoeopathic mode of treatment must be decided by facts ; on the Edinburgh portion of which we have already offered a remark. The reasonings or rather the expositions of Dr. Rus- sell will carry conviction only to minds already convinced.
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