Cholera; Its Nature and Its 
Cure. 
BY HENRY RAYMOND ROGERS/M.D. 
DUNKIRK, N. Y. 
REPRINTED FROM THE 
.JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 
SEPTEMBER 30, 1803. 
CHICAGO: 
Journal of the American Medical Association. 
1898. CHOLERA; ITS NATURE AND ITS CURE. 
"We have no better means of combating the chol- 
era to-day than at any time since it became known 
to civilization, a thousand years ago," said a distin- 
guished physician in a recent number of the Review 
of Revieios. The medical profession therefore stands 
confronted with the appalling fact that hitherto all 
theories of this disease have been so misleading, and 
all forms of treatment have proved so worthless, that 
longer to trust them would be little less than crimi- 
nal. Better theories and practice are urgently de- 
manded. 
The bacillus theory of Dr. Robert Koch, which was 
so eagerly grasped at, is now found to be fallacious. 
Dr. Koch himself admits that comma-shaped germs 
are found in the common diarrheas of summer 
everywhere, and he tells us: "Water, from what- 
ever source, very frequently, not to say invariably, 
contains comma-shaped organisms." He is not 
ignorant of the fact that these bacilli are found in 
the secretions of the mouth and throat of healthy 
persons and in the dejections of hardened fecal mat- 
ters. Dr. Koch also knows full well that Drs. Pet- 
tenkofqp of Munich, and Emmerich of Berlin, two 
of the most distinguished members of the medical 
profession of to-day, and experts in this disease, 
drank each a cubic centimeter of "culture broth" 
containing these pathogenic bacilli without experi- 
encing a single characteristic symptom of cholera, 
though the draught in each case was followed by 
liquid stools swarming with these germs. Hasterlik 
reports six cases of the same kind without any 
apparent results. The utter worthlessness of Dr. 2 
Koch's comma bacillus as diagnostic evidence of this 
disease is thus fully demonstrated. 
As the result of a personal experience in every 
epidemic of this disease in our country since 1851, 
together with an experience of its effects upon my 
own person and a success in its treatment quite 
phenomenal, I am prepared to assert that cholera 
need be no longer the dread and scourge which hith- 
erto it has been. 
It is strange that a new philosophy of this disease 
which must revolutionize its theories and its treat- 
ment is now found where it never before has been 
sought for, but where alone it is possible to find it, 
viz: in the right interpretation of the symptoms 
which characterize the disease. This philosophy not 
only reveals the essential nature of this disease, but 
points unerringly to a more successful treatment. 
The symptom of most vital importance, and the 
only one which is pathognomonic, is the watery ex- 
udations which find their way so profusely through 
stomach and intestines and skin. In fact, all other 
symptoms which follow this one have their origin in 
it, since, in the entire absence of this, neither of the 
others can have an existence. The most vital conse- 
quences, therefore, depend upon the right apprecia- 
tion of this symptom, together with the promptness 
and efficiency with which its indications for treat- 
ment are carried out. This watery element is con- 
stituted of the serous element of the blood, and 
comes from every part and portion of the system. 
The question now arises, by what process this 
rapid separation of the finer element of the blood 
from the coarser take place? The nerves of the 
system, when in their normal condition, preside over 
and maintain the tonicity of every organ, vessel and 
tissue of the body. They control the functions and 
processes of every part. The rapid filtration of the 
watery element of the blood through the now loose 
and patulous walls of the blood vessels indicates a 
loss of tonicity on the part of the nerves which per- 3 
meate those walls. On account of such weakened 
condition of the walls of the blood vessels a general 
serous outflow pours from every vein and venule of 
the body, and the great life current is thus robbed to 
supply these so-called rice water discharges. At 
the same time the weakened vessel-walls contract 
with diminished force upon their remaining con- 
tents, and consequently the brain and heart fail of 
an adequate supply, and the more fatal symptoms 
and death follow. Such is the secret of the disease 
and its rapid and phenomenal fatality. 
The rapid abstraction of a single element of the 
blood becomes disastrous in the same manner as 
when the full blood itself is lost in the more common 
forms of hemorrhage. It is, therefore, passing strange 
that this rice water phenomenon never has been rec- 
ognized as a hemorrhage, with all that such a hemor- 
rhage implies. All symptoms and conditions inci- 
dent to this disease, as also the changes observed 
upon the cadaver, are explainable upon the hypothe- 
sis of actual hemorrhage; and we are warranted in 
saying, only upon that hypothesis. 
Owing to the failure to discriminate between the 
actions of the red corpuscles of the blood and its 
white discs, its chief constituents, this hemorrhage 
hypothesis has not been applied in explanation of 
this disease. The vital forces of the system depend 
largely upon the action of the red corpuscles, for 
through these chiefly are effected the oxygenation of 
the blood and the consequent revitalization of the 
system. A small loss of this element may become 
quickly fatal. On the other hand, the serum or white 
element which constitutes the bulk of the blood per- 
forms less vital functions, and its abstraction be- 
comes neither so quickly nor so seriously manifest. 
In this disease enormous quantities are sometimes 
separated from the circulating current without fatal 
consequences. 
Treatment.-Since the disease is essentially a neuro- 
sis, and its controlling symptom a hemorrhage, its 4 
treatment becomes at once clearly defined, and the 
pure empiricism of the past must give place to a 
scientific treatment with vastly improved results. 
We must look upon the cholera hemorrhage as sub- 
ject to the same general principles of treatment as 
other hemorrhages. 
As the cholera hemorrhage occurs over so large a 
portion of the body, is colorless, and therefore virtu- 
ally a concealed hemorrhage with all that is alarming 
which that word implies, it calls for attentions at 
once prompt, efficient and watchful. No painless 
diarrhea or painless vomiting is free from danger 
during a cholera epidemic, since the milder condi- 
tions of the disease often quickly change to those 
more grave and fatal. 
Both the principles and the practice of medical 
science teach that position, position, position, is the 
prime safeguard in sudden and profuse hemorrhages 
occurring from any cause. In the treatment of chol- 
era hemorrhage, position with the body horizontal 
or with the head the lowest, is quite as indispen- 
sable as in that arising from any other cause. 
Position in the treatment of cholera is not simply 
a repose in bed with the head resting comfortably 
upon the pillow, and raised or lowered at the pleasure 
or caprice of the patient; but to be efficacious, as in 
its graver cases, it must be compulsory, and strictly 
maintained, as for the very life, until the danger period 
is passed. The vital necessity of position in the 
treatment of cholera is shown by Murray, Cunning- 
ham and other distinguished authorities when they 
tell us that "once sitting upright in bed sometimes 
causes death in this disease." Noteven in the act of 
evacuation of the bowels should the head be raised in 
the more serious cases. But position in this disease 
is sometimes difficult to secure, as the patient, when 
weakened by exhaustive discharges and pain, be- 
comes disturbed in intellect and is with difficulty 
controlled. 
If the best results are sought for, the horizontal 5 
position should be enforced in every case of even 
suspected cholera. In cases of great danger the 
body should be inclined with the head the lowest. 
This position should be maintained until the blood 
vessels contract upon their contents, which fact is 
shown by an improved condition of the pulse. 
In the present condition of medical science, opium 
and its preparations stand far above other remedies 
which may be employed in the treatment of this dis- 
ease. No remedy is known which surpasses this one 
in the power to change the perturbed condition of 
the nervous system and close up the diminutive ave- 
nues through which the watery element of the blood 
and the life ebb away together. During an epidemic 
it is hazardous to rely upon remedies taken through 
the mouth, since in*cholera the action of the mucous 
membrane often becomes changed, so that internal 
remedies either fail to act or are ejected. Moments 
are sometimes precious, as a life may depend upon 
the certainty of retention of a remedy and the 
promptness and efficiency with which it may act. 
The hypodermic method is here our best resource. 
According to the reports of cases in Asia, Australia 
and elsewhere, the hypodermic use of morphia has 
shown almost uniformly favorable results; the one- 
eighth to the one-sixth of a grain of the latter very 
rarely need be exceeded or frequently repeated. 
Opium and morphia in large doses are decidedly con- 
tra indicated in any of its stages; since, if these 
drugs are retained in the stomach, they may become 
cumulative and in the case of reaction they might 
become fatal. 
For the relief of the atrocious cramps, the admin- 
istration of chloroform by inhalation, together with 
small doses of morphia hypodermically applied, offers 
the most speedy and effectual means at our command. 
The stimulation of the brain by currents of blood 
sent to that organ by position, wonderfully facilitates 
the control of the cramps. 
For excessive thirst, ice may be given ad libitum; 6 
and if ice can not be obtained, the coldest water in 
small quantities and frequently repeated. The suffer- 
ing from thirst in this disease is inconceivable, and 
it is unjustifiable, unmitigated cruelty to withhold 
these necessaries from the sufferer. Ice has been 
given freely in every case under my charge, and with 
the happiest effects. 
The circulation should be promoted by the appli- 
cation of heat and friction to the extremities. Any 
further treatment may be conducted upon general 
principles. 
En This disease, so destructive to human 
life, is thus found to be most simple in its character 
and positive in its indications for treatment. As a 
problem in medical science, cholera resolves itself 
into a question of supply of blood to the brain and 
heart. If this supply be kept up, a fatal termina- 
tion to this disease is not probable. Whatever course 
will best promote this end, therefore, must secure 
the most favorable results in its treatment. 
The inestimable value of position as the funda- 
mental idea in the treatment of cholera was first ex- 
emplified upon my own person in 1854, and has been 
abundantly demonstrated in the epidemics which 
have since occurred. 
The simple theory herein advanced is found in 
entire harmony with the highest principles and 
practice of the advanced medical science of to-day. 
It offers results such as never yet have been realized, 
and places within the reach of all a ready method 
of treatment. This treatment may be successfully 
employed even without the use of medicines. 
In fine, in the light of the study of this disease 
during forty years, both at home and abroad, such as 
few have had either the opportunity or the inclina- 
tion to pursue, and in view of the phenomenally 
favorable results of treatment based upon this phi- 
losophy, I believe myself fully warranted in asserting 
that the rate of mortality of this scourge may be 7 
reduced to less than half of that at which it con- 
fessedly stands to-day. 
The foregoing theories have been presented by the 
writer before the American Medical Association, the 
New York State Medical Societies and the Chautauqua 
County (N. Y) Medical Society; also through the 
columns of the Journal of the American Medical 
Association, the Chicago Medical and Surgical Jour- 
nal, and the Quarterly Epiiome of Practical Medicine 
and Surgery.