Observations on the Treatment of Cholera. 

W. Stevens^ M~ D. 

COPENHAGEN. Printed by C. Groebo % Son, 

1833. 



film no \° -' " ' 



JL here are many facts which render it more than probable that the only essential difference betwixt the arterial and the venous blood, is that the former contains pure atmospheric air, and the latter carbonic acid, which is the cause of its impurity and the darknefs of its colour. 

The above gases exist in the blood in a free state. When the venous blood arrives in the Lungs, the oxygen of the air attracts the acid, and the moment that this is effected, its place is instantaneously occupied by an equal quantity of pure atmospheric air. 

Whatever the original cause of cholera may be, it is highly probable that it exists in the air of infected places in the form of a Subtile poison, Which contaminates the asmosphere particularly in confined places. When this impure air enters the Lungs, the poison enters with it into the arterial circulation, 



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consequently the blood is the first part of the body that feels the effect of the remote cause, and this is rendered almost certain by the following facts. 

First) When a person is bled after having been exposed to the poison but before the commencement of the disease, the blood is not only darker in colour and diseased in its appearance , but when exposed to the air it assumes a bluish colour, which is never met with in the blood of individuals who have not been exposed to the cholera poison. 

Second) When we mix salt with blood that is under the influence of the cholera poison it becomes redder, but the salt does not give to such blood, the same bright arterial colour, which a similar quantity of salt invariably gives to a similar quantity of healthy blood. 

Thirdly) Agents which act by a direct impression on the nervous system invariably produce an immediate effect — when light for example strikes upon the eye, the effect is instantaneous — On the other hand those agents, which produce their effect through the medium of the blood, act slowly, and as the 



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poison which causes cholera does not produce any obvious effect for at least 24 hours after it has been taken into the system, we may infer, from this alone that it acts first on the blood and then on the heart, the brain, and the other solids through the medium of this their nutritive fluid. 

The attack of cholera is generally preceded by a bowel complaint, which in truth ought to be considered as the first stage of the disease. In the second stage, the bowel complaint continues, the patient becomes sick at the stomach, and considerable quantities of a fluid is ejected, both upwards and downwards, which has a striking resemblance to rice-water. At this period the patient generally suffers exceedingly from severe cramps, particularly in the extremities. There is also a sudden prostration of strength, the pulse at the wrist becomes rapidly smaller, and in a short period it ceases to beat. In the third stage the pulse is entirely gone, the skin is corrugated, the extremities are cold, the features are shrunk, the eyes are sunk deep in their sockets, the voice is almost entirely lost, the extremities become blue, and in some 



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cases they are almost, black, the breatjh is cold , and the tongue is almost as cold as ice, the kidneys and the liver cease entirely to perform their functions , there is a great oppression about the heart, and when the patient is either left to himself, or improperly treated, Death in a very short period puts an end to his suffering. Such is an outline of the symptoms. The following is the treatment which has hitherto been found to be the most succefsful. 

When a person who resides in a town where cholera exists is seized with a bowel complaint *) he ought to take a seidlitz powder as early as possible. Or if this be not at hand, 12 grs. of Rhubarb with one scruple of Carbonate of Soda may be used in its place. He ought to remain quiet in a warm bed, or at all events in a warm room. During this 

*) The Bowel complaint which is produced hy the cholera poison may be dis tingnished from n com mnn diarrhse a by the following peculiarities: 1) It is seldom attended with pain. 2) The Inclination to go to the night chair co- 

mes upon the p.iiient very suddenly. 

3) The ejections are thrown out with an unnatural degree of force. 



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period he should take every half hour, a teacup-full of thin bouillon well seasoned with Salt, and drink freely of cold water. 

When the above treatment is faithfully followed, the patient is generally well in a few days. Should the disease however run on to the second stage, or should the attack be more severe, a more active treatment will then be necessary. 

When the patient feels sick at the stomach, but without being able to vomit freely three table spoonfuls of common salt ought to be dissolved in a large tumbler of warm water. One half should to be taken first, and if this does not produce free vomiting in 15 minutes, the other half ought then also to be taken. At this period warm tea may be used, but after the stomach has been freely evacuated it is then an object to lessen its irritability as soon as possible. A large sinapism ought to be applied to the pit of the stomach, and one of the common soda powders ought to be given every 20 minutes in a state of effervescence. As soon as the irritability of the stomach has been lessened by this treatment, the following powder should 



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he taken every half hour either in cold water, or thin bouillon. 

Muriate of Soda 9j Carbonate of Soda Chlorate of Potass grs. vij 

The above powder should be continued until the symptoms of cholera have entirely disappeared. After this it may be left of by degrees. 

When the cramps are severe a hot saline bath is of great use, and if this cannot be had, the parts affected should be well rubbed with hot flannel. 

In the first stage of cholera any attempt to check, or even to lessen the bowel complaint is always attended with the greatest danger. In the last stage should the draining from the intestines be so severe as to endanger life, it may then be checked with Tincture of Kino, chalk mixture, or even the sugar of lead may be used with propriety. When these remedies have produced their effect, the saline treatment can then be used with great advantage. 

During the disease the patient ought to be allowed to drink freely of cold water. 



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Seltzer water has also been found to be of great use *). The excretions which are passed should be removed as speedily as possible. The chamber ought to be kept warm with a good fire , and a window may be left open so as to change the air without producing a current over the patient. 

In some rare cases the collapse comes on without any previous bowel complaint. When such patients are either neglected, or improperly treated, they generally die in a Jew hours. In such cases, Salt emetics, and saline purgatives are of great value , and even one or two drops of the Croton oil may sometimes be used with advantage. But should the disease gain ground under the use of internal remedies, there is no doubt that many lives may be saved by injecting a hot saline fluid into the veins. 

When the Saline treatment is not commenced until late in the disease, it does not always produce immediate reaction, but very 

*) This may also he used as a preventive. When the cholera was raging in Moscow not one of those persons died who had been using the artificial mineral waters. 



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frequently the progrefs of the disease is instantly arrested. I have seen patients remain jn a state of collapse upwards of 30 hours, and afterwards recover in a \ery short period. In such cases both the carbonate, and the muriate of ammonia, have sometimes been used with great advantage. 

When the Saline treatment is faithfully followed, from the very beginning it is generally succefsful. It is also a well known fact that those who recover under this practice escape the typhoid fever which is so common and so fatal in those who are treated with opium, and the other medicines which have been and still are, but too much in general use. The patient however must be exceedingly careful during the period of convalescence. He ought not either to eat animal food, drink spirits, or expose himself to cold, or rain, for at least a week after the attack. 

The above is an outline of the practise which has been found to be the most succefsful in every instance where this treatment has been fairly tried. And to those who &at all acquainted with the nature of the ise, the reasons for this are very obvious. 



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Cholera is evidently the effect of a narcotic poison the direct tendency of which is to lessen the vitality not only of the blood, but of the whole body. It is therefore of essential importance that this poison should be removed from the system as early as possible. Those physicians take but a narrow view of this subject, who look only to the solids, and prescribe merely to relieve symptoms. When they are called to a patient with cholera they give opium, chalk mixture, and other astringents even in the beginning. By such practice the bowel complaint is lessened, or perhaps it is entirely checked. The symptom is cured for a titie, but the poison is locked up in the sytem, and if the case be at all severe, the patient is ultimately sure to die. This has been the great error in the treatment of cholera all over the world, and this is the true cause, why in the hands of such practitioners, and "their number is legion" the cholera is as fatal as when first known. 

The Bowel complaint which occurs in the first stage of cholera appears to be neither more nor less than an effort of the preservative 



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power to remove the poison from the circulating current, and this effort is essentially necessary for the safety of the patient. Those cases in which this effort is not made are generaly fatal in a few hours. Such cases however are extremely rare, In 49 patients out of 50, the disease begins with a bowel complaint, and the great secret in the treatment is not to check but to encourage this. If we assist nature by the means which I have advised, the poison is soon removed, and the disease but very rarely runs on to the last stage. 

When the colera was raging in the prison of Cold Bath Fields, in London, of those patients who were admitted previously to the state of collapse, the average mortality did not exceed 1. in 30. Out of 315 patients who were admitted previously to the state of collapse into the cholera hospital in Greville-Street, London, there were only 4 deaths. In truth innumerable proofs might be brought forward to shew the propriety of encouraging this effort of nature by Bd purgatives in the commencement, but following will with some be the more 



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conclusive, inasmuch as it rests on the authority of an individual who had no theory of his own to support. 

In the month of May 1832, the ship Barbadoes, Capt Lee, left the cove of Cork in Ireland for Canada. In addition to her crew she had on board 140 emigrants. The cholera broke out during the passage. The Captain treated the first cases with opium and brandy : three of them died. Fortunately the small quantity of opium which lie had was soon consumed. The cases however were accumulating fast upon him , and having no surgeon on board he had recourse to Epsom Salts, which was the only medicine that he now had left. He gave each a tablespoonful as soon as they were attacked, and the result was that though every person on board was affected with the disease yet not a single case proved fatal except the three above mentioned, with whom the Salts had not been tried. 

It is not merely in the beginning however that much may be effected by proper treatment, for even at a later period a great number may still be saved. 



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The rice-water fluid which is ejected from the system in colera is neither more nor less than the Serum, or watery part of the blood, probably highly impregnated with the poison. The serum is a saline fluid, and in proportion as this is drained from the vital current, the blood which remains becomes not only black but vapid from the loss of its salts *), and thick from the loss of its water. Such inert blood can neither stimulate the 

*) It is now I believe almost universally admitted that it is not the Iron, hut the natural salts of the blood which is the true cause of its red colour. They are also the chief cause of its fluidity, for the fibrin in its natural state is only solable in a saline fluid. The ejections which are passed in cholera contain a very notable portion of the salts of the blood, and if this be not replaced by the absorption, of a salins fluid the whole current becomes black, and so thick that it can scarcely circulate in the smaller vessels. The following are the proportions betwixt healthy blood and that of cholera us ascertained by Dr. Thomson Professor of chemistry in Glasgow. 

Healthy blood 

Scrum 55,00 Oassamcntum . . 45,00 Cholera blood. Serum 32,3* 

Crassamciiltiiu . . 67,66. 



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heart, nor the secreting organs, and even when the poison has been removed, this diseased state of the blood is of itself quite sufficient to cause death. Hence the propriety of saline fluids, which are rapidly carried into the circulation by the veins of the stomach and intestines. These not only dilute, and redden the black blood, but they add to its power of stimulating the heart, and the action of the vascular organs is kept up until all the symptoms of cholera have entirely disappeared. 

In every part of the world where healthy blood has been analyzed it has invariably been found to contain a given portion of saline matter and of all the material ingredients of the blood this is by far the most essential. The addition of oxygen may have some share in giving to the blood its arterial properties, but still it is a mere secondary agent. Salt can redden the blood without oxygen, but oxygen of itself can no more redden or give an arterial colour to black blood, that has lost its salt, than it can give an arterial colour to comnion ink. The essential difference betwixt the black blood in the last stage of cholera and 



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the red blood of health is, that in the former the quantity of its saline matter is greatly diminished. It is exactly in proportion as this takes place, that that the oxygen ceases to act upon the blood in the pulmonary organs, and in the last stage of cholera the colour remains black, even when such blood is directly exposed to the oxygen of the air, consequently it is only through the medium of its salts that the oxygen produces its direct effect , on the vital current, and when these are lost it ceases to act. 

The blood is a living fluid and like every thing else that possesses life, it is subject to disease. In health a smaller quantity of its natural salts are sufficient to enable it to produce that impression on the internal surface of the vascular organs which is in reality the cause of their action. But when the vital fluid is under the influence of a narcotic poison Which lessens its vitalily an increased quantity of its natural salts is then required for the purpose of enabling the preservative power, to remove, or resist the action of those noxious agents "whose effect, holds such an enmity with the blood of man." 

Salt is also essentially necessary in the 



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procefs of secretion. In cholera the natural saline matter of the blood appears to be exhausted in conducting the poison out of the system. When this is diminished to a certain degree, the liver and the kidneys cease to secrete, and the stoppage of action in. these important organs must soon be followed by death. Ample experience^ however has proved, that we can keep up the action of these organs, and even restore their action when it has ceased, better by the use of the nonpurgative salts than by any other remedies that have yet been used. 

In the advanced stages of cholera there is great prostration of strength. The patients may be roused for the moment by brandy, opium, and other stimulants, bat the first effect of these agents is soon followed by great exhaustion, one poison is added to another, and the patient soon relapses into a worse condition than he had been before. 

The non-purgative salts are by far the best remedies for producing permanent increased action in the vascular organs, and 



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one great advantage of these is, that their use is not followed by subsequent debility. 

In health when a strong saline fluid is taken into the stomach a part of it is immediately absorbed by the numerous veins of that organ, and carried directly into the blood. This produces almost immediate excitement all over the system which continues until the excess be removed. This is chiefly effected by the kidneys. When we administer saline fluids in cholera, the yellow fever, and other diseases in which there is a deficiency of the natural salts of the blood, they increase for a time the action *>fthe whole vascular solids. When the poison is thrown out of the circulation, the excess of the -Salts will also be removed, but the natural quantity is retained, in the circulation, and this is essentially necessary; iorfolood without salt can no more perform tts functions than air without oxygen can upport life. 

It is well known, that some of the salts are complete antidotes against certain poisons. The muriate of soda for example has a specific effect in destroying the poison of 



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the Rattlesnake; and after having witnessed in some cases the almost magical effects of saline treatment in cholera, I have been almost tempted to believe that the salts have a specific effect in destroying the poison which causes the disease. 

The peasants in Russia have a general belief that oil, and salt, are the best antidotes against poisons. When the colera was raging in villages where they had no medical assistance, they used a dose of oil in the commencement. After this the patients were treated with large doses of salt, and the fact is notorious that the mortality was comparatively speaking infinitely less in patients who were treated in this way than it was amongst those who Were treated with opium, calomel, brandy and the other remedies which were generally used in the large towns. 

The following are the circumstances under which I have generally found the Saline treatment to be of little use. 

1) In persons who had organic disease in some of the important organs before the attack. 



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2) When the patients had previously been treated with large doses of opium. In such cases I have frequently been sorely disappointed. But with these exceptons I may venture to assert, that if the cholera be taken in time, and properly treated, it will be much less fatal than it has hitherto been. 

With the exception of the yellow fever there is perhaps no other disease, in which the medical treatment founded on the doctrine of pure solidism has done more mischief than in the malignant cholera. Prescribing merely for symptoms has been the radical error, and opium has been in this disease, a fatal medicine. Still the loss of 50 pCent does not make the slightest impression on the hardened solidist. It is well known that those who have used nothing but cold water have saved much more than the one half. Cold water does some good by rendering the blood less thick: at all events, such inert practice does no harm, and this is probably the true secret of their success. Iced water has also been recommended, but in the malignant cholera this has already been tried without effect. In the 



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common cholera there is no specific poison in the system, consequently it is seldom fatal under any treatment. In fact the patient is almost sure to recover whether he be treated with hot brandy and laudanum, or ice water. But in the real asiatic cholera, in which there is a specific and deadly poison in the system, iced water can no more remove the cause, redden the black blood, or restore the action of the paralysed organs, than it can prevent death in those who have been poisoned by the prussic acid. 

In private practice the saline treatment has been much more succefsful than in public hospitals, where the patients are generally brought in late in the disease, and very often after their fate has already been fixed by previous treatment. Still they ought never to be despaired of even to the last. In one of the London hospitals, out of 81 cases which were admitted in a state of complete collapse, there were only 7 deaths and 74 recoveries. In these cases however, the patients had not used one particle of opium, and when admitted, they were treated solely and interely with the saliue medicines by 



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a practitioner who took a scientific view of the- disease, and knew well how to vary the treatment according to circumstances. 

The experience of ages has taught us that every improvement which is directly opposed to common belief is sure to meet with determined opposition. Should the saline treatment be found to be eminently succefsful in cholera, it will strike at the very root of the present doctrine of pure solidism, and for this very reason, it will probably for some time neither be fairly tried, nor generally adopted. The older practitioners will not readily admit the success of any practice which may lead to the conclusion that they have not only been educated, but practising in error up to the present day, and the young will be slow in adopting any practice which is not yet recommended by their own teachers. There have been however some brilliant exceptions to this rule; for many individuals both old and young, even at the risk of severe attacks, have publicly declared themselves perfectly satisfied of the B" : ded superiority of the saline treatment, theory of pure solidim is now I believe 



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very rapidly passing away , and a more scientific doctrine will probably in a short period occupy its place. The belief in the propriety of attending to the diseased state of the blood has already saved a great many lives, and whatever difficulties this belief may have to contend with, I have a Bough conviction that by this thousands be saved, not only in the asiatic cho • , but in the yellow fever, and probably ,cry other type of malignant disease. 

Much has been said against the saline treatment , particularly by those who have tried it only in the very last moments of life, or in those cases where the patients had previously been poisoned with opium. Those however have given a very different report, who have not only tried it fairly, but used it extensively. Were I to publish all that has beeii said in its favour, it would make a volume. As this practice however was first tried in the Prison at Cold Bath Fields, in London I will insert the following letter which was written to the editor of the Medical Gazette, by Mr. Wakefield the gentleman who had the medical charge ef the prisoners. 



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LiHiadown place, Bi-unswick Hqiuu'c, 

April 25, 1832. 

Sir! 

So much lias already been written on the subject of cholera, that I should not now appear before the public, but from a conviction that the facts which lam about to state , if generally known and properly authenticated, (which they can easily be) must be useful to those of the profession who in future may be called upon to treat this new, but most malignant disease. 

The first case which I saw occurred on the sth of this month, iv the prison of Cold-Bath Fields. Three others quickly followed, and were immediately put under the common treatment: these four patients died, after a short illnefs, with all the symptoms of cholera distinctly marked. 

Soon after the commencement of the disease, a number of the prisoners were attacked with marked symptoms of derangement in the gastric organs; and as all of these cases occurred in the infected part of the prison, it is more than probable from this, as well as the general appearance of the patients, that the diarrhoea with which they were attacked, was the effect of the poison winch produces cholera. From having seen similar cases in the commencement transformed rapidly into a state of collapse, my conviction is that every one of those patients were more or lefs iv serious danger; and I believe 



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also that had they either been left to themselves or improperly treated, the majority of these cases would have run into a state of collapse, perhaps in a few hours; indeed I have little doubt that the one half of them would have been lost under the practice which is generally adopted in the treatment of this disease. Independently of the numerous cases where the individuals were labouring under the premonitory symptoms, I have now had twenty-five cases of decided cholera, where the patients were in a state of collapse: and in justice, to Dr. Stevens, who suggested the use of the saline remedies, as well as from a sense of what 1 owe to the public, I conceive it my duty to state, that after having seen both the old and the new treatment fairly put to the test, I am fully convinced that the saline practice is not only the most scientific, but decidedly the most succefsful that has yet been adopted for the cure of cholera; and from what I have seen my Conviction is, that if this treatment be fairly and extensively tried, the mortality from cholera will be greatly diminished. When used at an early period, it either prevents or arrests, the progrefs of the fatal symptoms; but even where this treatment is not used until a later period of the disease, its effects are distinctly marked; and I may safely say that I have seen several most malignant cases recover from the state of Kse under the saline treatment, where the ts, 1 doubt not, would have died under any practice* 



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We have now upwards of twelve hundred persons in this prison ; and from the commencement of the disease up to this date, there have been nearly one hundred cases where individuals have been more or lefs evidently labouring under the iufluence of the cholera poison. Twenty five of these assumed the malignant character of the disease , having the majority of the symptoms described in the printed document issued by Dr. Macann. Four of the first cases, as before observed , were treated in the common way, and every one of them died. All the others, however were immediately put under the use of the saline practice, as recommended by Dr. Stevens, and out of the whole number who have been thus treated, we have only had three deaths from cholera, and two of these were cases of relapse. I may also state that within the last few days, 1 have had one most malignant case in the new prison at Clerkenwell, where the patient was in a state of complete collapse before I saw him. His extremities were cold ; his pulse at the wrist was entirely gone; he had the cholera voice, and his tongue was icy cold. This man like those in the other prison was immediately put under the saline treatment with the happiest effects, and I consider him now in a state of convalescence. 

I am Sir 

Your obedient Servant 

H. Wakefield. 



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The above letter refers only to the beginning of the disease. At two different periods during the summer the cases were not only very numerous, but many of them very severe, particularly amongst those who were ittacked in the cold cells of the prison durng the night, and not put under treatment until early in the morning. The saline practice was followed from first to last, and the result was indeed very different from what it was in the other parts of London, where this treatment was not' tried. I may add that Mr. Mars den, who had charge of the cholera hospital in Greville Street published a small paper of popular Instructions for the treatment of cholera in which he strongly recommended the saline remedies. The demand for this was so great that 15000 copies were circulated in a very short period amongst the Inhabitants, and this was probably one reason why there were only 3200 deaths from cholera in London, whilst in Paris they lost about 40,000. 

The cholera frequently begins differ- Bin different individuals, owing partly c degree of concentration with which 



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the poison has been applied, and partly to the state of the persons health when exposed to the remote cause. It is consequently necessary to vary the treatment according to the circumstances of the case, but in all, the great objects to be accomplished are essentially the same 

1) To assist nature in removing the poi- 

son, as soon as possible 

2) To remedy the diseased state of the 

blood, which is the effect of the poison, 

but almost invariably the cause of death. The following communication contains some valuable remarks on this subject. It was communicated to the Editor of the London Vledical Gazette, by one of the best pratiioners in England. 

"With regard to cholera, it seems now in the highest degree desirable to arrange the vast mass of evidence contained in the numerous journals of the day, so as to discriminate all the circumstances of those cases which have been benefited by a particular remedy, and thus reconcile the apparently opposite modes of treatment, by pointing out tjiiit condition of the disease in which each 



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may be successfully adopted. We can have no premised right to believe one who tells us that he cures a very large proportion of his patients by calomel, opium, and other stimulants, in preference to another who affirms himself perfectly successful with salines. If their cases are equally well authenticated, he is as worthy of belief who debars his patients from all fluids, as he who drenches their stomachs with cold water < — he who gives kino, and he who administers croton oil; or we must disbelieve all. As the supposition, that our profession contains so many men willing to give gratuitously false evidence, is absurd, we must attempt to account for the recorded success of such opposite methods of cure. 

We are told of cases in India where the person, apparently in health the minute before, suddenly became cold, pulseless, and dropped down dead; the poison acting, it is probable, in a concentrated dose, and imitating the effect of the Upas antiar, and strong infusion of tobacco, by paralysing the heart. In doses more dilute it has a pro- Btionably less influence on the heart, and ses vomiting, purging, suppression of the 



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urinary secretion, and of the secretion of the liver, or it prevents its passage into the duodenum. All these symptoms are subject to the modification of local causes, and individual constitutions, which may give predominance to one over the others , —as we know that persons of a relaxed habit are more liable to the diarrhoea of cholera, while in some districts purging, and in some vomiting, is regarded as the chief symptom. These effects of the poison aid its deadly action, by becoming of themselves sufficient causes of destruction to the patient. Spasm may be so violent as to exhaust the nervous energy; the peculiar vomiting and purging may render the blood unfit to maintain life, by depriving it of its salts and water, even though the ultimate cause of the disease be thrown out of the system by these means; and we too frequently observe the deleterious effects of charging the system with bile, urea, or their elements, when the secretions of the kidney or liver are suppressed or detained. In a word, any of the effects of the poison may be the immediate cause of death, according as each .predominates. Surely, 



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then, a person writhing in the agony of a violent spasm, without saline purging, should be treated differently from one lying prostrate devoid of pain, but with insensible i J1 ~aining of serum. Would it not be absurd give a patient a mustard emetic, whose •eady irritable stomach was discharging coously a component of the blood highly nessary to life; or to give nothing but croi oil to one purging salt and water in abun - nee, and already cold and pulseless, where, the remedy should reproduce the secretion bile, the blood is left in a state unfit for culation? Would any one think of debarrr a patient from water who could keep it his stomach, or allow the action of voting to exhaust one whose stomach would not retain a drop ? Yet all these opposite modes of treatment might have been suited to the cases to which their inventors first applied them. The mustard emetic may in gome cases have succeeded, by rousing the action ,of the heart, when the poison was paralysing that organ ; and provided the blood was but slightly deteriorated from the loss of its serum, these patients might recover. Croton 



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oil may serve to excite the biliary secretion, or relieve a loaded stomach , as in the case of the gentleman who recommends it; but either of these remedies I should be cautious in exhibiting in cases with purging. Bleeding, mustard poultices, and small doses of calomel and opium, may be useful in the spasmodic form of the complaint; and cold water may be both allowable and useful where there is purging, if it do not excite an exhausting irritability of the stomach. But will any of these remedies restore to the blood the salts of which it has been deprived by the vomiting and purging? We must, therefore, receive accounts of any universal remedy, for all stages and symptoms of cholera, with suspicion. 

In my own practice I at first used calomel, opium, and mustard poultices, then gmall and frequent doses of calomel and opium, in combination with the saline treatment, and had certainly more success with the latter plan. But I soon found that the treatment must vary with the circumstances of the case* On analysing the evacuation according to the directions of Dr* O'Shaughnessy, 



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I found one patient was passing salt at the rate of a drachm in the hour, while the stomach would not retain the stronger saline medicine. In short, the purging was draining the system much faster than the saline fluid could be replaced ; and my task, like that of the Danaides, was useless. It seemed to be the first indication to arrest this purging. I tried catechu, kino, and the usual astringents , but the stomach Would retain nothing of any bulk. In this emergency I met a patient who, a short time before, had had painter's colic, and given me infinite trouble to open his bowels; and it occurred to me, that if I could induce a temporary attack of that disease in one of my patients, and thus correct the prominent and fatal symptom, I might be able to cure her. I therefore administered some acetate of lead directly. This has been prescribed by Dupuytren, but not in a manner sufficiently impressive for me to have had recourse to it had it not been for this case of painter's colic: I then used it on his authority. My patient took 7 grains, in repeated doses, in 



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a few hours, and I had the satisfaction to find the purging stopped and the stomach (either from the action of the lead or not) become quiet. In other respects she was no better; the voice was a whisper, and the coldness and lividity of the skin, the restlessness and suppression of urine, continued. i now gave Dr. Stevens's saline mixture in .arge doses, with plenty of cold toast-water. All was retained, there was no further purgng, and I had the inexpressible gratification to find her convalescent; in short, she recovered without the consecutive fever. This was on the 20th of July. I have since had several similar cases, quite as successful. In some, where vomiting was the most urgent symptom, I have at first forbidden the use of fluids, and given carbonate of ammonia, in doses of 5 grs. made into pills with crumb of bread ; then effervescing powders , with oil of peppermiut and a small quantity of water; and, when the stomach was quiet, ilenty of toast water, &c. 

I must also mention another method which occurred to me in the case of an infant at the breast, whose mother was one of 



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the patients treated with lead and salines. 

It was a marked case. The child, which I had seen the day before plump and healthy, was cold and shrivelled, and had vomited and purged a large quantity of the peculiar rice-water fluid. I immersed it in a strong hot solution of salt for half an hour, and, on taking it out, it was quite red and amazingly plump. It retained its mother's saline mixture on its stomach, and got well without any other medicine. This child passed, after its recovery, the most foetid motions possible. I have since, in all cases where the introduction of salt into the system seemed indicated, used frictions of strong hot brine over the abdomen and chest, instead of the mustard poultice. 

BI have seen several recover under calomel and opium, but these were cases in which cramp was the worst symptom; and this, although it appears most alarming, is in reality far less formidable than the passive purging which people seem most inclined to make light of. As far as my observation goes, I have seen none recover after such purging as that of the woman abovemeiitioned, except 



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under the saline treatment, modified as I have explained. 

I attended an old man in whom the cramp was excessive, he had no vomiting or purging , but his bowels had been relaxed the day before. He was bled to twelve ounces, took several doses of calomel and opium, and was fomented with the hot brine. He was now relieved, having a natural stool the day after, and appearing quite well, with the exception of soreness in his limbs. At six the next morning purging came on, and at ten, when I happened to call, (for they did not send, though I met three messengers when he had cramp,) he said his bowels had been acted on at least thirty times, and the fluid was beginning to run from them without his knowledge; his skin was getting blue and cold, and his pulse Was very feeble. I immediately supplied him "with four pills, each containing two grains of acetate of lead, one of which he was to take directly, and one every quarter of an hour after, if the purging continued. He took three, did not vomit, swallowed a pint of Dr. Stevens's mixture in a few hours, and 



37 

recovered without the consecutive fever , although an habitual drunkard. This case requires no comment. 

I do not remember to have seen this consecutive fever, as it is termed, except after severe serous vomiting and purging 1 , and when the salt was not replaced. If this observation be confirmed, it will complete the chain of evidence that the consecutive fever is not a necessary consequence of the first cause of the disease, but of some of its effects. *) 

I have, of course, had unsuccessful cases. Altogether, without reckoning the lighter though well-marked cases, but only those Which became collapsed, I have treated thirty-one ; out of which ten died, and twentyone recovered. Of the ten which terminated fatally, two died before the remedies could be administered, and four before I adopted the views I have endeavoured to explain to you. I have injected the veins four times: once successfully in a. very desperate case, when the patient was all but dead; once fairly without success ; and in the other two the patients were drunkards and had taken opium, so that they should not be received into the account. Ido not hesitate in saying that the proportion of deaths would have been very different but for the saline treat- 

*) It is more probably the effect of the medicines which are generally used, for, when the patients are properly treated, 49 out of 50 escape the con- 

secutive lever. W. S. 



38 

ment; without it, the lead, ammonia, fee. 1 feel certain would have, been of little use to those who recovered; and, for one, I give my full quota of the thanks which I thin] are due from the profession to Dr. Stevens for calling its attention to the absence o salt from the blood in cholera, and opening a new field of investigation to others." *) 

The practice of treating cholera with large doses of common salt has been long adopted by the natives in certain districts in India and the fact is notorious that the disease is infinitely less fatal in these districts, than it is in those places, where it is treated by bleeding, opium, calomel and brandy. Without being aware of the above fact, 1 adopted the saline treatment in the yellow fever in the year 1827. In a paper which was written in 1829 and read at the College of 

') I was the first who pointed out that this was the case in the yellow fever ; and in the paper which it as read at the College of Physicians, I predicted that the salts would be found to be diminished in cholera, and in fact in every other disease where there is black blood, and putrid symptoms in the last stage. When the cholera came to England the above prediction was verified in as far as relates to that disease by Or. O'Shanghnessy, Dr. Turner, and several others. Dr. Clanny has also proved that the same is the case in typhus. 1 may add that in this disease the saline practice is more extensively used in Russia than in any other country, and the disease is much less fatal there than it is in Lnndon, Paris, and other places where typhus is treated, even in the last stage, either with calomel, opium, and acids, or inert ptisans* leeches, and gum water* 



39 

Physicians in May 1830. I recommended the same Practice in cholera and in fact in all other putrid diseases. It was after the publication of this paper that the saline treatment was tried in the Custom house hospital in Petersburg by Dr. Ysenbeck. He had in all 52 cases and the result was 3 deaths and 49 recoveries. His report was officially communicated to the board of health but it made no impression on the medical profession, for though the proofs in favor of the saline treatment were as numerous as the sands on the sea shore, the pure solidist either cannot or will not understand why such practice can be of any use. The new facts which have been ascertained with respect to the blood cast a strong light upon this subject, and except amongsi those who are very poor, the practice which I have recommended has many advantages over that which is used by the natives, bu if I be entitled to any merit, it is for having given a more scientific view of the nature o: the Asiatic Cholera, as well as the modus operaudi of the medicines which are generally the most successful, in its cure. 

Cholera- is not a local disease neither is it the effect of a nervous impression, and should it be proved that the poison of cholera as well as the other aeriform poisons which cause fever, produce their effect, through the medium of the blood, or that the remedies which are th« most guccef*- 



40 

/ 

'ul in practice act through, the same medium, this alone will strike at the very roo of the present fashionable doctrine of pure soidisni and lead not only to a radical change mt to a great improvement both in the theory and practice of medicine. Some of the ablest nen in the profession have already become converts, and the number is daily increasing, t has been said however and with truth, that 'the most monstrous absurdities, gain ground aster in physic than useful facts". Evey real improvement has been received with eluctance, and time must pafs before the heory which I have given, will be generally dmitted, or that the practice which I have ecommended will be either fairly tried or generally succefsful in the hands of those who )ave been taught not only to look merely to the solids, but to treat diseases, as if there was not one particle of blood in the living body. Such practice is so directly opposed to common sense that it cannot last. We may therefore expect that the time is not distant when the generality of physicians will adopt a more enlightened pathology and attend to the diseased state of the blood as well as the solids. When this change becomes general we may venture to predict, that the cholera the yellow r fever, the plague and other malignant diseases which are now so fatal, will in a great degree be disarmed of their terrors.