A. B. Whitney

“ In declaring all remedial agents a failure, does not the author himself commit a greater failure in omitting to survey the whole subject of treatment, and to trace out and to show from the application of the pathology of the disease the probable cause of such failure? ”

“ It is universally admitted that in many instances we may learn much from observing the manner of death which, in a majority of these cases of cholera, may be described by the term asthenia—a death similar to that which occurs in congestive fevers, and in some cases of accidental poisoning. Perhaps the most striking fact observed in these cases is the perfect exhaustion attending the last moments of existence, and the quiet, undisturbed manner in which life terminates. ”

“ The passage of the blood, they affirm, is impeded, clogged, and partially suspended. To remove this obstruction, relieve spasm, and secure the prompt aeration of the blood, in hope of arresting the progress of this disease, is ostensibly the object. However, they seem studiously to avoid the most logical conclusions of their explanations, and justify a practice that can give no hope of permanent relief, while every fact and symptom is ominously suggestive of the wants of the system, which imperiously demands the aid of electrified oxygen, ozone, or free caloric, for the oxydation of the blood. ”

“ Every necessary convenience should be at once provided to prevent, if possible, the patient from rising to, or standing upon, his feet, for the erect posture, before relief is fully obtained, will inevitably hasten the unfavorable termination of the disease. On this direction, therefore, the physician must insist if he would save his patient. Says an eminent physician, perfectly familiar with the disease, "This direction faithfully observed, and good nursing, will save very many patients even without medicine." ”

“ There is another mode of practice which has been exhibited to some extent in almost every part of the world, claiming to be more efficacious and successful than any other in the cure of epidemic cholera. It is the general principle which is the great and important consideration with which we are concerned in presenting it among the various modes adopted for the cure of this disease. ”

“ Pure air, pure water, and a frugal nutritious diet are Nature's great preventives for the thousand ills of life. These are the great essentials in sustaining the healthful and normal condition of the system, always of primary importance in preserving its tone and energy, and rendering it impervious to any miasmatic or epidemic influences. ”

“ In no instance is this more important than in time of prevailing epidemics; for it is an undeniable fact, that multitudes will neglect the most obvious principles of hygiene, and tolerate, with utter indifference, the most offensive nuisance, in and around their dwellings, and if attacked by disease, will often wonder why they, more than others, should be visited by a malignant disease, or become the victims of a prevailing epidemic. Hence the necessity of urging the observance of some [p.205] of the most obvious principles of hygiene, in the preventive treatment of Asiatic cholera. ”

“ Urgent thirst is one of the most distressing symptoms in cholera; there is incessant craving for cold water, doubtless instinctive, to correct the inspissated condition of the blood, due to the rapid escape of the liquor sanguinis. It was formerly the practice to withhold water—a practice as cruel as it is mischievous. Water in abundance, pure and cold, should be given to the patient, and he should be encouraged to drink it, even should a large portion of it be rejected by the stomach; and when the purging has ceased, some may, with much advantage, be thrown into the bowel from time to time. ”

“ Great and sudden changes in the habits of living are always deleterious, and must be particularly so, when an appalling and fatal epidemic is prevailing. Temperance, sobriety and cheerfulness, regular hours for meals, for rest and for business, repeated ablutions and perfect cleanliness, moderate exercise and avoidance of irregularities, persevering self-government and duly subjected passions, all contribute to health, to happiness, and the prevention of disease. ”

“ The voice, before hoarse and almost extinct, was now natural; the hollowness of the eye, the shrunken state of the features, the leaden hue of the face and body had disappeared; [p.81] the expression had become animated, the mind cheerful, the restlessness and uneasy feelings had vanished; the vertigo and noises of the ear, the sense of oppression at the precordia, had given way to comfortable feelings; the thirst, however urgent before the operation, was assuaged, and the secretion of urine restored, though by no means constantly so. ”

“ However formidable this disease may appear, on account of its rapidity and its firm, unyielding grasp upon the vital powers, the forbidding and almost hopeless prospect of relief, and the lamentable results which have attended some modes of treatment, it seems particularly unfortunate for the profession that there should have been a disposition on the part of this learned author to abandon all remedial agents as comparatively useless, without a more thorough investigation into the cause of failure. ”

“ If we go still further, and examine the tendency and effects of the various baths exhibited at Scutari, the use of the flesh-brush, the bare hand, the heated sand, the embrocations, the turpentine and other irritants, the boiling water, or the burning alcohol, skinning and cooking the patient alive, we shall be shocked at the enormous cruelty and barbarity that have been pursued, and turn from the repulsive exhibition, without discovering one ray of light to guide us in the right direction. ”

“ Here in this vast pest-house, where every conceivable vegetable and animal substance is left upon the soil by the retiring inundation, exposed to the heat and dews of a tropical climate—where, too, noisome and infectious diseases have prevailed for centuries, the Epidemic Cholera is said to have arisen and acquired its strength and full development. ”

“ The modern writers, according to the more popular views, almost universally adopt the hypothesis that the remote or final cause of the Cholera is a specific poison; for at no period has a person in good health in this or any other country been known in a few minutes to be shriveled up, his face and extremities to turn purple, his whole body to become of an icy coldness, and with or without vomiting a peculiar fluid, like rice-water, to die in a few hours, except under the influence of poison. ”

“ 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. ”

“ The England, and a few days later the Virginia, with crews and passengers all in perfect health, departing from a healthy port where no cases of cholera were known to exist, and after being out at sea six or eight days under the influence of a cool, invigorating atmosphere, were surprised by the sudden irruption of cholera on board. It breaks out among the steerage passengers who are crowded and packed together between decks like sheep for the slaughter, in a confined atmosphere, daily becoming more noisome, without the means of ventilation or disinfection. ”

“ 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. ”

“ We unhesitatingly affirm the principle suggested by the pathology of the disease is, and must be, one that will reproduce and resupply the lost caloric, or restore warmth to the body; one that will restore promptly the lost nerve-power to the ganglionic nerves especially; one that will arrest and remove the tendency to congestion, equalize the circulation and relieve the oppressed respiration, and thus mitigate the long [p.181] train of dependent symptoms. ”

“ A large body of evidence, however, has been exhibited, going to show that human intercourse has, at least, a share in the propagation of the disease, and that it, under some circumstances, is the most important, if not the sole means of effecting its diffusion. ”

“ The insalubrity of the atmosphere may be regarded as a general, and, perhaps, the most extensive predisposing cause. In this state, its vital element becomes diminished or impaired to such an extent as to render it incapable of sustaining the normal and healthy functions of the system in their most vigorous condition. Hence, the foul and noisome air of close, ill-ventilated apartments becomes very depressing and baneful; a direct and effective element, often, in constant operation in generating and producing the cholera, typhoid fever, or other deadly maladies. ”

“ The first symptom of returning health is shown by the patient falling into a sleep of unusual soundness, during which the respiration becomes [p.62] light and easy, the pulse freer, while a gentle, warm perspiration bedews the whole body. This grateful pause in the disease appears to be the result of the returning powers of life, uninfluenced by medicine, for it often occurs where none has been given. After this balmy slumber the patient awakes refreshed, and often recovers so rapidly, that in the natives of India it almost resembles a restoration after syncope. ”

“ Almost the only organ which seems to preserve in any good degree its powers is the brain—the mental faculties in some cases being retained till the close of life;—in other cases feeble, weak, and much impaired. On the accession of the spasms, the vomiting—and the purging—the disease may be considered as being fully developed, and the crisis at hand, which, in a few hours, must decide the fate of the patient. ”

“ Eminent scholars and pathologists have, during the century last past, patiently searched for its final cause, without arriving at any better, wiser, or more satisfactory conclusion than the earlier writers, who regarded it a poison, commingled with the food they ate, the water they drank, and the air they breathed. ”

“ It is usually admitted that a remedy that has power to control disease, will, by its continued action and influence, restore the normal condition of the system permanently, or at least aid Nature to repair her own work. ”

“ Constant vigilance is necessary to guard against the numberless causes tending to produce an abnormal condition, resulting in the derangement of the stomach and bowels, or [p.209] in depressing the nervous power, thus enfeebling and prostrating the general health. The neglect of these hygienic principles and essential preventives of cholera may induce the condition which temptingly invites the disease. Some are vastly more susceptible than others, and may not be able, with all their watchfulness and care, to avoid an attack, should the disease extensively prevail among us. ”

“ The impeded flow of the blood—the comparative [p.102] emptiness of the left ventricle of the heart and arteries—and the excessive loss of temperature, all indicate a rapid process of congestion attending the progress of disease. This is one of the peculiar and prominent features of cholera, and is strikingly exhibited in the morbid appearances observed in all those instances where death has occurred within a few minutes from the first indications of attack.
When the attack is violent, the process is rapid; when mild, it is slow; and even in the collapse stage progresses tardily. ”

“ Bell represents, it is the cold stage which is alone essential, and is the physiological cause of the subsequent stages. It is the specific disease-poison, so often referred to, that has been inhaled, the leaven that has effected such obvious changes in the blood. The poison, virulent, and subtle, and unknown, so marvelously active in its operations, that is exhibited so prominently in all the works we have perused as the one great, mysterious, and efficient cause which produces the disease called cholera, and all the phenomena of its development. ”

“ There are some other predisposing causes of no inconsiderable influence, which not only favor the operation of the infecting agent in the production of the disease, but even awaken its latent power, and stimulate its activity and development in the system, once exposed to its invasion. ”

“ It is said, some have observed a chemical change in the constitution of the atmosphere, and have attributed the cause of the cholera to the loss or diminution of its ozone—a principle which is understood to represent what is very properly termed electrified oxygen. Ozone is, therefore, the vital element of the air. It is said that oxygen cannot be assimilated or combined with the blood except when it is in an electrified state constituting the peculiar property or state of ozone. In this state it produces vital electricity of the blood, which is the life. ”

“ Whatever tends to depress the vital powers, impair normal action, or relax in any degree the tone of the nervous system, favors the operation of the final cause. So, too, the low, underground, damp, unventilated apartments, the crowded and uncleanly tenement houses, in which multitudes of the poorer class live, in a confined, foul, and noisome atmosphere, not only favor, but actually invite, the active operation of the infecting agent. ”

“ The commencement of the disease is often so insidious as to pass unnoticed till the system is fully prepared for the sudden and violent attack. The slight, painless diarrhœa, [p.58] depression of the nervous power, and occasional vertigo may all pass unheeded, and the patient be apparently in perfect health. He may retire to rest entirely unconscious of approaching danger, and after enjoying a sound and undisturbed sleep for hours, be, on awakening from his slumbers, seized with a remarkable sickness, perhaps vomiting, accompanied with most remarkable and profuse discharges from the bowels. ”