Treatment

Respecting the treatment of Cholera there are two parties in the Medical profession, each holding a different set of opinions, and each basing their opinions on the results of experience in the treatment of cases,-the one party advocating the employment of evacuants-particularly Castor Oil-to get rid of the "Cholera poison;" and the other advocating the stoppage of the preliminary Diarrhoea as quickly as possible by means of astringents.

The leading advocate of the "Castor Oil treatment" is Dr. George Johnson, the Professor of Physic in King's College, London. Sir Thomas Watson, who formerly held that position, was an advocate of the astringent mode of treatment, but he has lately come over to Dr. Johnson's opinion, and the following are his remarks on the subject: "Whatever may have been Dr. Johnson's earlier purpose, he does not now propose to excite discharges from the mucous surface of the digestive canal, but simply to facilitate the removal of matters lodged there. And this he would do by emetics, by draughts of tepid water or other diluents, or by Castor Oil, of which the action is both speedy and gentle. The recommendation of the evacuant plan, must, after all, lie in its comparative success, and its worth has already been put closely and extensively to the proof.

"In the fiftieth volume of the ' Medico-Chirurgical Transactions,' there is a most instructive communication from Drs. McCloy and Robertson. They show that, of 375 cases of Cholera, admitted into the Liverpool Parish Infirmary in the last epidemic, 161 proved fatal. Of these cases 91 were treated with astringents and stimulants, Camphor and iced water, applications of ice, and injections of Opiates into the skin; and the mortality per cent. of these cases was 71. 87 cases were treated with Castor Oil, and with a liberal use of food and alcohol; and the mortality was 41 per cent. 197 cases were treated with Castor Oil only, and the mortality was 30 per cent. The authors of the paper declare that recovery never occurred without the continuance of intestinal discharges; or their restoration, if previously arrested.

"The late Inspector of Prisons, Mr. Perry, had charge, in 1832, of the Cholera patients in the Marylebone Workhouse. He told me that, though he had no specific notes to refer to, he distinctly remembered that about thirty patients were treated with Castor Oil, and that they did better than any of the others."

Dr. Watson's previous advice had been "whenever a suspicion arose that Cholera was present in the community, not to try, in cases of Diarrhoea, to carry off the presumed offending matter, but to quiet the irritation and to stop the flux as soon as possible, by astringents, aromatics, and opiates." He now says:

"When I last spoke on this subject, I stated that the few recoveries I had witnessed, had all taken place under large and repeated doses of Calomel, but that I could not venture to affirm that the Calomel cured them. At present I am much disposed to believe that by its cleansing action, the Calomel may have helped the recovery; and, after all that I have since seen, heard, read, and thought upon the matter, I must confess that, in the event of my having again to deal with the disorder, I should feel bound to adopt in its generality, the evacuant theory and practice; and to avoid alcoholic stimulants and opiates."

Drs. McCloy and Robertson say: "Our experience of Diarrhoea (that is, the preliminary Diarrhoea of Cholera), was very extensive. Several thousand cases came under our observation in the different dispensaries connected with the West Derby Union, and in the Liverpool Parish Infirmary. Among these were doubtless many who would have recovered under any mode of treatment, but there were many too of a most severe choleraic type. The treatment adopted was generally evacuant in its nature; and consisted in the administration of Castor Oil, Calomel, Rhubarb, or Magnesia. In every case, relief was afforded pleasantly, quickly, and safely. It was but seldom that more than two or three doses of Oil were required." The Medical officers of the Bootle Dispensary depose to the same effect: "We certainly had less trouble with the evacuant mode of treatment. Our patients seldom gave us a third visit; two doses of Castor Oil or Rhubarb Mixture being generally sufficient to cure the disease. We never saw a Diarrhoea patient, treated with evacuants from the commencement of his attack, require subsequent removal to hospital. In a large proportion of our cases, there was premonitory Diarrhoea which had been treated, often for four or five days, with astringents. Diarrhoea patients undoubtedly recover when treated with astringents; but the recovery is not consequent upon the arrest of the discharges, as these are invariably restored before the patient feels well."

On the other side of the question we have the evidence of Mr. W. Sedgwick, who states that "in the epidemic of 1866, the statistics of the cases treated in King's College Hospital, under the direction of Dr. G. Johnson himself, gave a mortality of about 62 per cent. In University College Hospital, in 1854, eight of the patients were treated with Castor Oil; but as only one survived, the treatment was changed. The committee appointed by the Medical Council of the general Board of Health to consider and report upon the treatment of Cholera by Castor Oil, ascertained that in eighty-nine cases so treated, by fourteen different practitioners, sixty-eight were fatal, recovery having occurred only in fifteen cases, while the six remaining cases were still under medical treatment. Similar, if not even more disastrous results are said by the same writer to have attended this practice in India."

In India the medical practitioners seem to have relied principally upon bleeding and Calomel in large doses; combined with Opium, also in large doses. These were followed by cordials and antispasmodics. But the bleeding and Calomel at the commencement were considered indispensable.

Looking at the general results of treatment, it is very evident that the same treatment will not do for every patient; but it must be varied according to the nature of the case. The Diarrhoea, which is usually the forerunner of the disease, should be stopped as soon as possible. If the Diarrhoea has been caused by a foul state of the stomach and bowels, then it will be well to clear them out by means of Castor Oil or Rhubarb and Magnesia, before commencing with astringents.

Dr. H. Hartshorne, of Philadelphia, says "that his experience (especially in 1849 and 1854), in the early stage, before or in the beginning of collapse, has assured him of the great value of antispasmodics and mild stimulants given at short intervals, with ice. External stimulation, by mustard poultices, frictions, etc., are also useful. Upon the suggestion of the late Professor W. E. Horner, a preparation has been much used, with success in a number of bad cases; as follows:

Chloroform...............................A Dram and a Half.

Laudanum................................A Dram and a Half.

Camphorated Spirit....................A Dram and a Half.

Aromatic Spirit of Ammonia.........A Dram and a Half.

Creosote...................................Three Drops.

Oil of Cinnamon.........................Eight Drops.

Brandy.....................................Two Drams. Mix.

Of this, from ten to twenty drops may be given (in iced-water, and followed by small pieces of ice) every five minutes until reaction takes place. This has followed, says Dr. H, under his observation, in a few hours, in several cases even of blue, cold, and pulseless collapse. Dry cups to the spine, in one severe case, seemed to assist materially in promoting recovery."

The Hydrate of Chloral, which from its power over spasm bids fair to be a valuable remedy in the "collapse" state of this disease, has not yet been fully tested.

Dr. Austin Flint states that, "during one epidemic he prescribed for hundreds of persons with Diarrhoea, not one of whom had an attack of Cholera; while of those whom he attended who suffered from Cholera, none had received treatment for premonitory looseness of the bowels."Dr. Flint adds, "The treatment of Diarrhoea during a Cholera epidemic is very simple. An anodyne astringent remedy, with regulated diet, rest and recumbency suffice. Cathartics are on no account to be given."

Whenever Cholera is prevailing epidemically, great care should be taken to insure the purity of the water used for drinking: when its purity is doubtful, it should be boiled and then filtered, says Dr. Watson; but I think the filtering should come before the boiling.