MECHANICAL TREATMENT OF CHOLERA. BY A PHYSICIAN. LONDON: JOHN CHURCHILL AND SONS, NEW BURLINGTON STREET. MDCCCLXVI. f-'h« a/& % k(?2c£ , >^o , £ TREATMENT OF CHOLERA. On Saturday afternoon last I was in London, and, calling on a medical man, I introduced the subject of Cholera. On mentioning to him a conversation I had with the late Sir Benjamin Brodie, he was so struck with a scheme I proposed to Sir Benjamin, and which I had worked out merely for my own amusement, that, before leaving his house, he made me promise faithfully to lay it before the public as soon as possible. This brochure I accordingly draw up with the greatest expedition, having but a few hours to spare from professional duties. I may here state that the medical gentleman with 4 whom I held the interview, being thoroughly conversant with the subject, is in a position to form an opinion of the scheme I propounded; and, indeed, the conviction left upon his mind as to the feasibility of my theory of the disease, and the treatment proposed, is my apology for bringing them before the notice of the profession and the public. At first sight, my views may appear rather astounding, if not extravagant ; but as they are founded upon strictly physiological principles, I am not devoid of hope that, if they be not adopted in practice, they may contribute to the solution, in some slight measure, of a very difficult problem. On reading Marshall Hall's book ' On Drowning,' I was much impressed with his mode of restoring life to those apparently dead. It occurred to me that, if we could recall life in a seeming corpse, how much easier it would be to sustain life in one from whom the vital spark had not yet fled. Long before Marshall Hall's work appeared my gardener, then a little boy, fell into a pond, where it was supposed he had been fifteen minutes. He was found by his mother, who in a frantic state snatched him up, carried him into the house, and shook him violently and 5 rapidly up and down, with the effect of restoring him eventually. When I first formed my impression that circulation and respiration could be maintained by mechanical and external means, I wrote to Sir Benjamin Brodie, my former teacher, in order that I might have an interview with him on the subject. As he had lately undergone an operation for cataract, he was unable to apply himself practically to rendering me that assistance which he otherwise would have done. Recommending me to pursue my experiments, he concluded with the following speech, nearly the last words I ever heard him utter: — "Well, doctor, if we can maintain circulation and respiration, independent of the vital force of the heart and lungs, I do not see how a man could die, excepting by degeneration of the blood." Are there not symptoms of this degeneration of the blood in Cholera ? My theory with respect to Cholera is this — that it is caused by the absorption, through the medium of air or water, into the blood, of a peculiar and highly concentrated poison, in some instances so subtle as to produce an instantaneous shock and death, without the usual symptoms of cholera having had time to be developed, when it is obvious that no relief could be afforded, 6 excepting the patient were treated the very moment of seizure. This poison, I believe, produces depression of the nervous system, particularly that of the sympathetic, the result being the relaxation of the muscular coats of the blood-vessels and subsequent congestion, as evidenced by the lividity of the skin, as well as by the exudation of the watery portion of the blood through the walls of the intestines. So, too, must be accounted for the engorgement of the organs and the arrest of their secretions. Simultaneously, there takes place general retardation of the circulation and respiration, more or less rapidly. In consequence of this retardation, the blood fails to absorb a sufficient amount of oxygen, the element calculated to restore the vital powers, and likewise fails to evolve carbonic acid, which, continuing to accumulate, poisons the nervous centres and so causes anaesthesia and death. If this theory be a correct one, one of the two following systems of treatment must be had recourse to. First, some powerful nervous excitant, to overcome the paralysed state of the nervous centres or systems, must be exhibited, with a view to reviving the action of the peripheral fibrils, and so restoring the contractility 7 and functions of the capillary vessels, and thereby excite the secretory organs to eliminate the noxious matters retained in the blood. I know of no nervous excitant so powerful as a very strong decoction of pure tea, which, before now, has saved life by rousing patients from a comatose state.* This, then, is a remedy which, I think, might be used with effect in cholera; or, secondly, some means must be adopted to carry on the circulation and respiration, independently of the vital forces, and such means must be pursued until the nervous system has been so far restored as to be enabled to carry on these functions by itself, and so gradually adjust the balance of health, by expelling the morbific poison. What I have termed the mechanical treatment of cholera is based upon the idea just alluded to. The treatment is this : — Let the patient be placed, supported on a flat board, in a horizontal position and on his back, the legs being partially flexed. In this position a rocking, * Just now I have seen its effects in a case of cerebral excite- ment, where the pulse was 94, weak, and thready, which, in the course of an hour, was reduced to 56, and became comparatively full and strong, after a minimum dose of concentrated decoction of tea. Along with this effect upon the pulse was a restoration of the function of the skin. 8 see-saw, or to-and-fro movement must be communicated to the body, either by means of rollers, or by poising the board upon semicircular supports, or by suspending it from above. The object in view being to give momentum to the blood, and to compel it to circulate, also to induce respiration by the concussion of the intestines against the diaphragm, synchronously with the momentum imparted to the blood. The momentum imparted .to the body of the patient by some such means is analogous to that given in walking (the action of the heart either in Walking or running being synchronous with the step), and is intended to imitate the same, only without the consecutive exhaustion, there being no expenditure of nerve force on the part of the person operated upon. To complete the correspondence, the jerks conveyed to the body ought to number from eighty to one hundred in the minute, and the action of the jerk ought to be from four to five inches. The modus qperandi seems to be as follows: — The body being composed chiefly of fluids, any motion communicated to it must cause the blood to flow onwards, the valves preventing an opposite course. The heart's action is assisted by the momentum so imparted by the jerks to the blood, the respiratory acts 9 are relatively increased in frequency, and so, while oxygen is being absorbed, carbonic acid is being eliminated, as well as other impurities. Since there occurs a constant drain of the watery portions of the blood through the coats of the intestines, at any rate in most cases, it will be necessary to give water frequently to keep the blood in a fluid state, and so facilitate its circulation. Alcohol also will, no doubt, assist in raising suppressed nervous action, inasmuch as it acts on the nervous tissue directly through the blood, causing it to enter more rapidly into combination with oxygen, just as the combustion of an inflammable substance is enhanced by the addition of a substance more inflammable. Some years ago I received an important letter from the manager of an extensive salt works in Cheshire, to whom I had explained my theory of Cholera. In this letter he informed me that, although a large number of his workmen had been seized with Cholera, not one of them had died ; and he accounted for this success by the treatment which was adopted, viz., as soon as a man was attacked he was carried and placed on the hot stoves, his body was kept in motion, and frequent draughts of brandy-and-water administered. 10 So far, therefore, the theory of my treatment was corroborated. It has struck me since, that the hot air surrounding the stoves, being impregnated with salt, might have had an important effect on the blood of the patient, when inspired, there being every probability that the blood has lost some of its saline ingredients during the attack. I believe that the hot air had the effect of exciting the peripheral nervous filaments, and thereby of rousing into action the nervous system. To sum up my treatment of Cholera — Firstly. Place the patient in a room of a temperature of 120° to 150°. Secondly. Administer a strong decoction of pure tea. Thirdly. Apply mechanical movements, as above described. Fourthly. Rub the whole body with brine, especially the region of the liver and epigastrium. As mustard-and-water exerts a specific influence on the nervous system, and I have often observed this in the use of the mustard-bath, I should recommend its being added to the brine. Fifthly. Give brandy- and- water, as required. 11 It is not to be understood that the above is intended to embrace the treatment of Cholera throughout all its stages, or as including the^management of incidental or collateral symptoms. SEkt* expulsion of the materies morbi, so far as it has been eliminated into the intestines 4^ the repeated administration of small doses of castor oil (the so-called " Eliminative " treatment), must be accepted as a rational procedure. Or, again, the exhibition of iron, as early as possible in the course *of the illness, might prove beneficial by assisting in the absorption of oxygen into the blood, and thereby helping to sustain vitality. The ammoniocitrate, I believe, would be the most efficacious form under such circumstances. By hurriedly throwing together the foregoing suggestions I have fulfilled my promise to a professional brother ; .and, if with a chance of throwing any light upon I dark and difficult subject, I shall have obtained the ly reward I seek. August 6th, 1866.