A treatise on the epidemic cholera, as it has prevailed in India (Google eBook)

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Preface

In submitting the present work, it may be proper to meet the inquiry respecting its necessity, when so many treatises have already been published on the nature and treatment of the Epidemic Cholera. For this purpose, the author requests the attention of readers to a statement of the motives which induced this undertaking, and of the plan on which it is conducted.

Among the publications on the subject, many of them written by gentlemen of acknowledged talents, and some by those whom, from personal knowledge, the author has great reason to esteem, there is none, he conceives, adapted to serve as a book of reference. Every writer basset forth his own views, and supported them By proofs drawn from his own practice; circumstances which render the works alluded to more suited for a substratum on which to form a general view, than to serve as guides to the practitioner who consults them without the advantage of personal experience of the character of the disease. These works were also, most of them, written at an early period of the progress of , the disease, by which the authors of them were necessarily deprived of the benefit of comparing their own ideas with those of preceding observers.

The pretensions of the present treatise, to be considered as a work of reference, consist in three particulars: — 1. It contains a statement of the author’s own

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opinions. — 2. An examination of all the works that

have yet appeared on the subject 3. The result of

the different modes of treatment of the disease.

With regard to the author’s own opinions of the proximate cause of Cholera, and the treatment thereby indicated, it would have been unnecessary to say any thing in this place, but For the misconceptions on the subject which hehas with pain observed in some instances. It becomes incumbent, therefore, on the author to repeat here what he has more fully explained in the body of the work. He regards the. cause of Cholera to consist.in inequalities of weather producing sudden check of perspiration, a determination of blood .from the surface to the centre, and consequent inflammation .internally, at the same time that the skin is seized with a deadly chill. The remedies he would prescribe, in this state . of excitement within, are principally the immediate exhibition of sedatives , with the careful exclusion qf stimulants of eveiy kind. This treatment the author adopted and recommended, almost from the first. moment that he observed the Epidemic in the central division of the igrand army, to which he was attached as Staff. Surgeon: his surprise, therefore, may be conceived when he finds himself described as directing the use of brandy an d other powerful stimulants, as a part of the . remedies which his system comprised !

The author has not confined himself, in this work, "to the development of his own views, as this plan would have coincided with those of all the other works on .Cholera,; but has entered into an impartial examination of the merits of all the publications on the subject, to which he has had access. These publications include treatises published at different times by the authors ithesnselveg,

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and the Reports winch hare been published by the Medical Boards of the three Presidencies. The independent treatises require no farther notice here ; but of the Reports it is necessary to give some account.

The Honourable Court of Directors, in consequence of a request by the Supreme and Local Governments of Madras and Bombay, that their respective Medical Boards should preserve records of the Epidemic Cholera, having ordered, that the particulars of the progress of that disease through their territories, with the different modes of treatment, should be prepared and printed ; the Medical Officers accordingly transmitted their Reports to the Medical Boards of the three Presidencies. These Reports were published, with the view of affording to the Faculty in England, and elsewhere, such information, on the nature and treatment of the disease, as might be useful in checking its progress and ravages. These documents, however, are only partially known ; and although they are valuable in themselves, and extremely interesting, yet they are drawn up in a manner so desultory, the matter is so voluminous, and the opinions on the theory and treatment of the disease are so diversified, that a general reader finds it difficult to possess himself of the material portion of their contents, and to arrive, through so many conflicting opinions, at a just and satisfactory conclusion : indeed, for the task of an attentive perusal of them, which their voluminous form renders both laborious and tedious, few readers have either the inclination or the leisure.

With the view, therefore, of promoting the interests of Medical Science, and the welfare of humanity, the author has endeavoured to furnish his readers with a critical examination of them, in order to point out the viii

PREFACE.

most successful mode of treating the Epidemic Cholera. Being desirous that the views and practice of the several writers may be adopted, as far as experience has confirmed their propriety and efficacy, he has given their names, and quoted their own words in the description of their treatment ; thus offering both proof of his impartiality, and grounds for securing the confidence of his medical colleagues.

As the excellence of every mode of treatment must arise from its success, the author has carefully attended to the result of every system yet offered to public notice ; and he is willing, that the merits of his own views should be decided by this infallible test. It will appear to every unprejudiced reader, that while, on the one hand, the method of administering stimulating remedies has almost totally failed, the exhibition of sedatives has been successful to a degree which completely establishes its superiority over the other plan. The failure of the one, and the success of the other in a few instances, does not invalidate the conclusion. If sedatives have not successfully operated in every case, the reason of it, as will be clearly perceived in the course of the following pages, is that they were not prescribed sufficiently early. Nor is it surprising, that stimulants, though generally pernicious in their operation in Cholera, should have succeeded in some cases : difference of constitution, strength of the disease, and other circumstances, are sufficient to account for these exceptions to the general want of success of the stimulating plan. It is the general effect which must be taken into account, in estimating the comparative merits of the two modes of treatment. “ In a limited observation,” Sir Gilbert Blane has remarked, “ to which only one or

PREFACE.

is more cases, of the most infrequent effects of a medicine, may have occurred, one is in hazard of erecting an exception into a rule, by mistaking these facts for instances of the universal effects of it. It is only by computation, founded upon large averages , that truth can be ascertained ; and hence the danger of founding a general practice on the experience of a single case, or a few cases.”

On the subject of the cause of epidemical influence, which still continues, in a great measure, inexplicable, the Author deems it unnecessary for him to bestow attention ; while he has, to the full extent of his ability, directed to such preventives as experience has proved effectual.

These pages have been written with no view of exhibiting brightness of intellect, powerful thought, or laborious research. The Author’s aim has been the discovery of truth; he has honestly sought it, and, to the best of his knowledge, faithfully declared what ought to have been, but was not done, and what should now be done, for the removal of one of the most awful Epidemics on record, which is now spreading its evils and sufferings over all Europe. In the critical review of the opinions of his brethren, while he has solemnly protested against some speculations, displayed in a seductive garb, but unsupported by practical or clinical experience, he has carefully abstained from the language of disrespect or illiberal censure.

The Author takes this opportunity to acknowledge the obligation he is under to the Medical Board of the Bengal Presidency, for the privilege allowed him of inspecting the Original Returns and Reports in their Office.

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PREFACE.

It is gratifying to the Author to perceive the following favourable notice of his treatment of Cholera, in the Russian Hufeland’s Journal :

“ The treatment recommended is that employed by the best English practitioners, and consists in the administration of large doses of calomel and opium, early blood-letting if re-action has taken place, the warm bath and' warm clothing, together with counter-irritants to the surface, and the use of opiate injections. When the vomiting has stopped, they advise a gentle laxative, such as carbonate of magnesia, or the cold drawn castor oil to be given.

“ This formidable disease, which does not last be-' yond the third day, and is often fatal within twenty-four hours, requires the most active treatment from the physician. The Marquis of Hastings made the treatment recommended by Corbyn, generally known throughout the army, and which subsequent experience has proved to be the most efficacious.”