DR. B1781INAN'S CHOLERA AND ITS CURE. * Tin object of this
volume is to furnish a medical and historical account of cholera; to exhibit those collateral circumstances of its late visitation in this countdy, which, in Dr. Bushnan's opinion, aggravated its intensity, if they did not cause it ; and to ream- mend the saline treatment of Dr. Stevens, after an elaborate ex- position of that practitioner's cases at Coldbathfields Prison, in 1832. Dr. Bushnan first presents a cursory sketch of the geogra- phical progress of cholera in modern times, from its vio- lent outbreak in Bengal in 1817, till its arrival on the Asiatic borders of Europe in 1823; through which, after long lingering on the confines, it gradually spread, reaching England in 1831, France and America in the following year, the Spanish Peninsula in 1834, Italy in 1835, and Algiers m 1837. With this geographical sketch is combined some detailed account of the pro- gress of the disease in Frogland, and of the preventive or curative means recommended or adopted by various medical authorities. The author next proceeds to the history of medical opinions on cholera, beginning with Hippocrates and the ancient physicians, • Cholera and its Cures. An Historical Sketch. By J. Stevenson Bushnan, M.D., Sre. &e. Published by Orr and Co. and coming down to the present time ; exhibiting in the course of his survey discordance enough, but which could readily be matched on many other medical themes. The cholera in Fnedand is the subject of several chapters ; its statistics and connexion with the sanatory question forming the more prominent topics. The cures for cholera proposed during the visitation of 1848-49 are then handled; being first presented in a table which occupies fifteen pages, to exhibit the discordant, contradictory, and frequently ab- surd opinions promulgated. As, however, Dr. Bu.shnan dis- plays both lay and anonymous opinions, some allowance should be made for the profession ; though quite enough will remain after every deduction to display the "glorious uncertainty" of physic. The volume closes with a brief notice of the saline treat- ment of Dr. Stevens, anti a full examination of the disputes in re- ference to that question in 1832.
Dr. Bushnan seems much better qualified to exhibit facts or opinions than to pronounce a philosophical judgment upon them. His accounts of the progress of cholera' and of the various opinions on the causes, character, and treatment of the disease, are examples of writing, succinct, clear, and close. His statistics are carefully collected and neatly displayed; he imparts something of unity if not of freshness to the well-known sanatory condition of London, by the judgment with which he selects the statements and the purpose for which he urges them. He shows cogently enough, too, the discrepancies of medical opinion and the uselessness of medical practice. In fact, unless we suppose a laxer mode of statement in one place than another, we are better without the doctor than with him ; for while Dr. Bushnan describes the na- tural mortality of cholera—the proportion of deaths where nothing is done—at from thirty-flee to fifty per cent, he speaks of the mor- tality of treated cases as not being much below fifty per cent. At the same time, looking at the contradictory opinions of those who are to treat us, it is very possible that it is not a slip of statement or calculation, but a lamentable verity.
"Excluding secret remedies, the mere naming of which would occupy a good long summer-day, the foregoing [in the tables] are the majority that were proposed during the years 1848 and 1849 for the treatment of cholera. We cannot promise the reader that they are all; yet are they enough to make manifest the absurd notions abroad. Let us pass in review these remedies, so as to obtain, as it were, a bird's-eye view of them. They defy classifica- tion. Omitting for the moment the complex methods by which cholera was to be vanquished, what were the simple specifics that were to cure—in- fallibly cure—the fearful enemy ? Water, of every temperature. Wrap the cholera patient in a cold sheet,' says one. 'Dash cold water repeatedly over the sheet in which he is enveloped,' says a second. 'Ply him well with cold water internally,' says a third. 'Freeze him, cool his blood to 30° below zero,' adds a fourth. Fools that ye are !' exclaims a fifth, thus to treat the half-dead with cholera; I say, wrap him in sheets soaked in boiling water; and having thus half-cooked the shivering wretch, conclude the pro- cess by placing him over the boiler of a steam-engine.' Sage advice, learned Thebans ! The blood is dark, and the surface cold. My theory,' shouts one man, is, that oxygen reddens the blood, and by its action on that blood generates heat; therefore make the patient inhale oxygen.' Nay,' rejoins another, the blood in the lungs is too bright ; oxygen has nothing to do with the gmeration of heat ; stifle him with carbonic acid.' 'There are cramps present, which cause much suffering; and therefore are they the symptoms especially to be treated. Chloroform annihilates pain—let hini breathe chloroform.' 'It is evident,' avows one sapient doctor, that there is no bile in the stools—therefore calomel should be administered.' It is plain,' says another, that diarrhea is the great evil—therefore let him have opium' ; s. e., the dug which effectually prevents a free flow of bile. He is cold and depressed ; what so natural as to stimulate ? The wisdom of the proposal is proved by the numbers who recommended its adoption—the folly of the many is manifested by the proportion who died under the use of stimu- lants.'Give him alkalies,' vociferates one man. 'Nay,' says another, 'lemon-juice and acids are the true remedies.' 'it is simply a stage of in- termittent fever,' maintain some ; therefore,' they add, the drug for its prevention and its cure is quinine.' 'Not half potent enough,' whispers a supporter of the same theory ; give him arsenic.' lr Certain fanatics refuse the use of medicine, but in the course of their religious mummeries administer to the credulous a cup of olive oil. A patient recovered, and Eureka!' shout the populace. 'Vox et preeterea nihil,' say those who wait awhile before they decide. Opium, in one man's mind, is a specific in small doses—the twentieth of a grain frequently re- peated. Nonsense !' says another; 'opium is a specific ; but let it be given in doses of from six to twelve grains.' The latter has one advantage—if the power of absorption yet remains to the stomach, the patient will assuredly be saved all further pain, and, if he be a good man, mercifully provided for in a better world. However, as the duty of the doctor is to keep men here and not to hurry them off there, we suppose twelve-grain doses of opium will not be very extensively recommended by the profession. " Calomel is is the specific that will stay every symptom of the cholera— bring back the absent pulse—restore the genial warmth of the icy skin— bid bloom again the leaden cheek ; give it, then, freely, in large doses— give twenty or thirty grains, and see its magical effects!' ' Do so,' says an equally devoted admirer of calomel, and you will give the last blow to the dying wretch. Calomel is the remedy ; but it must be insinuated into the system in small doses, frequently repeated." Bah !' replies the first, if you follow this man's whim, the patient will slip through your fingers.' Then come other infallible specifics—pitch, sulphur, phosphorus, and carbon; gold, silver, zinc, and lead; strichnine, salicine, morphine, and cannabine ; hackish and zhorabia; abstraction of blood, and injection of blood ; perfect repose and incessant motion; to the skin, irritation the most severe, ap- plications the most soothing stimulants the most violent, sedatives the most_powerful ; inhalation, flagellation. "But if these are the simple, what are the complex methods of treatment that have been proposed ? A combination of all the absurdities contained in the foregoing. Let us just draw the reader's attention to one compound method of treatment. Here are the remedies proposed by one gentleman— port wine, calomel, opium, sulphate of potash, powdered ipecacuanha, spirits of nitric ether, cardamom-seeds, raisins, caraway-seeds, cinnamon, cochmeal, camphor, anis:eed, benzoic acid, benzoin, storax, balsam of tolu, aloes, rhu- barb, mil-volatile, ipecacuanha wine biborate of soda, oxide of bismuth, spirits of wine, nitrate of silver, tartar emetic, potassa, bismuth, calumba, canella, sulphuric ether, cayenne, brandy.
"What a divine dilates must have distended the mind of the proposer of the above remedies, ere he could have conceived the idea of bringing such an assemblage of drugs into one prescription !"
In the critical judgment which penetrates to the kernel of things, and settles the due proportions of right and wrong in opinion, praise and blame in action, Dr. Bushnan is not so much to be re- lied on. His deficiency in this respect affects not only his con- clusions but his composition. He sometimes uses words much stronger than the case requires, and occasionally presents statis- tics which though curious enough are too accidental and uncertain to establish anything. Thus, from a table to give an approximate idea of the manner in which cholera visited particular callings, the egg-merchant would stand very low in the scale of health, for (according to statistics) one out of every six died; the brisk, ready, talkative auctioneer, follows a safer calling, or the constitution that fits him for his vocation enables him to resist disease, as only one in 266 succumbed. We are not sure but that, like most men earnest upon a subject, and especially sanatory reformers, Dr. Bushnan rides his hobby too far, and if he does not attribute too much evil to dirt and its concomitants, guarantees more from Government in- terference than it can ever perform until it shall both educate the people and raise their pecuniary condition.
There is some deficiency of acumen in the medical view of the causes, character, and treatment of cholera ; the last, apparently, arising from a wish to panegyrize Dr. Stevens and. his system. There is no greater mystery about the origin of cholera than about the origin of any other epidemic or contagious disorder : the mys- tery is owing to rarity and panic. Plague, yellow fever, influenza, scarlatina, and various other disorders, originate we know not how, spread in certain directions, rage in some places, are less virulent in others, in some do not'appear at all, or so slightly as to be of no account. How is this ? Popular notion answers it something in the season, the weather, and the locality. Medical speculation can only say the same, or pfaething to the same effect, m learned
Why hy at certain periods are men afflicted with one com- plaint more than another? The answer to this, as to the last question, would truly be, we do not know. But popular and. medical opinion both point to the " Orley influences " ; and in epidemics, where organs are disordered that are known to be in- fluenced by the atmosphere, with evident soundness. Cholera dif- fers from fevers and many other epidemics in the severity of its symptoms and the rapidity of its course ; but in neither perhaps does it exceed the plague. We agree with Dr. Bushnan's fact, that "the results of the treatment employed by a vast majority of practitioners has not been diminished a single iota by the means generally employed " ; but not with the inference. For what kin-
dred is amenable to treatment ? What does it do for the Niger fever, the yellow fever, the plague, or perhaps any fever— for we must not confound nursing with treatment ? That food and sanatory reform will enable men to resist epidemics, is very pro- bable, from the example of the middle-age plagues and pestilenoes that have now ceased, and from the inferior ravages of their suc- cessor the cholera. But in all eases the weakest go to the wall. The old, the debilitated, the debauched, the feeble, and the reduced by poverty or care will hold on in fine weather and good harvests, but drop. off in extreme or unhealthy seasons and deficient crops, let physicians or governments do what they may. It is probable that the saline treatment of Dr. Stevens has not been sufficiently tried; not because the theory cannot receive an answer, (for that consists in the seeming fact that the experiments of Dr. Stevens only establish a chemical action, whereas to cure the cholera we must have a vital influence,) but because the theory is better founded as regards coherence and experiment than many others, and more than all, because no other treatment is tolerably successful. The principle, however, has had more trial than Dr. Bushnan seems to allow. Dr. Stevens's book excited great atten- tion at the time of its appearance, in 1832; and though we can- not always try experiments on the cholera, it must be remem- bered that the saline treatment was held by its promulgator to be available in various other disorders. We make this remark with- out intending any reflection on Dr. Stevens. The seeming ca- priciousness of disease is one of the remarkable phamomena of physic. Puerperal fever was once so fatal as an epidemic, that Doidcet, at the Hotel Dieu, abandoned his functions in despair. A. casual observation led him to employ ipecacuanb.a ; he cured every patient who would take it; and France thought a specific for: puerperal fever was discovered. Next year the disease again prevailed as an epidemic, and ipeoacuanha totally failed. We borrow the account from Dr. Ferguson's "Essays on the most im-
portant Diseases of Women."
"One day, in passing through the wards of the hospital, he chanced to see a woman at the very commencement of the attack, and to remark that it began with vomiting. Looking on this as an indication of nature, he fur- thered the instinctive efforts by an emetic of fifteen grains of ipecacuanha, which was repeated next day. The patient recovered. This unhoped-for success led him to try it on all the rest, and two hundred were saved; while six, who refused to take the emetic, died. His treatment, when method- ized, consisted of giving fifteen grains of ipecaeuanha repeated in an hour. The last dose acted generally on the bowels; an action which he sustained by a potion consisting of elm amygdal. two drachms, syrupi malvas one ounce, kennes mineral one grain; ; a table-spoonful every two or three hours. He repeated the emetic the next morning if the symptoms were alleviated, and the rather if they were not. If the belly remained meteorized and painful for several days, he looked on it as a reason for persevering. "The previous devastation of the malady, and the consequent despond- ency in the practitioners of France, caused the news of Douleet's signal success to be hailed with enthusiasm throughout the kingdom. The Go- vernment compensated the discoverer y. The faculty of medicine drew up minute instructions for this mode of treatment, and distributed them gratuitously over the whole of France. On the following year the malady once more was epidemic and the remedy of Doulcet resorted to in full and earnest faith; but this epidemic, it was quite unsuccessful."
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