26 SEPTEMBER 1846, Page 17

KENNEDY ON THE EPIDEMIC CHOLERA.

THE author of this work may claim the sad honours due to a prophet of evil, whose predictions have stood the test of twenty years' experience. When he published his first edition in Calcutta, in 1826, he was assured by those who were thought to be the best judges of the matter, that his book came too late to possess any interest ; that the disease had run its course, and was extinct, or on the point of becoming so, for ever. He, however, had conceived a theory of the disease essentially different from the views entertained by most of his colleagues. He held among other notions, that epidemic cholera was no new destruction suddenly let loose upon mankind, but probably as old as any other pestilence, and as likely to recur again. So far the event has but too signally confirmed his sur- mises, and enhanced the presumptive value of his authority on other points connected with this terrible and perplexing visitation. Here, then, is a writer, thus strongly accredited, announcing that lie has discovered the true pathological character of the disease, and consequently the true principles on which it ought to be treated. If this be true, its import- ance is inestimable ; for we hardly know which of the two evils has hitherto been the more fatal—the malignity of the epidemic itself on the one hand, or on the other the havoc caused by the wild and desperate measures taken to resist it, and by the panic dread of its presence. Who can tell how much this terror is aggravated by the palpable impotence of medical science, and the distracting spirit of empiricism that seizes the pro- fession, each man pursuing a different course, and all mayhap a wrong one.

The common opinion is, that cholera has its primary seat somewhere in the abdominal viscera ; and no doubt it will appear to moat persons exceedingly paradoxical to assert that it is not the disease, but ita natu- ral cure, of which those parts exhibit such violent symptoms. Now this is exactly what Dr. Kennedy undertakes to prove. He says-

" My idea may, then, be introduced in the language of the Bombay Medical Board, that in cholera 'there is a somewhat pressing on the vital functions'; and what that somewhat is I leave for those to speculate upon who can tell me what the gout is, or what the ague is, or, in short, what any other disease is which can- not be resolved into inflammation; but of the two suggestions offered by the Board, I consider that the oppression is on the nervous and not on the circulating system, for I know nothing but hemorrhage which in such rapid progress could thus affect the latter. I consider a nervous derangement, similar to concussion of the brainsock be the disease, how induced I know not, following the above inex- plicable sustained by the constitution; and the collapse and spasms to be symptomatic of the disorder of the brain; and finally, I consider the purging and vomiting to be no part of the disease, but the straggle and effort of nature to re- lieve the constitution, and cast off the noxious principle which is destroying it. For the treatment of such a disease, the indication is distinctly apparent to relieve the brain by bleeding, and to induce the sanitary process of vomiting and purgingwhere they do not exist, or to moderate them when violent. Into these brief in- junctions may be resolved all that has been written on respectable authority; and the only difference in my theory is, that I would propose a regular ays- tematic procedure in preference to the uncertainty, hesitation, and undecidedness, which in spite of everything that has yet been written, continue to prevail, in a case where, of all others, the patient's safety most mainly hinges on the promp- titude of treatment."

Before the more violent and well-known symptoms of cholera make their appearance, there is always an obscure stage of the disorder, little noticed in general by the patient's friends ; in which he labours under a strange nervous depression, the sign of disturbed action in the brain. Precisely the same thing is seen in the incipient stage of ague or of remit- tent fever.

"When a patient who has been subjected to marsh miasma, after a certain pro- cess of langour,.yawning, and restlessness, accompanied with an indescribable de- pression of spirits, assumes gradually a cadaverous expression of countenance with eyes engulfed in their orbits; nose pinched, and seeming more prominent from the sinking in of the cheeks; temples hollow; akin wrinkled and shrivelled, and of a hue betwixt blue and yellow; and lips colourless; the ears bloodless, and almost to be termed semi-transparent; and the hands and fingers like the ex- tremities of a corpse many days dead, and in which putridity has commenced its course of discolouration; we feel no uneasiness whatever at this appalling train of symptoms, and call it the first stage of an intermittent. In due time, the cold be- comes of a more intense severity, the teeth rattle together by the unrestrainable action of the masticatory muscles, the patient shudders as if he would shake to pieces, and a grinding sensation thrills down the neck and back, as if a small stream of water were running down, of such cutting chilliness, that it burns frore, and cold performs th' effect of fire.' This, we say, is the cold stage; and it is clearly the stage of disease, for when the termination is fatal, it usually takes place here. Happily, however, if the disease be properly. attended to, this is not so frequent as might be expected from the apparent severity of the disorder. But what is the first symptom of the cold diminishing? A nausea! followed by vio- lent straining and vomiting ! to which we have no hesitation of attaching the idea of its being a sanitary process; and which, whenever the patient is robust and plethoric, we induce, by administering an emetic at the outset, to hasten and aid the natural ordinary process ; nor do we ever find ourselves mistaken in our supposition, that our judiciously affording nature this stimulus and excitement to her sanative course is beneficial to the patient, by shortening the duration of the cold stage. This is our everyday experience, and needs neither argument to support it nor authority to enforce it. No sooner does the patient vomit freely, than, in a mild and ordinary case, the deathy coldness yields, the circulation gradually returns, and the hot stage of the intermittent supervenes, as the reaction of the constitu- tion. Now what is that hot stage? Is It that nature, having been depressed be- low her usual course, resumes her course of action, as it were, with a bound of over-excitement? or is it thus that nature works, to bring about the next critical evacuation, which forms the third or sweating stage of the intermittent, by which the train of febrile symptoms are finally to be relieved? I confess myself unable to reply; but when I see preternatural heat, or a paroxysm of fever, follow every shock or unusually violent stimulus the constitution receives, I cannot but believe that it is a part of a sanative process, and that nothing would be more deleterious than to attempt its termination in any other way than the one pointed out by na- ture,viz. by promoting the critical evacuation of the perspiratory vessels. "Here, then, is a routine instance of daily occurrence, and familiar to us all, where first the process of vomiting is a sanative process, an effort of the via me- dicatrix natures to shake off a disease, or a .poison inhaled from a polluted atmo- sphere, which seems to be acting with a malignity that threatens to overthrow as it were, at once, the resources and energies of life; and secondly, where the con- sequent reaction of the constitution is again lowered, and excessive action checked and reduced by a critical discharge of the superficial perspiratory organs."

Accident afforded Dr. Kennedy some remarkable opportunities for con- firming the correctness of his pathological views. In three cases, he was applied to by patients in what both he and themselves mistook for the incipient stage of ague, but which was in reality that of cholera. In each case he administered an emetic, with copious draughts of hot water : this immediately induced the second stage of the disease, which was then clearly cholera, and was treated with bloodletting and a dose of castor- oil, followed by pills of camphor and opium, until the patients fell asleep: they all three recovered. Just enough is now before our readers to enable them to understand what Dr. Kennedy's theory is ; those who desire fuller information may find it in his somewhat discursive volume. We incline to think his views correct : at all events, we agree with him, that it is high time for the medical profession to come to some decision, if possible, on the vexed questions connected with epidemic cholera.