ON THE SUCCESSFUL TREATMENT OF ASIATIC CHOLERA BY SMALL AND FREQUENTLY REPEATED DOSES OF CALOMEL

Joseph Ayre
1849 The Lancet  
145 water, was then -given. This favourable change, however, lasted but three hours. On visiting her at one A.M., she was beginning to sink into an insensible condition; she had not again vomited or purged, neither did the blue colour or corrugation of the skin return; the breathing became hurried, with mucous rhonchus, the pulse gradually failed, and she died at three A.M. Qn the 26th. I am indebted to the kindness of Dr. Marsden, in whose practice the above case occurred, for an opportunity
more » ... or an opportunity of witnessing the operation of injection and its effects. I must confess that, from previous reading and consideration of this subject, there was much doubt in my own mind as to any benefit that could be derived -from such a procedure to a patient in so advanced a stage of cholera, more especially in the one now reported. The effect, however, was so-very marked, and the patient's apparent restoration so perfect for a limited period, that there seemed tome to be every chance of permanent restoration, had the patient been in a moderate state of previous health, and not so reduced by long-continued disease. It is with a view of drawing attention to the subject cf saline injection that the above case is given, in the hope that it may again be thought worthy of trial and investigation, and some useful result obtained, applicable to the relief of such hopeless cases as the majority of those in the collapsed stage of cholera prove to be. The very ably reported case of trans-: fusion, in THE LANCET of the 21st, by Dr. Routh, showed many well-marked signs of improvement, and gave hopes of a more favourable termination; and I am much disposed to agree with him, that the prospect of success by transfusion, and I may add, by injection, is good in cases of cholera. MERLY PHYSICIAN TO THE HULL GENERAL INFIRMARY. BEFORE I had read, in THE LANCET Of last week, the remarks on my plan of treating the Asiatic cholera, and the invitation to me to communicate the results of -my treatment in the present epidemic, I had become aware of many circumstances which should induce me to come once more before the public on the subject; for, notwithstanding my having occupied more than twenty of your columns in explaining and recommending the treatment, I had still to lament—judging by the great and continued mortality of the disease-that-my plan of treating it was only followed very partially, and in numerous cases so imperfectly as to render it wholly unavailing: indeed, accounts had reached -me of parties losing their patients under a treatment which they believed to be mine, and which, in one case, consisted in giving one grain of calomel every hour; and in another, half a grain every half-hour, -as was done also at Tooting, and stated to be my'treatment. And I had-also learnt that gentlemen had adopted my treatment in individual cases, and after using it -for-a'few hours, had abandoned it, or united other means with it, by which its efficacy was prevented. Being desirous, therefore, of bringing the subject once, more before the public, and feeling it to be also a duty imperatively laid upon me, I received with unfeigned satisfaction your-request that I would report the results of my treatment in the epidemic now raging in this town. -This-report I now proceed to lay before your readers, and if it shall lead to-a general,adoption of the treatment, the hope in me will not be vain that it will lead to the saving of thousands of lives. First, I would remark, that, agreeably to what you state, I was invited to accept the appointment of physician to the sanitary committee of the board of guardians of this town, and at the same time my three friends, Messrs. Day, H. Gibson, and Archbald, were associated -with me. Our duty was to take charge of all the cases of Asiatic cholera among the poor of this large town, with above 50,00 inhabitants. To these -gentlemen, in having -whom -chosen as my colleagues I esteem myself fortunate, I explained the views I entertained of the nature of the disease, and the -treatment I would advise for it. To facilitate the means by which I might have a knowledge of each case as it occurred, a -parish officer was appointed to call at the houses of those gentlemen every three hours throughout the day, and to bring to -me the name and address of every fresh patient; and none passed through the disease without being seen early by me, and .each was visited from time to time by ua all. Itas now little more than twenty-three days since the disease reappeared here, and during that period we have had eighty-one cases of the disease, more or less advanced into the collapsed or blue stage, of the patients in which only ten have died. And here I feel required, in reference to the statement now given of the few deaths that occurred among our patients, to anticipate the inqniry that may be made by your readers, first, as to the deinquiry that may be made by your readers ,first, as to the e degree of severity of the disease; and secondly, as to the circumstances which occasioned seven of the whole to die; for rejection and experience have alike taught me, in regard to this disorder, that the same treatment which is equal to curing twenty patients should be equally efficient in curing thirty, unless some acknowledged causes foreign to the treatment have interfered to prevent it. 1st. As to the intensity of the disorder, it might-suffice to ; take, in their order, the first four cases we were oflacially called to attend, which, in company with Mr. Archbald-.and my other colleagues, I especially attended, -and by which I aimed at, and succeeded in, the fixing their attention to the mode I followed in the treatment. I gained, by the results of these cases, the entire confidence of my colleagues in its power. The first case was in a,girl, (Marshall,) nineteen years of age, who resided in St. George's-place, Little Passage-street, and had nursed a sister in the same court, who had died under the opiate and stimulant, treatment. This patient (the girl) became pulseless, and the discharges were so copious as to pass through the bed, and flow in a stream along the floor. The secretion of the kidneys was stopped for seventy-four hours, being longer by two hours than had happened to any patient I saw in 1832. This patient took* grains of calomel, in two-grain doses, was convalescent, that is to say, was safe from the disease, and free from consecutive fever, and was quite well in eight days. The next patient was also a girl in the same court, (Brewer.) She was thrust out from her lodging in an adjoining house, and, in. the absence of its owner, crawled into the hoase, and got into the bed of a woman who had died of the complaint two days before. She was nearly pulseless, but, like the first patient, was carefully attended by a hired nurse, and was convalescent in two days. The urine was suppressed forty-eight hours. The third case was a, youth, (Collins,) aged eighteen, of Duke-street. He had lost his mother a few days before, under the stimulant and opiate treatment, and his sister was dying at the time -of our visit, under the same treatment. They had all occupied the same room. The discharges of the patient ran from him, through the bed, and the secretion of the kidneys was suspended sixtythree hours. He took a large quantity of calomel; had very slight ptyalism; was convalescent in three -days; and was walking about, in seeminggood healfth, at the end of the week of his attack. This patient -was seen in company with Dr. Sutherland. 'The-fourth patient was a married sister of the : foregoing, (Smith.) She had been several days acting as -a nurse to her family, when she was struck down with the disease. She was, however, seen early, and was convalescent in two days, with a slight degree -of ptyalism. But to attain to a just knowledge of the intensity of the disease, the interests of truth =demand -of me to say, that, without any means of knowing the number that have been attacked, the mortality from the disease in this town has been very great under the opiate-and stimulanttreatment, which has been too generally -pursued, and, as I -will presume, from an ignorance -of any better method. -As the official attendants of the poor, and having been widely advertised as such, my colleagues and myself have necessarily had the greater number of the patients attacked; and when I notice among our recoveries a woman eight .months enceinte,-a half-famished; Irish labourer'fetched in by the police from the -outside of the town in a cold .and lived state, a-child two years and a half old several hours pulseless,-=it may be readily imagined that we have had our full share of intensely affected patients. But as I have-stated, if the treatment be-availalsle-fmr the cure of twenty severe cases,it should, ceteris paribus, be available for the cure of thirty, and so on; and I have, -in a former report of my treatment and its results, deemed it right, not only to explain how I saved some, but why I did not save all; for in the -absence of any disease previously present, and of the causes now to be noticed,-every patient, or well-nigh every ,patient, might be saved. The causes which have appeared to prevent our entire success in curing all our patients-are mainly * In a private letter to us, received with this paper, Dr. Ayre laments that he has " had to write it amidst incessant interruptions," and -is unable to see his colleagues before posting it. The above blank appears-in the MS., but it will probably be filled up in a subsequent statement concerning the cholera at Hull —ED. L.
doi:10.1016/s0140-6736(02)70160-8 fatcat:picbl3oqyfhxpcxodyjtut3bte