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ART. I. - Abstract of Proceedings of the Buffalo Medical Association.

TUESDAY EVENING, February 4th, 1868. On motion of Dr. Johnson, Dr. J. F. Miner, was elected Chairman of the meeting. Members present-Drs. Miner, Little, C. F. A. Nichell, Mackay, Abbott, Edmonds, Gay, Kamerling, Henry Nichell, Eastman, Wetmore and Johnson.

The minutes of the last meeting were read and approved.

Dr. Henry Nichell read the following Essay upon the treatment of Asiatic Cholera : Mr. President and Gentlemen of the Buffalo Medical Association:

In a former meeting you have appointed me to the 'honor of reading an Essay on some medical theme this evening. In compliance with your invitation I shall propose to you, observations and facts concerning a certain plan of treatment of Asiatic cholera adopted by the writer during the epidemics of 1852 and 1854, in the city of Buffalo. I sincerely hope the subject selected, although it may perhaps dissappoint your just expectations, is yet worthy of your earnest and thoughtful consideration.

All modes devised for the prevention and cure of this formidable malady, have been censured by modern and quite recent writers, more or less severely, and I may add in part, perhaps, justly. It was the late venerable Dr. Velpeau, who boldly declared before the Academy of Medicine in Paris, "that we know nothing more of treatment of cholera now than on its first appearance in 1832." “All our remedies and modes of practice,” he says, “have failed.” You will, therefore, pardon me when I frankly confess that it is not my fortune to offer to you any superior method or plan as regards the treatment of the disease in question, but to present to you simply “observations and facts” about what had been termed the treatment of cholera with calomel and opium, as employed in the second stage, and also to a certain extent, in the state of collapse of epidemic cholera. This mode of treatment has of late been bitterly attacked and condemned by some eminent authorities, although not a few articles upon the subject also show its enthusiastic advocates and able defenders.

vol. 7, No. 9-42.

Dr. R. Nelson, in his monograph on Asiatic cholera, page 174, does not hesitate to use the following language about physicians prescribing such agents, especially calomel:

“So potent were a wrong education, a defective physiology, a badly acquired habit, a blind faith in false doctrines, and a perni. cious obstinacy in adhering to habit, that almost ali physicians made use of calomel. One gave a grain, with or without opium, every half an hour, another two or five grains, finding these doses inefficient, ten to twenty grains; others, bolder, gave half a drachm, one or two drachm doses. Should one or two patients out of three (the average number) recover, the recoveries were boasted of, as cures.

For a long time the small, the medium and the heroic dose doctors published how successful had been their practice.

In time, however, this abuse of calomel declined, but it is not yet extinct among that numerous class of practitioners who cannot rise above the grade of routinists or mere medicators.

Again, Drs. E. and A. B. Whitney, in their treatise on the subject, page 112, speak as follows: “Has calomel any influence or power to arrest this disease, to quiet the nervous system, relieve the cramps or restore warmth to the body? Its specific action, as far as known, can have no tendency whatever to relieve the system in any essential particular, or stay the progress of disease, or delay its inevitable result, if it remains unsubdued by the action of other remedies.

Here we may ask, will opium aid or give the relief so urgently demanded? However serviceable as an astringent and anodyne in the premonitory stage of the disease, it cannot be exhibited in the second stage to so good an advantage, as, its direct influence is, to aid and promote congestions in those cases, where a tendency of this kind is already in existence.

Again, Dr. Hartshorn on cholera, page 65, says: “Unhesitatingly, I should hold the opinion that calomel is of no earthly use in cholera. The clinical experience, quoted for its success, is accounted for by the addition to it, almost always of opium in the prescription. Nor is the amount of success, with it, even then, great.

You observe that I have quoted three medical writers of quite recent times, who indeed are entirely averse to the treatment of cholera by calomel, with or without the addition of opium, for given reasons. Before I shall, however, proceed to say something as respects observations and facts relative to the employment of just these agents, I desire to lay before you the most positive convictions of no less high authorities, such as I consider rather advocates of this treatment.

Thus Prof. A. B. Palmer, who, according to his statements, had during three seasons, about two thousand cases under carefu observation and management in Chicago, in his remarks on Epidemic Cholera, page 19, says: “I am by no means insensible to the injurious effects, both proximate and remote, which the free use of mercury, under many circumstances produces. I have no sympathy with that class of practitioners, for ever seeing some liver complaint or bilious obstruction,' and hurling heroic doses of calomel or everlasting blue pills at these, so often imaginary difficulties. But mercury is a medicine of power, and has its uses, and cholera is one of the diseases where its remedial virtues are greatest. In this disease it seldom produces salivation, or other remote injurious consequences, and even if it did much more frequently, considering the extreme danger of the patient and the good effect it produces, we should be justified in its use. The use of this article (calomel) I consider of exceeding importance. My observations upon it have been careful and abundant, and I think I cannot be mistaken. The discharges may often be checked without its use, but unless the secretion of the liver is excited, (and calomel when properly given and retained, tends powerfully and far more than any other article to excite that secretion,) the cholera discharges will again return and severe consequences follow. When mercurials, however, are used with opium, such returns of the symptoms are exceedingly rare."

He also says, page 32: “Some of the most remarkable recoveries of this kind, viz: the fully collapsed state, which I have witnessed, have been after large and repeated doses of calomel.”

Further: Dr. N. L. North, on Epidemic Cholera, p. 24, remarks: “The calomel treatment, according to the reports of those who have used it, whether in larger or smaller doses, has produced better results than almost any other treatment, and it is said the patients are not apt to have consecutive fever, and that they are generally well in from three to five days."

Prof. Thos. F. Rochester, of this city, in a very ingenious and well-digested article, entitled “A few remarks on Cholera, (Buffalo Medical & Surgical Journal, vol. vi, Aug. 1866,) in respect to the treatment of calomel, page 4, expresses himself thus: “If the writer indicates a plan of treatment to be generally followed, he does so in no spirit of egotism, and with all respect to the opinion of those entertaining different views. It is the result of extended personal observation and experience; he has tried and has seen tried very many methods of treatment, and while he candidly admits that nothing is very reliable or satisfactory, his decided preference is as follows,” etc.

And further, he adds: “It has been argued that calomel should not be given in the manner advocated on account of the great liability of salivation. It will salivate but very few, but if it is potent in permanently arresting the serous diarrhea, and also in arresting some of the choleraic sequelæ, salivation is of minor importance."

What, however, has by distinguished modern observers been said, either to favor or condemn the use of calomel in this disease, the same applies also to the employment of opium.

Prof. Maclean, cited by Drs. E. and A. B. Whitney, in their treatise on Asiatic Cholera, page 66, remarks: “Opium in cholera should be given only in the premonitory diarrhea. At this stage in combination with a stimulant, it is of the highest value. If persevered in, particularly in the strong doses, it is a dangerous remedy, inducing fatal narcotism, at least, interfering with the functions of the kidneys, and so leading directly to uræmic poisoning."

Dr. Nelson, whilst he, as we have seen, in the strongest terms condemns the use of ca mel in cholera, seems to be an enthusiast, however, as regards opium. In his monograph, page 188, he says: “Throughout the whole reign of cholera, opium has been had recourse to, with benefit, when judiciously employed, but which, alas, has seldom been the case, for there are only a few practitioners who are deeply versed in the recondite action of this heroic remedy, while the great majority see in it only an every day drug, and are totally ignorant of its mysterious power; a larger dose than one grain might so paralyze the stomach as to arrest its power of ejecting what ought to be discharged and lock it in, to the injury of the patient "

Again, page 190, he observes: “When opium is administered at the proper time and in proper quantities, it will not only allay a state of vomiting, which is not longer needed, but it will also sooth the whole economy in a notable degree and pave the way

to a recovery."

Dr. Nelson here doubtless means the use of opium in small or medium doses in the second stage of cholera.

Drs. A. and E. B. Whitney, although according to page 112 of their treatise, they really appear as sharply opposed to the employ. ment of opium in the second stage of the disease, as you will please to recollect, nevertheless they at p. 191, strangely enough, advise the temporary addition of tinct. opii to certain injections into the bowels in cases in which on account of the great irritability of the stomach, their favorite combination of chloroform cannot be retained.

Prof. Palmer, in his remarks on Epidemic Cholera, p. 17, says: “Opium in proper doses and combination in certain stages of cholera, before the vital powers are much exhausted, and while irritation of the stomach and bowels is the most prominent symptom, is the great remedy in the disease, or at least one of the prominent and essential items of a correct treatment. far the most potent remedy we possess for allaying that irritation, arresting the flow of fluids to the mucous surface and controlling the debilitating discharges, and when from its use these effects are

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