No. II. ]
VII.—FOURTH STAGE—RE-ACTION.
85
Query No. 6,—continued.
Menzies, R., Surgeon, Ben. B.—In the cases I have treated, both Europeans and Natives,
I have used a combination of chloroform and tinct. scillas with marked good effects; water
being passed after δ or 6 hours. Dry cupping has likewise proved useful.
Moir, IV., Assistant Surgeon, Ben. I.—Sinapisms, dry cupping, turpentine, and poultices
or even blisters, may be applied over the hepatic and renal regions to remove congestion by
their derivative effect, and thus to induce the natural functions of the organs. After a free
application of these external remedies, acetate or chlorate of potash, sweet spirit of nitre, and
possibly tincture of cantharides even may be administered internally.
Munro, IV., Deputy Inspector General, Ben. B.—"Warm fomentation or with turpentine added,
dry cupping, and if there is pain in the loins, leeching. Blisters over the kidneys I object to,
and also to the use of cantharides. Nitrate of potash, acetate of potash, liquor potassæ, &c.,
I would use internally.
Pitman, H., Surgeon Major, Bom. I.—I should avoid all of these. If any thing can be
done, the powers of the body will do it. I would rather trust to demulcent liquids.
Playfair, G. R., Surgeon Major, Ben. I.—This is a matter about which there can be no
doubt. The congestion of the kidneys is always present, and the best pathologists in Europe
have said so. Congestion causes suppression of urine ; about this also there can be no ques-
tion, and I have shown that suppression of urine per se, without any cholera complication, is
dangerous and often fatal.
Roe, A. B., Assistant Surgeon, Ben. B.—The external treatment would, I believe, be neces-
sary ; but unless there were some urgent symptoms present, such as a tendency to coma, I
would not be inclined to use the tincture of cantharides.
Simpson, D., Assistant Surgeon, Bom. I.—If the kidneys do not act, symptoms of uræmia
appear and the patient dies comatose, or else the thoracic and abdominal organs become in-
flamed. To obviate this, an attempt must be made to restore the renal secretion. Potash
salts with broom tops, squill and nitric ether may be prescribed, and the loins dry cupped ;
and if it be necessary, an ounce or two of blood may be abstracted. A tendency to diarrhœa
at times exists ; it generally yields to simple astringents, compound rhubarb pill, or Dover's
powder. Vegetable bitters are required to promote digestion and to strengthen the system. In
the majority of fatal cases after reaction, death has been caused by uræmia. The kidney
secretion has been partially restored in some cases, but in others diuretics have failed.
Smith, H. S., Assistant Surgeon, Ben. I.—This symptom is the most alarming. I have
seen cases, where there would otherwise have been much reason for hope, often hold out even
for a week, and this would lead you to suppose from a merely cursory examination that they
were doing well. A negative reply to the query as to whether or not the patient has yet
passed water must always excite alarm. It is in cases of this sort, when the patient would
otherwise have every chance of recovery, that I should be inclined to use salines in every way,
by mouth, by euemata, by hypodermic injection, and by the bath.
Spencer, R., Assistant Surgeon, Bom. B.—For suppression of urine use hot fomentation of
infusion of digitalis and dry cupping to the loins, and give plenty of pure cold water to drink.
I have seen this sufficient.
Sexton, E , Assistant Surgeon, Bom. I.—One of the earliest and most encouraging symptoms
of re-action is the restoration of the renal secretion. Suppression of urine is always an
untoward symptom, and immediate measures must be taken for its relief.
Summers, /., Deputy Inspector General, Ben. B.—Uræmia is a very alarming symptom, since
fatal coma soon follows. It is the most frequent cause of death in cholera after re-action.
Additional Illustration to Section III, Query No. 9.
Macnamara, F. N., Surgeon, Ben. I.—I have very frequently seen the Calla Murrees among
the coolies of the Dhanghur caste. In 1864-65, we had upwards of 1,500 cases of cholera in
the Assam and Cachar coolie depots, and it was then a most common thing for these unfor-
tunate people to die, two or three at a time, as if they had been killed by some poison paraly-
sino- suddenly all the vital energies. The native doctors used to report to me thus—"one
man of the gang had cholera and died, and the rest fell about like dead men, and they also
died." The men died in an hour or so without vomiting or purging, as if in a deadly faint.
Others might vomit once or twice, or might be purged once or twice with the characteristic
discharges.