TREATMENT IN SECOND STAGE OR DIARRHŒA.
9
the mucous surface of the intestines, support the strength, and promote the
secretions of the liver, kidneys, and skin. The nervous system, though en-
feebled, is still sensible and amenable to the ordinary action of medicines. The
variety of remedies recommended on theoretical and empirical grounds, in the
various reports, is very considerable.
Adds are strongly recommended by some. Several report favourably of
diluted sulphuric acid, particularly in ordinary diarrhœa. There is no explan-
ation of its modus operandi and many have tried it without benefit. Those who
advocate its use combine it with opium, or spirits, and others alternate its
exhibition with alkalies, as soda and ammonia. The alcoholic combination of
hallier has been much used in the Bombay Presidency. Its use appears to
be cooling and astringent, and less dangerous than some other more active
remedies.
Astringents, as catechu, kino, &c., are recommended by some; but if they
retain irritating matter in the intestines they are injurious; and when this has
been removed, they are not required.
Antacids, as soda, and chalk mixture have often been employed without
injury, and in many cases with advantage. The combination of Gregory's
powder, with a little opium, is one of the best remedies for removing irritating
matter from the intestines ; castor oil with a few drops of laudanum is equally
valuable.
Carminatives, as peppermint, spices, essential oils, and assafœtida, are
very agreeable to the feelings of the patient, and valuable in stimulating the
sympathetic nerves and thereby promoting the restoration of the secretions,
after the irritation of the bowels has been removed.
Opiates are of the utmost value in this stage in checking inordinate action
of the bowels, soothing irritation, and calming the system. Opium in various
forms is the chief remedy. Its favourable action appears to be increased by
combination with chloroform as in chlorodyne. The objections to its use are
that it is apt to retain irritating matter in the bowels, and diminish or suppress
the action of the liver and kidneys ; but by keeping these points in view, and
counteracting them by calomel when necessary, opium is a most valuable
remedy in this stage. There is danger of its being continued into the follow-
ing stage, when it would be most injurious. This constitutes the chief difficulty
in combining it with other medicines for general distribution over the country
in cholera epidemics.
Enemata.—This form of exhibiting remedies has occasionally been tried
in this stage, when there was great irritability of stomach. Anodyne and hot
saline enemata have proved beneficial. The form of administration is incon-
venient, and not applicable for general use in extensive epidemics.
Counter irritation.—Sinapisms or hot applications to the epigastrium are
valuable, and when there is pain or irritability of the stomach, should not be
neglected.
Hot Water or Ain Baths, Wet sheets, Cold douche have been tried, and by
some are highly recommended ; but, even if available, their employment is not
generally to be advocated, and they are not essential in this stage.
A watery infusion of Chillies, or Cayenne Pepper, has been very strongly
recommended by some, as inducing re-action without being followed by danger-
ous sequelae. It is more likely to be useful than many of the nostrums which
have obtained ephemeral popularity, though the Surgeon who brought it to
notice died from cholera.
To guard against sudden changes of temperature, Flannel Belts are approved
of both as precautionary and curative in affections of the bowels. In India
they are also valuable in guarding the abdomen from intense heat. Belts are
better suited for India than flannel shirts during the hot and rainy seasons.
The symptoms in the earlier stages often subside after the use of many
different, or even antagonistic, remedies. It is therefore very important, in
determining the value of a remedy, to consider its influence in the subsequent
stages; more particularly, as in wide-spread epidemics, the exhibition of
remedies must be intrusted to people unaccustomed to professional work.