16
TREATMENT IN FOURTH STAGE OR RE-ACTION.
Mild nourishing food is necessary. It should be easy of digestion, and
given in small quantities, at short intervals, with a little wine.
Careful nursing is of vital importance in severe cases, more especially at
the commencement of re-action, when the strength must be husbanded with
extreme care ; since merely assuming the erect posture, has, in many instances,
been followed by instant death.
The employment of convalescents who have recovered from the attack, as
attendants on the sick, has been proposed under the idea that one attack affords
immunity from subsequent attacks. This is a mistake, as is shown in Table
No. VI. It would therefore be wrong to detain convalescents in hospital
longer than is absolutely necessary for their recovery.
In India, where efficient native substitutes can be obtained as champooers,
the practice of allowing or requiring their comrades to attend on the sick is
highly objectionable. These men are, as the rule, changed every six hours.
The number attacked within two days of being on duty in the hospital is
considerable; and the men sometimes have an exaggerated view of the danger
of the duty. It is a needless exposure of the individual, in addition to the
danger incurred of carrying the disease into barracks. The practice should be
discontinued in all situations where substitutes can be procured. Those in at-
tendance in cholera hospitals should be distinct from the regular hospital
servants. There should be a separate convalescent ward, or tent, as it is very
depressing for convalescents to see their comrades dying in agony by their side,
and removal diminishes the danger of relapse.
Appendix No. II is a mosaic of opinions and facts grouped symmetrically.
It is culled from reports of shrewd practical men, which have been collected
during the present and a previous investigation at Simla in 1867. The points
selected for illustration are those on which practical experience bears strongest,
and regarding which there is most obscurity or diversity of opinion in Europe
and India. It would have needlessly lengthened the report to have illustrated
the other important points on which the opinions expressed in the body of the
report are nearly unanimous. These are shown in Table VII, which is an
abstract of the replies from upwards of 500 Medical Officers of the British and
Indian Medical Services, who have had personal experience in treating the
disease. The general opinion is nearly unanimous on the sanitary and precau-
tionary measures, and there is a very general concurrence in the indications of
treatment, and regarding many of the individual remedies. The divergence
increases as old practice and recent theoretical remedies pass through this prac-
tical ordeal. Bleeding is repudiated, and faith in calomel gone. Opium is
condemned, and so is the excessive use of alcohol. Acetate of lead is regarded
with suspicion, and sulphuric acid with little confidence; and the danger from
purgatives is acknowledged. There are a few apathetic or hopeless despondents;
there are some who lag in the rear and will not be convinced; and a few
strongly advocate individual remedies which do not prove successful in other
hands. The general impression is, that much good may be done in limiting the
ravages of the disease, both in extent and intensity, and many lives saved by
recognising and treating the disease in its earlier stages, and much distress
relieved, even when life cannot be saved. I have carefully examined these and
other sources of information with the aid of thirty-six years of practical ex-
perience, and I trust that the conclusions that have been arrived at will prove
useful in saving life, and in imparting confidence till more certain information
of the nature of the disease be discovered.
JOHN MURRAY, M. D,
Inspector General of Hospitals.,
Bengal Medical Service.