REPLIES TO QUERIES ON THE TREATMENT OP EPIDEMIC CHOLERA. [Appendix
Query No. 16,—continued.
and positively attributed to the fact of the patient having been raised up by the orderly into a
sitting posture, after re-action had set in, but while the heart was too weak to bear the change
of position." My patients have their nourishment administered from a feeding bottle.
Munro, W., Deputy Inspector General, Ben. B.—The patient should never be allowed to sit
up. Great restlessness of a patient is, in my experience, a bad, nay fatal symptom. Leave all
bad cases in hospital on the occasion of a move taking place.
Rennick, R. II, Deputy Inspector General, Mad. I.—Anything that tends further to exhaust
the waning vital powers should be avoided as much as possible. . On the line of march I have
seen many a case which gave promise of overcoming the disease terminate fatally from the
fatigue undergone in removal from the hospital tent to the dooly. I have seen evil consequences
follow also from exposure to cold.
Smith, H. S., Assistant Surgeon, Ben. I. — Yes, many patients both in cholera and fever have
died of cardiac syncope, who would, I am convinced, have recovered if they had avoided exer-
tion and the attempt to sit or stand up.
VII.—FOURTH STAGE, RΕ-ACΤΙΟΝ.
Query No. 1.—This is a natural stage of the disease taking place in all but extremely
severe cases, and little accelerated by remedies, though tue subsequent symptoms often
are exaggerated by their use. The restlessness subsides, the burning thirst disappears,
the pulse with warmth returns, and bile appears in the stools. At this period brandy
and opium are powerful poisons.
Banister, G., Surgeon Major, Ben. I.—I have considered it advisable in some instances to cup
at the nape of the neck for cerebral excitement, and to apply leeches to the right hypochon-
drium for hepatic congestion. In many such cases, the collapse had not been profound, and
the cases of these patients had hardly awakened anxiety amidst the surrounding horrors ; and
yet over and over again, some of these apparently mild attacks ended fatally from rapidly
developed visceral complications, owing perhaps to the previous indiscriminate exhibition of
stimulants.
Chevers, N., Surgeon Major, Ben. I.—Discontinue medicine, give ice, use counter-irritation
to the epigastrium if the stomach is irritable, and small effervescing draughts with hydrocyanic
acid, iced milk; fomentations, dry cupping, sinapisms to loins to solicit renal action.
DeFabeck, F. W. A., Assistant Surgeon, Ben. I.—Yes, but it is also the stage which requires
more than any other the careful attention of the physician.
Durant, J. J., Assistant Surgeon, Ben. I.—The return to health is a natural process, and
so should not be impeded or hastened in any way by remedies. The manner of its onset is
much the same as here depicted ; besides the bile, the urine also at times is passed, though
scantily. These are two very important symptoms. Brandy and opium are strongly contra-
indicated in this stage.
Fogo, J. M. S., Surgeon Major, Ben. B.—As soon as re-action is established, the eliminative
treatment, so called, by castor-oil should be commenced. Brandy and opium should be looked
upon as poisons.
Griffin, J., Assistant Surgeon, Ben. B.—Yes, but I cannot concur with the opinion that it
is a natural stage of the disease taking place in all but extremely serious cases, as death in
several instances has occurred prior to the supervention of re-action. At this period brandy and
opium are directly powerful poisons.
Hooper, W. R., Assistant Surgeon, Ben. I.—He-action naturally takes place, and is propor-
tionate to the amount of materies morbi left in the system, and to the congestion of important-
organs, particularly the kidneys. The greater the amount of poison in the system, the higher
the fever, and the more severe are the subsequent symptoms.
Jackson, J. N., Deputy Inspector General, Mad. I.—To my mind, this is the most critical
period, and the patient requires constant and unceasing attention. Opium. I would not give, but
very weak brandy and water I would not object to.
Kendall, H., Surgeon Major, Ben. B.—Yes, the re-action should be watched and especially
the return of the secretions. Avoid opium.
Kennedy, J., Deputy Inspector General, Mad. I.—Brandy and opium should never be used
in this stage.
Lownds, T. M., Surgeon, Bom. J.—Re-action I consider to be the recovery from the weaken-
ed state left by collapse, with the complication caused by the effete material remaining in the
system.
McLean, A., Surgeon, Ben. B.—One important indication is to assist the efforts of nature
in establishing re-action, cure being taken not to overdo it. Under these circumstances brandy
and opium are objectionable and dangerous.