No. II.]
VI.—ΤHIRD STAGE—COLLAPSE.
81
Query No. 13,—continued.
calomel, mixed with a little salt and rubbed on the tongue and buccal mucous surface every
quarter or half hour until some evidences of re-action were apparent. Dr. Searle was a Madras
medical officer. He stated in his pamphlet on cholera, which was widely circulated by
Government, that a professional man who neglected to treat his cholera patient in this way-
should be indicted for homicide. The result was, over and over again, that numbers of those
who recovered from collapse died from consecutive fever in conjunction with enteritis. As
much as three ounces of calomel have thus been given to one patient. I do not remember,
however, that salivation ever took place.
Cox, C. L., Deputy Inspector General, Ben. I.—In this stage all powerful remedies are
dangerous. They remain inert in the system until re-action takes place. After re-action their
accumulated action is often more than the enfeebled patient can bear, and I have seen fatal
ptyalism induced in this way.
Elliot, R. C., Deputy Inspector General, Mad. I.—Medicines are apparently useless in this
stage, however powerful they may be, and there is danger from their action when re-action has
pet in.
Grantt, W., Surgeon, Bom. B.—I can only say that during complete collapse I have no
faith whatever in alcohol or drugs, as it appears to me that the assimilative powers of the
body are, for the time being, completely suspended. It is not improbable, however, that the
injudicious use of these may sometimes lead to unfavorable results after the setting in of
re-action, when the organs have resumed their natural functions ; but I have not been much
impressed with this result in the course of my experience.
Williamson, W., Surgeon Major, Mad. I.—Nothing, in my opinion, is more pernicious than
the system of pouring quantities of medicines or stimulants into a pulseless patient. The best
thing in the stage of full collapse is to gratify pretty freely the instinctive desire of the patient
for cold water.
Query No. 15.—To support the strength-small quantities of soup, arrowroot or sago with a
little brandy. Liebig's extract of raw meat is useful in very protracted cases.
Kean, W. H, Surgeon, Mad. I.—These are, in my opinion, the most useful means, and
will be retained when the drugs and spirits above referred to are rejected.
Maclean, A., Surgeon, Bom. B.—Liebig's extract would be invaluable; what seems to be
wanted is a powerfully stimulating and rapidly nutritious dietary.
Moore, W. J., Surgeon, Bom. I.—Leibig's meat soup used cold will sometimes be retained
when nothing else can be taken. During collapse, medicines are useless; nourishment and
some stimulant is required.
Ross, J., Assistant Surgeon, Mad. I.—It was this plan of dealing with collapse to which I refer-
red in my answer to the first query in this section. If in such cases we leave nature and the disease
to fight the battle out without assisting the former by nourishment, we fail to give the patient the
only chance in our power. By a judicious use of soup, arrowroot, and such like, with, in some
cases, perhaps a little brandy or wine, we give our patient the benefit of this last chance, and by
doing so we may be instrumental in saving his life.
Query No. 16.—Fatigue must be avoided, especially getting up to stool or assuming the erect
position, which is often followed by fatal syncope. On a march, bad cases to be left in
hospital.
Banister G.. Surgeon Major, Ben. I.—Most important. I have witnessed many instan-
taneouslv fatal results from muscular exertion and mental emotion. One poor fellow on being
awakened from sleep by the shrieks of a comrade started up m bed and fell down dead.
Cowen, H. L., Surgeon Major, Mad. B.—I have seen death ensue suddenly from syncope.
A patient got out of bed to go to stool against orders, and fell down m a fatal fit of fainting
on assuming the erect posture.
Fogo, J. M. S., Surgeon Major, Ben. B.-A patient with cholera should never be allowed to
raise his head from the horizontal position, as all his strength should be husbanded. It is a
curious fact noticed in this disease that a patient may be able to move about on his legs, with
a pulseless wrist, and yet not have syncope.
Illinqworth, J. A., Assistant Surgeon, Ben. B.-I agree entirely with this opinion. A pa-
tient of mine, far in canvalescence, was allowed to get up to stool, against my directions, and
he died before he could be assisted back into his bed.
Jacksonn J. M., Deputy Inspector General, Mad. I.-Yes; all medicines should be given
with the feeding bottle, the patient being kept perfectly quiet. I have known patients die when
raised to take medicine, and also when taken up to stool.
Morgan W. H., Surgeon, Mad. I.—My predecessor in this regiment (23rd Native Infan-
try) , in one of his annual reports, says :— "The fatal termination m many cases could be directly