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QUERIES ON THE TREATMENT OP EPIDEMIC CHOLERA.
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Appendix
IV.—FIRST STAGE, OR MALAISE,—continued.
2. Exposure to the sun or rain, and to great changes of temperature is dangerous.
3. Warm clothing, especially a flannel belt, is useful.
4. Remedies—There is no known antidote or specific remedy.
5. Spices and carminatives are useful,
6. Wine and spirits are useful to those habiuated to their use.
7. Calomel is valuable when the stools are light-coloured.
8. Quinine and bitter tonics are useful, especially in the rainy season.
9. Purgatives, especially saline, are dangerous, and are apt to induce congee stools and collapse.
10. Change of air useful. Long marches or fatigue to be avoided.
V.—SECOND STAGE, DIARRHŒA—CHOLERAIC DIARRHŒA.
1. Indications—To check the looseness, remove irritating ingesta, soothe irritation, and pro-
mote the secretions.
2. Remedies—Opiates remove pain and check looseness, but retain irritating ingesta and
diminish the action of the liver.
3. Chlorodyne is more energetic than opium with analogous action on the secretions—it sti-
mulates the brain.
4. Brandy and wine remove depression of spirits, but do not check looseness, and the re-action
is dangerous.
5. Spirits with opium check the looseness, but do not restore the secretions of liver, &c., and
the re-action is dangerous.
6. Astringents check the looseness, but retain the cause of the irritation, and do not restore
the secretions.
7. Spices and carminatives remove the depression and restore the secretions, but alone do not
check the looseness or remove pain.
8. The combination of carminatives and opiates removes the pain and checks the looseness
without suspending the action of the liver or affecting the brain.
9. Cholera pills are very valuable, and convenient in form; they are composed of assafœtida
and opium with black and red pepper, and sometimes camphor.
10. Calomel is powerful, and valuable in restoring the secretions of the liver and kidneys when
the looseness is checked, given in one large or repeated small doses.
11. Sulphuric acid in some cases appears to act beneficially; vinegar and acid drinks are useful.
12. Acetate of lead with opium checks the looseness and retains ingesta; it does not restore
the action of the liver.
13. Sinapisms to the epigastrium are valuable, especially when vomiting appears.
lé. Enemata—Hot saline, are sometimes most beneficial, but occasionally powerless.
15. Bleeding is not generally followed by benefit, and sometimes by collapse.
16. Warm baths and wet sheets are sometimes useful, and not likely to be injurious. Cold
affusion is sometimes useful.
17. Purgatives and antimonial medicines are apt to induce congee stools and collapse.
18. Over fatigue, exhaustion mental or bodily, and depression or fear, lead to congee stools
and collapse.
VI.—THIRD STAGE—COLLAPSE.
1. Indications—To relieve urgent symptoms, supply warmth, and avoid strong remedies, and
watch for re-action.
2. Remedies—For burning thirst—Cold or iced water frequently repeated, with occasional
addition of ammonia and soda.
3. Vomiting—Sinapisms or blisters to the epigastrium—hot turpentine fomentation—iced
water. Large doses of calomel; of hydrocyanic acid. Vomiting gives relief and
acts as a stimulant in the most intense forms of cholera.
4. Congee stools—These give relief till re-action comes on and the colour of the evacuations
changes; hot saline enemata are sometimes useful.
5. Cramps—Frictions with turpentine or dry ginger—hot bottles—hot saline enemata—
chloroform.
6. Feeble action of heart—- Transfusion of saline fluid restores the action of the heart and
colour ; but only for a short time. Hot saline enemata are sometimes useful. Alcohol
is powerless as a stimulant during this stage and injurious in the following.
7. Sinking or dead feeling in the epigastrium (paralysis of the sympathetic nerve?)—Infusion
of chillies or red pepper, camphor, am monia, aromatic spices useful in small quantities,
brandy, chlorodyne, æther, have little action in collapse and are dangerous on re-action.