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REPLIES TO QUERIES ON THE TREATMENT OF EPIDEMIC CHOLERA. [ Appendix
Query No. 17.—Purgatives and antimonial medicines are apt to induce congee stools
and collapse.
Brake, J., Surgeon, Ben. I.—The castor-oil, or eliminative treatment, I have seen tried
in many cases in India, but without sufficiently favorable results to satisfy me as to its
superiority ; and the same may be said of the saline treatment.
Cullen, J., Assistant Surgeon, Ben. I.—Dr. Johnson's plan of treatment by castor-oil
is on the principle of similia similibus curantur. I have generally found that the oil
could not be retained, and only served to increase the sickness, which it is the practitioner s
first and chief object to allay.
MacLeod, A. C., Surgeon Major, Mad. I.—From this I dissent. In the choleraic
diarrhœa I regard the deficiency of the biliary function as the proximate cause of the
diarrhœa. The irritation (inflammation) of the intestines is due to a two-fold cause ; firstly, to
the absence of bile in the duodenum, and secondly, to the presence of the uncombined
elements of bile in the blood ; as there is uræmic poisoning in cases of anuria so there is
cholæmic poisoning in cases of acholea. Choleraic diarrhœa is a result of cholæmic poison-
ing. Cholera itself is a result of cholæmic and uræmic poisoning together, a combination
unparalleled in any other disease, and to which unparalleled combination as a proximate
cause the intensity of the objective symptoms of cholera are due.
Moreover, though, for the sake of perspicuity, I speak of the presence of a "cholera
poison" in the blood, and of the necessity for its elimination, it would probably be more
correct to speak of the results of that poisoning, namely, of bile and urine retained in the
blood and of the necessity for their elimination.
Should it be objected that there is no trace of bile or urine in the cholera evacuations,
it is sufficient to observe, that it is the uncombined elements of bile and urine that are thus
eliminated, and that these bear no necessary resemblance to bile and urine respectively.
Choleraic diarrhœa then being due to cholæmic poisoning, it is to be regarded as an
effort on the part of nature to eliminate that poison from the blood. By the administra-
tion of a purgative we favor that intention. All purgatives are chologogues, some more
than others. By the selection therefore of a suitable purgative we fulfil two indications
together,—the purification of the blood, and the renewal of the biliary function. I say
" renewal," but in choleraic diarrhœa, it may be simply diminished, or only altered. In
cholera it is wholly suspended.
I have always found a purgative, oil, or rhubarb with magnesia, or the ordinary senna
draught, an unfailing remedy. Those who combine opium with such medicines, with some
vague idea of moderating their effects, will sometimes achieve success, in spite of the combi-
nations. For an intelligent patient who does not consider calomel poison, and in the absence
of special idiosyncrasy, I prefer in India, ten grains of this drug given alone. It acts firstly-
and almost instantaneously, as a direct sedative, as is shown by the subsidence of griping
pains, and the enjoyment by the patient of a sound sleep. The diarrhoea is at the same
time checked. Supposing the calomel taken at bed-time towards morning we may expect
two or three copious feculent stools passed with scarcely any pain or uneasiness. The first
stool is generally dark olive, almost black, owing to the presence of cystic bile, or bile that
has been for some time retained in the gall bladder; passing through shades of green and
bright yellow, the stools will at length arrive at the natural color of health. At the same
time the artificial diarrhœa that has superseded that of the disease, will gradually cease and
recovery will be complete.
Shelton, A., Surgeon Major, Mad. B.—I have witnessed instances of rapidly fatal cholera
when the disease already existed around, arising from over-fatigue, exhaustion, with perhaps
drink, and exposure to the sun or to heavy rain. The first case of cholera in Her Majesty's
48th Regiment at Lucknow in 1861 occurred in a man who had been lying out at night
in wet clothes, who had been drinking, and who had been much exhausted by walking from
the city to his barracks, some four miles distant.
VI.—THIRD STAGE—COLLAPSE.
Query No. 1.—Indications. To relieve urgent symptoms, supply warmth, and avoid strong
remedies, and watch for re-aetion.
Beatson, J. F., Deputy Inspector General, Ben. I.—I entirely concur. And I cannot
imagine experience having two voices here, though the means employed may he as various
us the opinions of men regarding their relative value.
Coates, J. M., Surgeon, Ben. I.—Calomel, soda, and ginger combined to be given, or muriatic
and hy drocyanic acid with tinct hyoseyami ; injections of lead and. opium. Egg beaten up with
an aromatic water ; mustard to epigastrium ; hot sand to body and extremities ; avoid fric-
tions and much opium.
Delpratt, S., Surgeon, Ben. I—Medicines have no efficacy; persevere in the rubbing of
the patient and in the local application of heat.