No.
II.]
VI.—THIRD STAGE—COLLAPSE.
69
Query No. 1,—continued.
Fogo, J. M. S., Surgeon Major, Ben. B.—Medicines or internal remedies are of no avail
now. Warmth should be supplied in some artificial way.
French, J. G., Assistant Surgeon, Ben. I. —Frictions, embrocations, no medicines.
Haward, H., Surgeon, Ben. B.—The great object is to maintain warmth of the surface
and the action of the heart.
Joynt, F. G., Surgeon, Bom. I—During an epidemic I found the cold douche most useful
in inducing re-action ; taking care afterwards to dry the surface, and to use friction, and
warm blankets.
Kidd, Η. Α., Assistant Surgeon, Ben. I.—The symptoms in these cases were, vomitting
and one or two rice-water evacuations, speedily followed by sunken eyes, cold and bluish
tongue, cold perspiration, husky voice, cold breath, slow respiration, great prostration of
strength, and restlessness followed by death. Some died in one hour from the attack, others
in 5 or 6 hours, a few in 24 hours. Those who got over 36 hours generally recovered, but
a few died as many as 20 days after from exhaustion.
Maclean, A., Surgeon, Bom. I.—I have found castor-oil inunctions all over the body ;
using some degree of smart friction, flannel bandages to hands and feet, hot water bottles
to hands, feet and sides, and English blankets useful. In the case in particular of a man of
the 72nd before Sebastopol, apparently hopeless, Surgeon Major Mackinnon, C. B., adopted
this castor-oil inunction treatment, at my suggestion, and he can speak as to its effect in
this case. Any of the ordinary oils or grease might have answered, but I prefer the castor-
oil as being the most consistent and adhesive. The principles of this treatment are
these ;—there being a fearful loss of temperature, this, if possible, ought to be increased
without delay, but as this cannot be done by any internal remedies, absorption being at a
stand still, or nearly so, the only other plan is by the application to the dried general
surface of some slow conducting matter to cause the retention and accumulation of what-
ever amount of heat is being produced in the system. And as castor-oil, flannels, and
English blankets are good slow conductors, these are used, and have been found often and
often to lead to a rapid increase of temperature and pulse and always to remove the
cramps.
Martin, T. E. P., Surgeon, Bom. I.—I think, until the disease is better understood
and the nature of the poison and its mode of action demonstrated, the treatment must
necessarily be usually empirical. People have recovered after all modes of treatment, and.
have escaped without any treatment at all. But still, small as is the scientific hold we have
upon the disease, the cry of society for help is sharp and imperative, and something must
be done. Experience teaches that it is consistent with our present knowledge to follow
the line of treatment generally indicated in these questions. It also teaches, that a patient
and enlightened use of means is often followed by signal benefit in many cases of cholera.
Menzies, R., Surgeon, Ben. B.—This is a stage in which little can be safely done
beyond endeavoring to restore the heat of the body, and to wait patiently for re-action.
Munro, W., Deputy Inspector General, Ben. B.—Yes. Cases in which collapse took
place without premonitory diarrhoea and vomitting were generally of short duration and
always ended fatally. The sufferers became blue before death.
Murphy, M. W., Deputy Inspector General, Bom. B.—I would endeavor to support the
strength of the patient as much as possible by nutrients ; and T would attend to cleanliness,
ventilation of the apartment, and careful and proper nursing. The recovery of the patient
from the collapsed stage depends, according to my views of the disease, on the power of the
patient himself to throw off the poison, or in other words, on the amount of the cholera
poison in his system.
Orr, J. H., Deputy Inspector General. Mad. I.—The indications here enumerated are
most useful.
Rice, W. R., Surgeon, Ben. I.—Here I have no faith in remedies. I should endeavor
to treat the symptoms ; namely, to rouse the depressed vital energies, to allay the distress-
ing vomitting, and to alleviate the painful and exhausting cramps. The watery purging
I should let alone. I should put the patient into bed, cover him up well, apply a strong
liniment to the abdomen, composed of capsicum pods steeped in mustard oil, with liquor
ammoniæ, and oil of turpentine ; and I should have the extremities rubbed with the same.
in the meantime I should give occasionally small saline effervescing draughts with aromatic
spirits of ammonia or a little brandy, as cold as they can be made. If ice were at hand,
I should have a small piece kept in the mouth, and allowed gradually to dissolve. I should
hope by these means to allay the distressing and exhausting vomitting, and to contribute
something of help to the attempts at re-action which nature makes. Mild nourishment
should be continued. Large draughts of liquids should not be allowed.
Smith, C. M., Surgeon Major, Ben. I.—Yes, I believe this ; support strength, avoid all
strong remedies, and leave the rest to nature.
Wright, T. P., Surgeon, Ben. I.—Nothing to be done but to give stimulants, and to
use hot fomentations, and turpentine stupes.