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REPLIES TO QUERIES ON THE TREATMENT OF EPIDEMIC CHOLERA. [ Appendix
Query No. 2.—Remedies for burning thirst are cold or iced water frequently repeated, with
the occasional addition of ammonia and soda.
Banister, G., Surgeon Major, Ben. I.—The piteous cries of sufferers for liquids to
appease their burning thirst, and the sense of heat at the epigastrium, have naturally
suggested the use of ice, and it has to my knowledge been most indiscriminately prescribed.
I do not, however, despite the transient relief it affords, think that the practice is theoreti-
cally rational or suitable to the stage of collapse ; nay more, I am of opinion that, by
lowering animal heat, it is mischievous if not absolutely injurious. That it is temporarily
refreshing there is no question, but as it can be shown to have an evil tendency, it would
be wise to withhold it, or to give it most sparingly. I would do no more than moisten the
mouth, and would prefer bland fluids such as linseed tea, gum and water, barley water, &c.,
given as hot as could be tolerated.
Barclay, A., Deputy Inspector General, Mad. B.—Give lumps of ice frequently, or small
draughts of iced water. I have found small draughts of iced water, with tincture of
lavender and aromatic spirits of ammonia, most grateful to the patient ; or chloric ether may
also be added with benefit.
Barker, Civil Surgeon, Ben. I.—Carb, ammonia, 3 grs., rum, ½ oz., water, ½ oz., every
hour ; sometimes chloroform, ether, and aromatic spirit of ammonia ; frictions ; hot bottles
to feet.
Beatson, J. F., Deputy Inspector General, Ben. I.—Iced water is perhaps of all the most
grateful ; and when weakly acidulated it is much to be commended. Also infusion of
tamarinds with small doses of the nitrate or supernitrate of potash added.
Browne, J., Surgeon, Ben. I.—Relieve thirst with iced water, solid ice in mouth, cold
water with ammonia or soda, and effervescing draughts. I do not think the patient relishes
acid draughts. I consider sodawater, with 10 or 15 grains of bicarbonate of soda to each
bottle, to be a most beneficial and grateful drink. Considering that the collapse is due to
the loss of the watery portion of the blood, I have always allowed patients to drink water
or sodawater. as mentioned above, freely, in the hopes that the water might be taken up by
the blood by the non-vital process of endosmose. I have never seen that water (the patient
as a rule always asks for cold water), given thus freely, has increased the vomitting, or has
made the patient worse in any way. In 1866, in the Fort at Allahabad, during a short but
pretty sharp outbreak of cholera, I have given fluid as I have described. And in one case
of cholera, an apparently hopeless case, and in some cases of choleraic diarrhœa, I measured
the quantity of fluid given as drink with the quantity vomitted afterwards (a proceeding
which can be carried out with fair accuracy), and I found, that in the cases of choleraic
diarrhœa (all of these recovered), some quantity of fluid was absorbed between the time of
drinking, and the act of vomitting, and re-action gradually set in, while the thirst
became very much diminished. In the case of cholera, the patient was in profound
collapse for some five hours, during which time in addition to a bottle of cham-
pagne, he drank either 31 or 33 bottles of sodawater ; and the first cause we had
to hope for improvement in this case was, when the quantity of fluid vomitted was
less than that given as a drink, thus proving that absorption was going on. This man recover-
ed. Another fact I observed during this cholera outbreak in 1866 was, that the severity of
the stage of re-action is in the inverse ratio to the severity of the stage of collapse, or of the
cold stage, and this rule is found to hold good, I believe, with regard to fevers generally. On
the day on which this apparently hopeless case of cholera was admitted, there were some
three or four men admitted suffering from choleraic diarrhoea. In the case of the man with
cholera, and who was most severely collapsed, the re-action was exceedingly slight, while in
the cases of choleraic diarrhoea, the stage of re-action was excessive, and mostly complicated
with hepatic congestion ; the man who recovered from cholera was at his duty for a
considerable time before the men who were admitted into the hospital with choleraic
diarrhoea.
Browne, J., Surgeon, Ben. I.—Dry cup over the loins. Sinapisms. Diffusible stimulants
given in effervescence ; citrate of potash draught.
Cameron, J. M., Assistant Surgeon, Ben. I.—Small quantities of stimulants well diluted.
Drinks acidulated with acetic acid. Warmth and frictions.
Chalmers, C. B., Deputy Inspector General, Ben. I.—Pounded ice in small quanities ;
avoid overloading the stomach with cold drinks.
Chappell, J. J., Assistant Surgeon, Bom. B.—Very good. Also a small lump of ice given
to suck. Dilute sulphuric acid and water forms a grateful beverage.
Chevers, N., Surgeon Major, Ben. I.—Continue the treatment. ; rub with ginger and flan-
nels, apply hot bottles, shampoo the loins, do not rub them. Give chloroform mixture fre-
quently, ice constantly, or iced water in tablespoousful.
Dwsarkanuth, C., Sub-Asst. Surgeon, Ben. I.—Diffusible stimulants, ether and ammonia,
weak brandy and water with care, plenty of iced water ; use friction ; sago, port-wine and
broths for food.