41
TREATMENT IX FOURTH STAGE OR RE-ACTION.
confidence, and apparently with some advantage. But care must be taken
that this most potent medicine does not accumulate in the stomach.
Quassia and Chlorate of Potash have been lauded as inducing re-action
when employed by subcutaneous transfusion, and chlorate of potash has been
often used internally, but permanent good has too rarely followed these
remedies to encourage their being generally used.
Diffusible Stimulants are much used, and occasionally with some benefit,
such as ammonia, camphor, peppermint, cajuputi oil, &c.
Cold Affusion or Cold Douche employed during this stage is highly praised
by some as restoring the action of the heart, which, they say, may be kept up
by brandy.
The great necessity for maintaining a recumbent position, and the danger
from fatigue or exhaustion, must be borne in mind in the use of all remedies.
I have met with several cases, and many more have been reported, in which
simply getting up to stool, or rising in the bed, has been followed by fainting
from which the patient never rallied. It is probable that the extensive
coagula formed in the heart in many fatal cases may have formed during these
fainting fits. It is possible that such coagula are occasionally the cause of
subsequent secondary symptoms.
To support the strength during collapse is of the greatest importance.
Little reliance can be placed on the assimilation of food through digestion, as
this process is in abeyance, as well as the other functions of the ganglionic
system. Still it is important that the watery parts of the blood, which are
expended in the profuse perspiration and congee-stools, should be replenished.
The cold, acid, watery extract of meat recommended by Liebig appears to be
more efficacious than any other form, particularly in cases of protracted col-
lapse. Many apparently hopeless cases have rallied favourably under its use.
Liquid food in the shape of arrowroot or soups well spiced and salted are
most generally recommended. In these cases absorption without previous
digestion takes place. Small quantities of brandy or wine are often added
with apparent advantage ; but in the cases which rally without this addition,
convalescence is more satisfactory. Some speak highly of milk, and some
Nsative baids have great faith in "ghee" (melted butter) or sweet oil, which
they give to the extent of six or eight pounds. Solid food should not be given.
It is not digested, and if retained, it decomposes and does mischief.
Little suspecting that the means employed extinguishes the last hope of
the patient's recovery, it has been in these protracted and apparently hopeless
eases, that the fatal practice of increasing the quantity of brandy and wine,
and the use of violent remedies, has been resorted to, in the anxious desire of
rescuing a hopeless case by desperate means.
TREATMENT IN THE FOURTH STAGE:—RE-ACTION.
Re-action is a natural stage in the course of the disease. The restlessness
subsides, the burning thirst disappears, the pulse with warmth returns, the
congee evacuations subside and become colored, bile appears in the stools, the
urine flows, and sleep ensues and nothing but debility remains, which rapidly
disappears.
The functions of the involuntary system of nerves return, in manner
similar to those of the voluntary system after insensibility induced by suffoca-
tion from drowning, or fire damp, or from intoxication from alcohol, or from
breathing chloroform. Where the suspension of action is short, there are no
sequel; but where the suspension has been prolonged, it is followed by fever
of a low type. This is frequently complicated in cholera by local derange-
nients caused by the action of the poison, or the remedies employed, or by the
partial retention of the poison in the system. The re-action which follows
copious congee evacuations is generally free from dangerous sequelæ. As the
poison is contained in these discharges, their suppression, before it is completely
eliminated, will leave a residuum which will continue to act injuriously. Eut
the congee discharges are most exhausting, and life may succumb before the
poison can be removed by them; therefore, they must if possible be restrained,