No.
II.
]
VII.—FOURTH STAGE—RE-ACTION.
83
Query No. 1,—continued.
McDowall, C., Surgeon, Bom. I.—The injection of solution of morphia under the skin was
always followed by re-action in fifteen cases, all of which were collapsed when brought for treat-
ment. Where re-action is weak and the patient is in danger of failing into the typhoid state
from uræmic poisoning, stimulation may be required.
Menzies, R., Surgeon, Ben. B.—Yes, they are powerful poisons.
Miles, H. L., Surgeon, Bom. B.—A natural stage of the disease. The less this stage is ex-
perimented on the better for the sufferec. Brandy and opium are alike pernicious.
Mills, J., Surgeon Major, Bom. I.—Opium is to be avoided now, as in the former stages,
as much as possible, on account of its tendency to promote cerebral disturbance and to check
the restoration of the secretion of urine, to effect which is now one of the most important indi-
cations. Hyoscyamus may be used to induce sleep without fear of affecting the brain. I
have found greater tendency to cerebral congestion in the more robust patients.
Munro, W., Deputy Inspector General, Ben. B.—Yes.
Murray, T., Surgeon Major, Bom. I.—This is the natural stage of the disease which is
anxiously looked for, and when developed, brandy and opium are contra-indicated and
would be highly injurious.
O'Leary, T. C., Surgeon Major, Mad. B.—To which may be added the secretion of urine,
mostly, if not always, a very favorable sign. Brandy and opium if now given will kill the
patient.
Rice, W. R., Sure/eon, Ben. I.—The period of convalescence requires much care, which
should not he hastily discontinued. I have met with several cases where chronic organic
disease of the digestive organs was set down to an attack of cholera, and with fairness, when
the details furnished by the patient were fully weighed. Amongst these, I have met with a
case of chronic gastritis with most troublesome enlargement and ulcération of the tonsils,
another of chronic and incurable dirrahœa, a third of chronic inflammation of the capsule and
areolar tissue of the liver, resulting in cirrhosis, and in a fourth Bright's disease of the kid-
neys appeared. In all of these, the patients stated that the symptoms arose out of an attack
of cholera which they had one or more years before. Any unfavorable symptoms which may
arise should be treated on general principles.
Roberts, W. H., Assistant Surgeon, Mad. I.—This is a natural stage of the disease, and its
occurrence is hoped and prayed for by the physician, the patient, and his friends. I do not
believe that it is in our power to accelerate its advent ; it is much better that we should be
specially careful that we do not retard it. The after-effects of previous treatment will now
manifest themselves for good or for evil. Brandy and opium combined would be a poison.
Nourishment and time to allow the system to rally and the secretions to resume their opera-
tions is what is chiefly required.
Roe, S. B., Assistant Surgeon, Ben. B.—Re-action has taken place (as nearly as I can ascer-
tain) in three-fourths of the cases that have come under my observation. The stage is, I
think, a short one, and most of the symptoms alluded to in the folio wing queries might be re-
ferred to a fifth stage or one of subsequent fever.
Sainte, J. D., Assistant Surgeon, Bom. B.—A natural stage of the disease. Yes, brandy
and opium are positively injurious.
Simpson, D., Assistant Surgeon, Bom. I.—Busy interference as re-action is beginning can-
not be too strongly reprehended. The secreting organs must be allowed time to recover their
functions and the blood time to regain at least its watery constituents before absorption and
secretion can be established.
Smith, C. M., Surgeon Major, Bom. I.—Though certainly a stage of the disease in a
medical point of view, the existing condition arises not from the disease itself, but rather
from the effects of the previous changes and alterations that have taken place in the blood
and secreting organs, generally aggravated by the remedies and stimulants that have been
employed in the first stage.
Smith, D. B., Surgeon, Ben. I.—Discontinue calomel, or give it at longer intervals.
Diuretics and quinine, castor oil. Nourishment.
Query No. 4.—Quinine in small doses is very valuable in restoring the secretions and pre-
venting the recurrence of collapse, especially in the rainy season.
Eteson, A., Surgeon, Ben I.—Although many, indeed most cases are so violent that the
disease proceeds unchecked to the end, yet I have seen a great number especially among
natives, where almost when the patient was at the last gasp, the disease could be clearly seen
to have expended itself, and in such a case if strong nourishing soup, warmth, quiet, and, in
short, all the details of good nursing are provided, the little spark of life may once more be
fanned alight. The smallest dose of quinine, the warmth of a succession of flannels, and
even of persons, may then be of far more value than the unceasing doses of the collapse
22