8
TREATMENT IN SECOND STAGE OR DIARRHŒA.
which medicine has little power ; whilst during the previous stage of diarrhœa
few medicines are found more beneficial than opiates and anodynes. The ex-
planations appear to be that the poison or the secretion caused by it is of an
irritating nature to the mucous surface of the intestines, and that opiates soothe
or lull the irritation during the period the poison is passing; whilst purgatives
add to the irritation, and thus increase the power of the poison in producing
collapse. It is therefore of vital importance to ward off this stage, even should
the process detain the poison—a most dangerous inmate, but in a controllable
state. One of the first points of treatment is therefore to soothe the irritation
which causes the diarrhoea, and avoid or remove any extraneous matter which
ordinarily induces irritation of the bowels.
The next point is to promote the secretions of the eliminating organs,
which have been diminished or suspended by the presence of the poison, viz.,
the liver, kidneys, skin, and lungs. In all these excretions the evidence is
strong that the poison is contained, and it is apparently through them that the
poison is quietly eliminated in mild cases, without exciting violent symptoms,
The action on these organs of the remedies employed to check the diarrhœa
must be borne in mind. Those medicines found by experience to diminish the
secretions of the liver or kidneys should be avoided,
The elimination theory has only a few advocates. They appear to consi-
der purgation and elimination as synonymous terms, and recommend such
remedies as increase the discharge from the bowels, as castor oil, rhubarb and
tartar emetic. The result has not been such as to recommend its adoption by
others who have had practical experience of the danger of exhibiting purgatives
during cholera epidemics. The removal of irritating contents from the intes-
tines, such as improper or undigested food, is essential, and is best done by a
combination of castor oil and laudanum; but increased action of the intestines
is not the only, or the safest method employed by nature to eliminate the poison
This is clearly shown by the natural cure of the disease when no purgation ap-
pears, as in the stage of malaise.
There is no known antidote for the cholera poison, though there are few
substances that have not been tried. Those which prevent fermentation or
putrefaction have been strongly recommended; but hitherto tried without
success.
The depression of spirits naturally calls for the ordinary remedy, viz.,
brandy or wine which, in moderation, is not injurious ; but moderation is rare
when panic is present. Excess should be guarded against with special care,
and this will be aided by considering malaise as the first stage of the disease.
The action of the poison is depressing on the nervous system and the indications
of treatment are to support the strength by gentle stimulants and tonics,
till the poison is changed by running its course, being digested, or simply
passed off with other extraneous admixtures with the blood. The precautionary
measures consist of carefully avoiding exhaustion and purgatives. The medi-
cines required are anodynes or opiates, carminatives and tonics, especially
quinine in the rainy season, wine in moderation and nourishing diet with little
change from routine,
TREATMENT IN SECOND STAGE :—DIARRHOEA OR CHOLERAIC DIARRHŒA,
This is generally considered the first stage of cholera. It is marked by
copious, light-coloured, painless purging ; the stools gradually become more
watery, and at length colourless like rice or congee water. There is often un-
easiness in the stomach, like heart burn, with occasional vomitting and cramps.
The signs of malaise continue, the pulse is feeble, and the breath cold, the
countenance dark and eyes congested. This stage lasts from a few hours to a
week or ten days. The watery stools are sometimes preceded by billions
vomitting and purging, with headache and febrile symptoms. The secretion
of urine is scanty and wandering cramps are occasionally felt in the extremities.
There is here in addition to the diminished action of the sympathetic nerves,
the supervention of irritation of the mucous membrane of the intestines, with
disturbance of the nervous system generally. The indications of cure are to
remove or dilute any extraneous or specific irritant, to soothe the irritation of