TREATMENT IN THIRD STAGE OR COLLAPSE.
13
stomach; but it is generally a cooling and innocent remedy, without any special,
influence on the poison of cholera.
Castor Oil, or medicines to increase the action of the bowels, are strongly
recommended by some, on the theory of eliminating the poison through the
bowels ; but the use of purgatives is acknowledged by all of experience in
India to be most dangerous during the prevalence of cholera. The ordinary
laxatives are combined with carminatives or opiates, otherwise they are often
followed by congee-stools and collapse. The bowels form one channel for
elimination, but the purging is most exhausting and dangerous, as it is apt to
lead to collapse, when the system is little under our control. A prudent man.
will avoid such danger, though it does not follow that benefit would arise from
shutting up the evacuation by plugging the rectum, as has been recommended.
In many instances, irritating matter, such as indigested food, must be removed
from the stomach and bowels. Mustard appears to be the safest emetic, and
castor oil or rhubarb the safest laxative; but these must be cautiously used,
and the action of the bowels checked when the irritating matter has been
evacuated.
Bleeding was an old remedy, and it is still occasionally tried amongst des-
perate remedies, but not with results sufficiently satisfactory to encourage
persistence in its use. It is generally very severely condemned.
Calomel.—This old idol of the Indian Doctors has still a few advocates.
In scruple doses it is said to be a sedative, and in small doses, frequently re-
peated, to promote the action of the liver and kidneys. The action of
calomel in this stage is not more active than that of diffusible stimuli, which
are inert. After re-action, it is not generally required, and it is injurious if
mercurial action supervene. It is safer than violent remedies in the hands of
those who think strong medicines required, but less powerful to alleviate dis-
tressing symptoms than other and safer remedies, and it is generally inert.
Belladonna has a few zealous advocates, but it has not been found useful
by many who have tried it. It is not recommended.
Acetate of Lead combined with opium or dissolved with excess of acetic
acid is much relied on by some, and it is useful in many kinds of diarrhœa in
diminishing the frequency of the evacuations. It has occasionally a similar
effect in cholera; but that this is beneficial is questionable when the poison
is passing off painlessly, and while the evacuations are not very profuse,
Carbolic Acid is generally considered as worthy of trial. It is doubtless
a powerful antiseptic and restrainer of fermentation or the development of the
yeast fungi; but it has not been proved valuable in arresting the progress of
the cholera germ in its earlier stages, and it is questionable if this germ be a
fungus subject to similar laws of vitality. The same remark applies to the
sulphites, sulphur, carbon, chlorine and many other remedies that have been
recommended on theoretical grounds. They have been tried, and they do not
stop the disease.
Quinine is one of the most valuable remedies, especially during the rainy
season, in India. Not that it is supposed to have any specific action on the
Cholera poison, but it is employed as a prophylactic, or general tonic, in
strengthening the action of the enfeebled organs, and warding off diseases
which would render the body more open to the action of the cholera poison.
It counteracts the influence of the miasma which prevails at that season in all
tropical climates and predisposes to the attack. It should be used in small
doses of about two grains daily, alternated or combined with chiretta, or
some other bitter tonic. It should be given three times a day during the
stage of malaise. In collapse, it is most beneficial when given two or three
hours before the period of exacerbation, dissolved with a few drops of
sulphuric acid in the small quantities of cold water given to allay the thirst.
The hour of exacerbation, as a general rule, is about three o'clock; but a crisis
twelve hours after the attack should be guarded against by precautionary doses
of quinine. It has no apparent action and is powerless in many cases; but
when re-action follows this mode of treatment, it is mild, and the restoration,
of the secretions occurs early. In my experience, it has favorably turned
the wavering scale in many critical cases. Some of the surgeons combine
strychnine with the quinine, and some give the strychnine alone, with much.