TREATMENT
IN THIRD STAGE OR COLLAPSE.
more efficacious than cold or iced water, or soda-water. It palliates the
agonizing burning thirst, and should be given in small quantities, frequently
repeated, vis., from an ounce to two ounces every 10 or 15 minutes. It is
generally vomitted after the third or fourth dose ; but it is brought up easily, and
the exertion frequently strengthens the pulse, and brightens the countenance.
This vomitting is certainly less distressing and exhausting than dry retching ;
and some of the poison is probably eliminated in the fluid discharged.
Vomitting of a congee-like., mawkish fluid is one of the most constant
symptoms of this stage. It is concomitant with the burning pain in the
epigastrium, and probably depends on the irritating contents of the stomach.
In some cases the dry retching would appear to indicate irritation or inflam-
mation of the stomach, and in other instances reflux of bile. The most useful
treatment is the same as that required for thirst, viz., cold water or a small
piece of ice placed in the mouth. Sinapisms to the epigastrium are valuables
chloroform gives temporary relief, opium does no good, and alcohol often
aggravates it. Hydrocyanic acid and chloroform act rapidly, and often succeed
in allaying the vomitting and cramps, but only for a short time. These
remedies lead to danger when re-action takes place. Ice to the spine is spoken
of favorably by a few, and no injurious effects have been attributed to it.
Cramps of the voluntary muscles are very constant and distressing. They
appear to be connected with the irritation of the mucous membrane of the
bowels, appearing on the side of the body where there are griping pains in the
abdomen. The universal remedy for this symptom is friction, or champooing
of the parts affected, with the occasional addition of oil, turpentine, opium or
chloroform, or rubbing with dry mustard and pepper. Chloroform by inhala-
tion is strongly recommended ; the immediate effects are pleasing, but the relief
is temporary, and the after effects uncertain, if not suspicious. Hot saline
enemata remove the cramps in a large proportion of cases; and in some
instances, the most marked benefit has followed their use, not only in checking
the cramps, but also in restoring the pulse and colour, in relieving the other
symptoms, and in being followed by mild re-action. The chief objection to
them arises from the trouble and inconvenience of their exhibition in extensive
epidemics; besides, in many advanced cases they are powerless, and it is dis-
heartening to toil in vain. Cramps often cease long before death, and they are
often absent entirely in the worst cases.
Extreme depression with feeble action of the heart shows defective
nervous energy. Some of the symptoms may be removed without the fatal
course of the disease being materially delayed. The pulse which was imper-
ceptible at the wrist may be restored, and a florid colour return to the livid
countenance, and plumpness to the shrivelled fingers, by the transfusion into
the veins of a saline fluid; but the voice remains broken, the secretions of
the liver and kidneys are not restored, and death ensues in a few hours. A
similar temporary re-action sometimes follows sub-cutaneous injection of quassia
and chlorate of potash, and the use of the cold douche. There are several advo-
cates of the sub-cutaneous exhibition of opium, chloroform, &c. ; but as these
remedies cannot be retained on the stomach, there is danger of the punctures
being followed by sloughing sores, should re-action take place. It is sad to
desert so hopeful a line of treatment; but the most ardent advocates at last
lose heart from the transitory influence of these measures.
The cold livid skin arises from the suspension of the natural vital combus-
tion of the carbon in the lungs. Artificial heat gives relief to the local pains,
stimulates the heart, and assists re-action. It is a powerful auxiliary. Although
it does not remove the impurities from the blood, it stimulates the voluntary
nervous system, promotes the circulation on the surface of the body, and relieves
the internal organs. It is universally recommended in the reports. It is ap-
plied by hot bricks or bottles, or by means of hot air passed under the blankets.
Hot baths are also recommended by some; but they are objectionable in
consequence of the fatigue incurred in using them. The general application of
heat does not imply that the local application of cold would be injurious.
Experience proves that it is most agreeable and beneficial.
Powerful remedies are recommended which are applicable to similar symp-
toms in other diseases; but in the collapse of cholera they are powerless,
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