No. II.]
IV.—FIRST STAGE OR MALAISE.
59
Query No. 10,—continued.
Ross, J., Assistant Surgeon, Mad. I.—I believe the usefulness of this measure will be
made more and more evident by further experience. Not only is the individual removed
from the locality of the disease and thus given a chance of getting rid of it altogether, but
the moral effect at such a time is immense. I am disposed to think that change of air at
this stage might probably mitigate the seventy of the attack, or might possibly in some
cases prevent it altogether.
V.—SECOND STAGE, DIARRHŒA— CHOLERAIG DIARRHŒA.
Query No. 1.—Indications. To check the looseness, remove irritating ingesta, soothe the
irritation, and promote the secretions.
Beatson, J. F., Officiating Deputy Inspector General, Ben. I.—Certainly check the loose-
ness. My experience makes me prefer for this purpose gallic acid in combination with ginger
and laudanum, or any carminative. As regards the removal of irritating ingesta, though the
indication of vomitting is not without danger, I am convinced, from actual experience, that
where there is good cause to suspect the presence in the stomach of undigested food, a
mustard emetic is an excellent remedy to administer. It unloads the stomach, rouses the
system, and favors the action of remedies. All of these are not accomplished by the vomit-
ting of the rice-water fluid, however abundantly that may be taking place. This I have
over and over again seen. I quote the following from my report of 1859 :—" The mere act
of vomitting the rice-water, no matter in what quantity, does not empty the stomach of
solid contents. Repeatedly, men who had vomitted copiously the characteristic fluid and
nothing else, upon having a mustard emetic administered, threw up large squares of . meat,
literally, just as they had swallowed it hours before, showing that this treatment, which at
first was simply experimental, was both rational and useful."
Bell, A., Surgeon, Ben. B.—This is most important. Nothing is more so, for if we
succeed in checking the purging, the formidable after-symptoms seldom appear.
Chalmers, G. B., Deputy Inspector General, Ben. I.—Unquestionably in some cases a
mild purgative with some carminative is found useful.
Colles, J. A. P., Assistant Surgeon, Ben. I.—The peculiar smell of choleraic discharges
is a very valuable pathognomonic sign, and this is not enough dwelt on in books. I expect
that the pathognomonic "choleraic smell" will be found in all cases of true choleraic
diarrhoea, and not in the hill diarrhœa, or in that which occurs early in the cold season in
the plains. In the spring of 1860, I observed this smell in cases of what at other times
would have been regarded as diarrhœa. Within 24 hours such patients were, as I antici-
pated, attacked with cholera. The epidemic kept possession of the station (Gonda in Oudh)
for nearly a month. At Peshawur, in October and November, the occurrence of cold sweats,
vomitting, purging, cold tongue and cramps, in the cold stage of malarious fevers, is not
uncommon. As a rule, these choleroid symptoms attend the first attack of ague only, the
subsequent paroxysms presenting nothing peculiar ,· nor is there any necessary connection
between the occurrence of these symptoms and the severity of the hot stage. Some of the
cases, which on the first occurrence of ague can hardly be distinguished from cholera, run a
very mild course afterwards, and yield readily to treatment.
Cullen, P., Assistant Surgeon, Ben. I.—When I find the ailment is owing to an
irregularity in diet, I try to get rid of the irritating ingesta by a rhubarb draught guarded
by some carminative tincture. In such a case the patient is most likely cured without
further treatment. But if I find that the person has become affected without any appreci-
able cause, I at once commence with astringents and stimulants and more especially the latter.
For knowing the course the disease will take if not checked, I try to ward off its debilitat-
ing effects by using stimulants from the first, and by raising and keeping my patient up I
endeavour to cut it short before it has a strong hold on him. For instance, if a man were
just seized with purging and vomitting, I would give him an ounce of brandy in as much
water, hot or cold ; and the effect of this in the early stage is generally to allay the
vomitting for a time. I then give him some astringent mixture in small closes, such as
10 grains of gallic acid with an ordinary dose of dilute sulphuric acid, or an equal quantity of
the aromatic sulphuric acid, in an ounce of plain or cinnamon water.
Fleming, A., Surgeon Major, Ben. I.—Check the purging by cholera pills or tincture.
Stop opium when vomitting and purging are arrested.
Fogo, J. M. S., Surgeon Major, Ben. B.—In the first indication of the looseness, the
remedy found most useful is acetate of lead and opium, either in the form of a pill or
mixture. It will arrest many a case of cholera. When the looseness has been stopped by
the one or two or three doses that may be required, the intestines should be cleansed by a
dose of castor-oil with a few drops of Battley's solution of opium. Rest in the recumbent
posture should be enjoined.
Gibbons, J., Surgeon, Mad. B.—During every cholera epidemic, diarrhœa and looseness
is more or less prevalent ; and it varies in degree from slight increase of the natural
excretion to what is characterized as " choleraic diarrhoea." I believe this diarrhoea is often
an actual manifestation, that the individual has been subjected to the cholera poison, or that
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