TREATMENT IN FOURTH STAGE OR RE-ACTION.
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even at the risk of entailing future complications. They sometimes suddenly
stop from the poison having passed off, without subsequent ill effects ; but if
this stoppage has followed the use of remedies which have merely paralysed or
shut up the channel through which they were passing, a similar favorable
recovery cannot be expected, and sequel should be anticipated.
The action of the latent remedies may be traced in the symptoms super-
added to those found in ordinary re-action. A knowledge of the remedies
employed in collapse will facilitate the diagnosis of the cause of those sequelæ
which follow re-action. When re-action takes place early and is uncomplicated,
no active treatment is required. Rest is essential and sleep necessary, with
mild nourishing diet and a little wine, and careful nursing.
When collapse has continued for many hours, on re-action the stools are
dark or green, the urine clouded, and the skin hot and dry; with low fever in
severe cases. Tonics, especially quinine in the rainy season, are here required,
and change of air during convalescence is beneficial.
Irritability of Stomach is one of the common sequelæ of severe attacks.
It may be the effect of imperfect elimination of the poison, or the result of its
action on the stomach, or a consequence of the remedies employed. The
diagnosis on this point will indicate the nature of the treatment, either to
restore the secretions and eliminate the poison, or to subdue the inflammation.
Tonics and anodynes are required in the first case; and ipecacuanha and
calomel with anodynes in the second. Counter-irritation is valuable. Where
there is great irritability of stomach, nourishment is best supplied by means
of enemata of soup or arrowroot. I have seen exhausted cases safely supported
by this means alone for several days, where the smallest quantity of nourish-
ment was immediately rejected by the stomach.
The Diarrhœa is often very difficult to cure. It has sometimes the character
of the preliminary diarrhoea, arising probably from the same cause and requir-
ing similar treatment. In other cases it depends on an excessive discharge
of vitiated bile, or on irritation of the mucous membrane of the intestines,
caused by the previous presence of the cholera poison having denuded the
villous surface of its outer covering or epithelium, or again it may arise from
inflammation, induced, like the vomiting, by the remedies, and requires similar
treatment. The most obstinate form is attended with light colored, frothy,
and copious stools passed with little pain. These cases often arise from
disease of the kidneys. It is easy to check the number of stools by astrin-
gents or opiates; but this does not cure the disease. In fact, it frequently
causes mischief, and is followed by fever or other dangerous complications.
Calomel, ipecacuanha, and diuretics are more valuable. They are laxative
in their action, and so far follow the line of cure indicated by nature. The
appearance of the stools is sometimes improved by the use of turpentine, or
the application of blisters. Change of air is generally required to complete
the cure. Sea bathing and drinking mineral waters are often useful in
restoring health.
Suppression of Urine, followed by uræmia, is one of the most dangerous
sequelæ. This paralysis of the kidneys may arise from the imperfect elimi-
nation of the poison, or from the torpor caused by the action of narcotics
or alcohol exhibited in the previous stages. The history of the previous
treatment will facilitate the diagnosis. Tonics and diuretics will prove useful
in the first case; but in the latter, the prospect of success has been rendered
almost hopeless by the previous treatment. The battle between disease and
life was lost ere re-action was established. Many of the cases in which alcohol
or chloroform are said to have produced relief, or in which the evacuations
have been restrained by the use of opium or acetate of lead, are followed
by these intractable sequelæ. A lingering hope of success is sometimes reward-
ed by a favorable result from the cautious use of blisters, or from dry cupping
to the loins; or from the employment of calomel, chlorate or nitrate of
potash, nitric æther, digitalis, and diluents, aided by nature, hope, good
spirits, and a strong constitution. There is here full scope for the employ-
ment of all the resources of medical science, and though they may be used in
vain in some instances, yet the general safety of the sick rests on the intelli-
gence with which they are used. Uraemia is rarely met with in natives, and
with them alcohol is not freely used.
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