12
TREATMENT
IN THIRD STAGE OR COLLAPSE.
though given in quantities that would prove injurious in health. Whilst they
are inert they may be accumulated in the system to a fatal extent, as they
resume their ordinary power on re-action.
Opium is universally and justly condemned in this stage, as having little
power, and as leading to coma and the suppression of the secretions of the
liver and kidneys, on re-action taking place.
Alcohol, in the various forms of brandy, wines, or beer, is the ordinary
stimulant for exhaustion or depression. Many consider it to be essential, and
some think it useful in proportion to the quantity given. Many think it neces-
sary in small, but dangerous in large quantities. Others again of great experi-
ence doubt its aiding re-action, and think it may even prevent its coming on ;
and consider that when re-action does take place, where stimulants have been
freely used, it is generally followed by dangerous sequel, such as fever and
delirium. Any remedies likely to induce this state, more especially if they
have no decided influence in removing collapse, should be avoided. In small
quantities, combined with soups or arrowroot, they appear useful; but in large
quantities they materially diminish the hope of recovery at the critical moment
of re-action, when life is flickering, and when the wavering balance may be
turned by influences which may be unconsidered or overlooked in this anoma-
lous disease.
Brandy in large quantities aggravates the vomitting; yet it is sometimes
recklessly continued even though the patient complains of its doing no good
A very small quantity in effervescing draughts is often given with relief, and is
not likely to be injurious as it is soon vomitted, but it should not be given if
retained.
Champagne when, iced, is often given with relief to the thirst and vomitting,
and sometimes it is retained when other medicines are rejected. This is a very
agreeable form, but iced soda water or effervescing draughts are safer, less ex-
pensive, and not less efficacious.
The use of Stimulants has much increased of late years, and so has the
rate of mortality. In former years life was considered safe when re-action
appeared, but now a large proportion sink after re-action. This is most marked
amongst the European troops. The great expenditure of spirits and wines,
and the high rate of mortality during the epidemic of 1867, is shown in Table
No. V. The quantity issued in excess of the maximum allowance may be
fairly set down as expended 011 the cholera cases. There were (including men,
women and children) 557 cases, and the expenditure above the maximum was
1,954 bottles. This would give an average expenditure of three and a half
bottles to each case; but the expenditure varied in practice from no excess, to
seven and a half bottles. The mortality in the latter instance amounted to
92.913 per cent. out of 127 cases. In this instance, the disease was very
intense, but there was no advantage gained by the excessive use of spirits.
This practice is condemned by the most experienced medical authorities.
Though it be objectionable to interfere with the private judgment of executive
officers, yet this excessive use of stimulants should be controlled by the
administrative authorities.
Chloroform is one of the most prominent of the remedies recommended
as valuable in collapse. It is sometimes given in effervescing draughts, or in
combination with opium in the form of chlorodyne, or as a local application
externally; but the best form appears to be by inhalation. It relieves the
cramps and vomitting for a time, and in some cases appears to induce re-action,
with a return of pulse and colour, but without the appearance of bile or urine.
These cases are often followed by excessive re-action and fever, with fatal deter-
mination to the head. It has been recommended to combine other remedies
with the chloroform used for inhalation, but the vehicle is dangerous.
Stdphuric Acid has been extensively used, and it is strongly recommended
by some as being very agreeable to take, and, when combined with opium,
useful in restraining the vomitting and purging. Those cases in which it is
used to the exclusion of spirits show a more favorable return than when the
latter are freely used. A combination with alcohol in Hallier's mixture, and
with aromatic spices has been used extensively in the Bombay Presidency,
without apparent bad effects. It sometimes aggravates the burning pain in the