The Sun.
London, England, 1866-08-09 00:00:00

this ona condition is common to all classes of cases, viz.,
that the contents of the bowels are unnatural and offensive.
These offending materials are the immediate cause of the
purging ; and they must be expelled from the bowels be-
fore the diarrhoea can come to an end.

From the above considerations we deduce one important
and guiding rule of treatment, which is this—not to at-
tempt by opiates, or by other directly repressive means, to
arrest a diarrhoea while there is reason to believe that the
bowels contain a considerable amount of morbid and offen-
sive materials. It is certain that these offending materials
must be cast out from the bowels before the diarrhoea can
permanently cease. The effect of an opiate at this stage
is to prolong the.disease, and to increase the risk of mis-
chief, from the retention and reabsorption of the morbid
contents of the bowels. If the opiate have the effect of
retaining within the blood-vessels some of the morbidly
changed blood-constituents, this astringent action will
probably be more injurious and even deadly than the re-
tention of morbid secretions within the bowels.

The purging is the natural way of getting rid of the
irritant cause. We may favour the recovery by directing
tho patient to drink copiously any simple diluent liquid—
water cold or tepid, toast-water, barley-water, or weak tea ;
and we may often accelerate the recovery by sweeping out
the alimentary canal by some safe purgative, and then, if
necessary, soothing it by an opiate. Castor-oil, notwith-
standing its unpleasant taste, is, on the whole, the safest
and best purgative for this purpose. It has the advantage
of being very mild and unirritating, yet withal very quick
in its action. A tablespoonful of the oil may be taken,
floating on cold water or any other simple liquid which
may be preferred by the patient. A mixture of orange-
juice or of lemon-juice with water forms an agreeable
vehicle for the oil. If the dose be vomited, it should be
repeated immediately ; and the patient should lie still, and
take no more liquid for half an hour, by which time the
oil will have passed from the stomach into the bowels.
Within an hour or two the oil will usually have acted
freely. Then a tablespoonful of brandy may be taken in
some thin arrowroot or gruel ; and if there be much feel-
ing of irritation, with a sense of sinking, from five to ten
drops of laudanum may be given in cold water. These
means will suffice for the speedy arrest of most cases of
choleraic diarrhoea. If the patient have an insuperable
objection to castor oil, or if the oil cannot be retained on
the stomach, ten or fifteen grains of powdered rhubarb, or
a tablespoonful of the tincture of rhubarb, 3r a teaspoon-
ful of Gregory's powder, may be substituted for the oil.
If the diarrhoea have continued for some hours, the
stools having been copious and liquid ; if there be no
griping pain in the bowels, no feeling or appearance of dis-
tension of the intestines ; the abdomen being flaccid and
empty, and the tongue clean—we may conclude that the
morbid agent has already purged itself away. There will,
therefore, be no need for the castor oil or other laxative,
and we may immediately give the brandy in arrowroot
and the laudanum, as before directed. The rule in all
cases is, not to give the opiate until the morbid poison and
its products have for the most part escaped ; not to close
the door until " the enemy" has been expelled.