The Sun.
London, England, 1868-07-17 00:00:00

TREATMENT OF CHOLERA AND DIARRHCEd.

Sir Thomas Watson, Bart., whose lectures
on medicine have most influenced the practice of
this half-century, writes this week in the British
Medical Journal:—" I find it necessary to modify
considerably some advice which I formerly gave my
auditors as to the treatment of a disorder which
appears to be again increasingly prevalent through-
out the country." The form and features of this
dreaded pestilence have, he says, " been the same
in all its visitations to this country." " Must we
still, as heretofore, make the mortifying confes-
sion that our art is unable to cope with it success-
fully ? Not so, I trust. Among the many and
discordant experiments which have been brought
forward, and fairly tried, for the cure of cholera,
one long since suggested, and almost scorn-
fully rejected, has emerged of late into cleirer sig-
nificance and more intelligible and ascertained
value. I mean the method—recognised as legiti-
mate and reasonable in various other maladies—of
elimination of which the main advocate has been
Dr. George Johnson, Professor of Physic in King's
College." After commenting upon the facts and
principles involved, Sir Thomas Watson lays down
the following rules in language partly his own and
partly that of Dr. George Johnson :
" Diarrhoea ought not to be neglected, even for
an hour.

" One important and guiding rule of treatment
is, ' not to attempt by opiates, or by other directly
repressive means, to arrest a diarrhain, while there
is reason to believe that the bowels contain a consi-
derable amount of morbid and offensive materials.'

" The purging is the natural way of getting rid
of the irritant case. We my favour the recovery
by directing the patient to drink copiously any
simple diluent liquid water, or (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, notwithstanding 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 caster 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, or a tea-
spoonful 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 feel-
ing or appearance of distension of the intes-
tines; 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 arrow-root, 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. While there
are some cases in which the evacuant dose is not
required even at the commencement of the attack,
there are many more in which the opiate is un-
necessary in the later stages. In some cases of
severe and prolonged diarrhoea, it may be ne-
cessary to repeat the oil and laudanum alter-
nately more than once at inter(als of three or
four hours. Practical skill and tact are required
to discriminate these cases. It must be borne
in mind that, ►vhen the choleraic secretions are
being :active!y poured out from the blood-vessels,
the blood, though it may have been completely
emptied by a dose of oil, may quickly again be-
come filled with morbid secretions, and hence the
need for an occasional repetition of the evacuant
dose."
" If the diarrhoea be associated with vomiting,
this should be encouraged and assisted by copious
draughts of tepid water. The vomiting affords re-
lief, partly by the stimulus which it gives to the

circulation, but mainly by the speedy ejection of
morbid secretions."

" If there be nausea without vomiting, and more
especially if the stomach be supposed to contain
undigested or unwholesome food or morbid secre-
tions, an emetic may be given—either a teaspoonful
of powdered mustard, or a tablespoonful of com-
mon salt, or twenty grains of ipecacuanha powder,
in warm water.

" In all cases of severe diarrhcel, the patient
should remain in bed."