No. I. ] QUERIES ON THE TREATMENT OF EPIDEMIC CHOLERA. 33
VI.-THIRD STAGE-COLLAPSE,-continued.
8. Quinine in small closes before the hour of exacerbation is often useful in aiding re-action
and warding off the recurrence of sinking.
9. Belladonna, quassia, chlorate of potash, sulphuric acid, strychnine, acetate of lead and
opium, hot water, air baths, and small bleedings are said by some to be useful. Hy-
podermic injections, tartar emetic, mustard emetics have been used.
10. Opium is injurious, preventing re-action, and causing coma should re-action come on.
11. Chloroform or chlorodyne gives temporary relief, but re-action is often followed by head
symptoms or delirium.
12. Brandy, alcohol, or wine do not restore the action of the heart, or assist re-action; and
when re-action does take place, it is often violent and dangerous.
13. Active or powerful remedies should not be used, as in this stage their action is in abeyance;
this returns on re-action, and these remedies are often accumulated in the stomach.
14. Carbolic acid, sulphite of soda, charcoal, have been recommended.
15. To support the strength-Small quantities of soup, arrowroot or sago with a little brandy-
Liebig's extract of raw meat is useful in very protracted cases.
16. Fatigue must be avoided, especially getting up to stool or assuming the erect position,
which is often followed by fatal syncope. On a march, bad cases to be left in hospital.
17. Supply warmth to the body by hot bottles, &c.; cold affusion is said to induce re-action.
18. Support the spirits of the patients by the hope that the favourable re-action may soon come,
and cheer them when the first symptoms appear.
VII.-FOURTH STAGE-RE-ACTION.
1. This is a natural stage of the disease, taking place in all but extremely severe cases ; it is
little accelerated by remedies, though the subsequent symptoms often are. The rest-
lessness subsides, the burning thirst disappears, the pulse with warmth returns, and bile
appears in the stools. At this period brandy and opium are powerful poisons.
2. The indications are now to induce sleep, relieve distressing symptoms, restore the secre-
tions of the liver and kidneys, and support the strength.
3. For sleep, rest and surrounding quiet-carefully avoid raising the body-iced water.
4. Quinine in small doses is very valuable in restoring the secretions and preventing recur-
rence of collapse, especially in the rainy season.
5. After sleep the prominent symptoms must be relieved, and the secretions restored.
6. Suppression of urine calls for immediate treatment by turpentine fomentations and blisters
to the loins, nitrate of potash, ther, tincture of cantharides, chlorate of potash, dry
cupping, hot baths.
7. Deficiency of bile-Calomel and ipecacuanha, with opium if looseness continues.
8. Purging-Anodynes, calomel and ipecacuanha, enemata.
9. Vomiting-Effervescing draughts-counter irritation. Nourishing enemata are valuable
when food is vomited.
10. Nourishing food at short intervals with a little wine.
11. Change of air in convalescence.
12. One attack does not prevent a recurrence during the same season or in subsequent epidemics.
Note.-The object of the accompanying queries is to elicit the opinion of the medical profession in India with
regard to the treatment of cholera.
With a view to conciseness, the questions are generally put in a suggestive, rather than in a directly interrogative
form, and the replies founded on the personal experience of the Medical Officer answering, are requested.
In several instances, the value of the particular line of treatment is indicated, and the good or had effects of in-
dividual remedies in the different stages of the disease are noted. On these points the result of extended personal experi-
ence will be very valuable.
Should there be any other remedies, or opinions of practical importance, which are not alluded to in these queries,
on which Medical Officers are able to afford personal experience, they are requested to add them in the final remarks.