A treatise on Asiatic cholera / edited and prepared by Edmund Charles Wendt, in association with Drs. John C. Peters, Ely McClellan, John B. Hamilton, and Geo. M. Sternberg.

Edmund Charles Wendt

Date:: 1885

Credit: A treatise on Asiatic cholera / edited and prepared by Edmund Charles Wendt, in association with Drs. John C. Peters, Ely McClellan, John B. Hamilton, and Geo. M. Sternberg. Source: Wellcome Collection.

Provider: This material has been provided by the Gerstein Science Information Centre at the University of Toronto, through the Medical Heritage Library. The original may be consulted at the Gerstein Science Information Centre, University of Toronto.

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$Yet by exercising the necessary amount of tact, the families composing- his practice may be informed of the urgent necessity of attending imme- diately to the most insignificant intestinal derangements, that ordinarily might be disregarded. If slight diarrluKa occurs and is clearly traceable to errors or excess in eating, and if there is reason to believe that undigested food is still irri- tating the bowels, a mild laxative, such as castor-oil or the usual salts with a little opium, may be safely given. Ko possible harm can result from a. single dose of an unirritating laxative. And even should the sequel show that the case was one of choleraic diarrhoea, the physician may rest assured that the attack was not aggravated by his remedy. No sooner lias the laxative produced its effect of removing the offending matters, than anij persistence of diarrhani should be followed by the prompt administi'ation of opiates in small or moderate doses, repeated at short intervals. If there is no distinct evidence pointing to the presence of irritating bowel contents, the preliminary laxative is contraindicated, and treatment by opium may be at once begun. If the distress is gastric rather than intes- tinal, an emetic dose of ipecac is a preliminary measure of undeniable ad- vantage. In fact Briquet, Laugier and Ollive, and quite recently Fabre, commonly employ this drug, and warmly recommend it not onl}^ in the premonitory stage of an attack, but also after the disease has actually begun. Fabre ' uses it even when grave phenomena already exist, provided the tongue is coated sufficiently to indicate gastric derangement. He remarks that it is surprising to witness the calm that follows the vomiting, to ob- serve the pulse rise, a moisture bedewing the limbs, the cramps cease, the countenance lose its pinched appearance, and the general condition of the- patient improve. Saline emetics are, however, universally condemned, and without sharing the sanguine views of the French writer just cited, it may yet be worthy of remembrance that whdn an emetic is advisable our choice should fall upon ipecacuanha in preference to other similarly acting drugs. But to resume: A few drops of some minei^al acid (nitric, or hydro- chloric, but preferably sulphuric) largely diluted with water and taken frequently, may be added to the treatment by opium; not merely in the hope of destroying, as ]\Iacnamara and many others believe, the specilic cholera process going on in the intestinal canal,^' but because it is grateful and slightly astringent, and also for the purely empirical reason that, patients have seemed to be benefited thereby. ]\Iore important, however, than the use of opiates and acids, even at this early stage, we hold to be the general regimen of the patient. He should be instructed to cease all Avork at once, if possible to eat and drink nothing for several hours, and to lie down either in bed or on a sofa, ])ref- crably between blankets, with a ffannel bandage applied over the abdomen. A well-aired room, in which an equable temperature is maintained, should be provided for the ])atieut's occupancy. Bland fluids, such as egg-water or mucilaginous decoctions, also soaked toast, gruels, farina, rice, may be allowed, if after about eight ll()^lrs of rest and abstinence there is no return of the diarrhoea. Beef-tea and all concentrated meat broths should be interdicted, even those prepared Avith muriatic acid. For several days following a warning of this kind, the patient should be directed to strictly ' Traiteraent clu Cholera. Logons faites par le Professeur A. Fabre. Marseilles, 1884$