ON THE TREATMENT OF CHOLERA

H. Beigel
1866 The Lancet  
204 than the organic; the chlorides, and of these the soda salts, I more readily than the phosphates. The result of all these changes in the fluid of the blood and in the blood-cells is, that at the height of the transudation period the constitution of the blood is profoundly altered. The inorganic constituents, if compared to the water, are during the first four hours increased, because at this time the water is passing off with great rapidity ; afterwards, as the salts pass off, the
more » ... ion is lessened, and after eighteen hours or so the proportion of salts is greatly diminished, and, if compared with the organic constituents, the diminution is enormous. With respect to the individual salts, there is in the blood a relative preponderance of phosphates over chlorides, and of potash salts over soda salts. By the end of eighteen hours or so, the blood-corpuscles are left in a most abnormal condition ; the great loss of water and of salts, especially of the chloride of potassium (a most important constituent of the blood-cells), at once leads to the conclusion that their functions must have e been greatly impaired. Schmidt accordingly found that the amount of oxygen contained in them was lessened by onehalf. " In 1854 we observed that with a sultry, stagnant atmosphere, accompanied by a dark, misty sky, the number of cholera cases at once materially increased. ASSISTANT-PHYSICIAN TO THE METROPOLITAN FREE HOSPITAL. ALTHOUGH the opinions of authors as well as of practitioners widely differ in respect to many points concerning cholera, yet in one point they well-nigh all agree-that the blood, in consequence of being poisoned, becomes thick, unfit to circulate, and produces the different symptoms which are connected with cholera. It is therefore but rational that in our treatment we should endeavour to liquefy the blood, in order to restore a regular circulation, which, if effected, places us in a position to apply remedies-antidotes-with much more prospect of success. For this purpose I propose to inject tepid i , water hypodermically. One ounce, containing 480 minims, would require twenty-four injections, twenty minims each. Two or three ounces could be injected at once, with the greatest ease, in different places, in about ten minutes; and, as the absorption takes place with remarkably great rapidity, the injections could be repeated several times a day. The little wounds caused by the syringe are neither painful nor of any importance, and the irritation of the skin, in consequence of the presence of the water, would rather be an advantage than otherwise. The mode of treatment which I propose is theoretically justifiable, it is rational, and has, without doubt, the same claim to be tried as any other hitherto recommended. It would of course be of the highest interest if practitioners who may try the method would report on its value and usefulness. Finsbury-square, August, 1866. APPLICATION OF COLLODION IN CHOLERA.-Dr. Drouet, of Paris, maintains, in L' Union 11:fédicale of the 26th ult., that such application will arrest the premonitory diarrhoea, and yields excellent means of calorification in confirmed cholera. Ordinary collodion, six drachms ; castor oil, one drachm. This should be smeared on the abdomen and covered with cotton wool. This application used during the first hours of the choleraic attack will certainly arrest the progress of the disease, provided the latter be not of an extremely violent form and the power of organism have not as yet been annihilated. Last year Dr. Drouet thus cured seven cases of cholera where he had been called within the first two hours, and more than fifty cases of choleraic diarrhoea. This year he has been equally fortunate in two cases of the former, and four of the latter kind. Nulla autem est alia pro certo noscendi via, nisi quamplurimas et morborum. et dissectionum historias, turn aliorum, turn proprias collectas habere, et inter se compa.raj-e.—MOE&A6NI De Sed. et Cau8. 3for&., lib. iv. Procemium. A REFERENCE to the subjoined table will show that a markeddiminution has taken place in the number of cases admitted during last week. It is only, however, by a visit to the wards that one can judge of the full force of this favourable change. It is difficult, indeed, as we pass bed after bed occupied by a smiling inmate, sitting up, perhaps, and consuming bread-and-butter, to believe that we are looking at patients. who have suffered from an attack of the disorder by which so ', many were swept away in the earlier weeks of the outbreak. Of course there are exceptions to the favourable aspect. Patients are still admitted with symptoms as severe as ever ;, but their number is much diminished. At the time of our visit a boy died in whom the injection of salines into the circulation had been tried. Mr. F. Mackenzie has very kindly given us notes of the case, which is one of some interest. W. L-, aged eight years, a well-developed boy, of Angelgardens, Back-road, Shadwell, was brought to the hospital at nine A.M. of the 18th of August. He had attended the funeral of his aunt (who had lived in the same house and died from cholera after eighteen hours' illness) the day before. On themorning of his admission, at four A.M., he was taken ill with severe purging and vomiting, accompanied with cramps in his feet and hands. The surface of his extremities was cool; eyes sunken; tongue cold and coated; respiration 36 in a minute and he was almost pulseless. At two P.M. Dr. Fraser saw him, when his symptoms were much aggravated: his face and extremities were livid; he had the choleraic voice; the eyes were much sunken, semiclosed, with a contracted pupil;.. stomach tense, and dull on percussion. A thrill was audible at the end of inspiration, which was felt at the upper part ofthe left hypochondriac region. At this time the temperature in the axilla was 97 '2°, per rectum 99 '80; respiration 38 ; and there was no pulse. Dr. Fraser thought this was a case for saline injection. Mr. Little agreed, and proceeded to inject. Thefluid contained sixty parts by weight of chloride of sodium, six of chloride of potassium, three of phosphate of soda, and twenty of carbonate of soda : 140 grains of this dissolved in 40 fluid ounces of distilled water, with 4 drachms of alcohol. Mr. Little injected into the left median cephalic vein thirty ounces of this fluid, at a temperature of 110° Fahr., in half an hour. After the first few ounces the pulse was clearly per-ceptible at the rate of 90 in a minute ; from this it increased to 130 by the time the injection was finished. The colour of the boy's face and extremities improved greatly; he spoke plainly, and said he was better. Half an hour after the ope-ration-i. e., at three P.M., the temperature in the axilla was, l 98'6°, per rectum 100'2° ; pulse 150; respiration 32. He was. ; in a warm perspiration all over; had vomited copiously, and was once purged. At ten P.M. he was pale ; the surface cool; pulse 120; respiration 24. During the night he took brandyl and-egg, and was not sick. On the following morning (19th, eight A.M.) he was warm, had a weak pulse, the purging continued, but no vomiting Twelve, noon : Still warm, restless, thirsty, and wanderino"; y t taking the brandy mixture; had just passed an opaque dirtys yellow coloured stool. i 20th.-Eight A.M.: Purged, same colour. There was a s slight flush on his cheek. Respiration 24, slightly laboured ; pulse 110, small. He is still wandering, and very excited f . zvhen roused to take anything. Eight Was much flushe<J -during the afternoon ; is now blanched and white round the mouth ; was seen passing urine twice to-day.
doi:10.1016/s0140-6736(02)32463-2 fatcat:35tx6r7wardg3otp5mgrzhnbpi