CHOLERA AND ITS TREATMENT. By Assistant Surgeon SHUNKER LALL, Srinagar, Garhwal, JV. W. P. Srinagar, the principal town of the district of Garhwal, and the old seat of a Native Government, is situate on the right bank of the Alaknanda, one of the main tributaries of the Granges Proper; hence the sacred water of the river being also specially cool, on account of its snowy origin and easy of approach, is greatly used for the purposes of drinking and bathing by the inhabitants of the town at all seasons of the year. Beiug a town out of the way,sanitation is here greatly imperfect aud little looked after, specially in the hot and rainy seasons, when it is the most needed. There are no public latrines, except the banks of the river, and 110 proper drains, the town draining itself into the The elevavery Alaknanda at various places. tiou of the town of Srinagar being only 1,820 ft. above the level of the sea, the temperature in the shade sometimes rises to 110? Fahr. 011 the hottest day, and hence, though a hilly station situated in a valley aud surrounded on all sides by lofty mountains, its climate is the reverse of what may be expected. The rains have been considerably delayed here this year, aud there have beeu very scanty showers, till the middle of July. Srinagar also stauds in another double disadvantage that, in the presence of an epidemic in the district, being itself a town of trade, it allows the affected persons to come in from the suburbs, but when the calamity falls upon its own head, it is entirely cut off from human communication and the supply of provisions, according to the general In the late outbreak custom of the country. of an epidemic at this place, as far as enquiry goes, cholera was imported into Srinagar by a pilgrim from the last Dashara gatherings at Hardwar, by the 1st of June 1887. The affected pilgrim was brought here on the 10th of June, aud put up at a temple a short distance up the upper eud of the town, whence the river flows down to the side of the city. This pilgrim died here by the evening of the 10th June, and his body was floated down by his friends as usual into the Alaknanda, and soon after landed at the upper end of the town, aud it was not discovered and That very removed till late next morning. one case of June, 11th the got cholera and day, so subsequently his neighbours and others. With reference to treatment there are certain points of interest regarding the method and drugs that I used iu the last outbreak, and on

THE INDIAN MEDICAL GAZETTE.

208

which I wish to offer a few remarks. It was generally in the developed stage of cholera when vomiting and purging had been fairly established, that cases usually appeared before us; the away unnoticed, or in which there was only vomiting and no diarrhoea, but on pressure distinct gurgling could be felt in some places over the abdomen. Under these circumstances the following mixture was put into practice at this hospital to start with, and from which a great amount of benefit

premonitory stage passing cases

resulted,

viz.

Acid

Sulph.

...

...

???

m. xv

...

...

m.

...

...

...

...

...

...

Aetic Aquai Anisi

one

vi

m. xx

?j

dose

At the ordered 4 such doses, one every hour. time a large mustard plaster was placed on the whole surface of the abdomen and allowed to remain till it began to touch in some places. By keeping the plaster to this extent, I am sure that an enormous amount of exosmosis that the bowels was checked and was going on in reaction initiated. If, after the above 4 doses of chlorodyne mixture, diarrhoea and vomiting continued, another dose of the same mixture was repeated, but generally no more was required. In some cases vomiting has been very persistent, and would not yield under ordinary circumstances, until a dose or two of? same

Vin.

Ipecac Aquce Purre

...

...

...

m.

i

3 i half an hour, worked like a repeated every Alonocharm, and stopped the vomiting. with these, Dr. Aitken's mixture of some essential oils proved so useful, that I give it here again for general information, and to which I have given the name of stimulant oil iu my dispensary, viz.:? ...

...

01. Anisi ? ?

Cajeputi Juniperi

a.a.

iEtlier Liq. acidi Halleri Tinct. Cinnam. ...

...

...

...

...

...

...

...

...

3jss 3iss 3iss

?ij

misce.

The dose of this mixture in 10 drops every quarter of an hour in a tablespoonful of water. It served very admirably; the thirst was quenched, by giving it with cold water, all

and foul breath removed, aud it soon digestion iuto order, and assisted the digestiou of food to a great extent; when administered, it also very well checked the coming of collapse, aud the lowering of patients; iu fact, kept them well up till reaction had commenced. , Directly purging and vomiting had ceased, the excretory organs, as a matter of necessity, were the first to be attended to.

indigestion

hereafter

:?

]$>

put the impaired

Liq. Lyttae

...

...

Potas. nitr. Sodae bi-carb Chloric aether

???

...

anisi

mi gr.

???

...

Aqu?

Dil.

?

]?,

Patients generally complained of great thirst, heat of the body, restlessness, headache, and even hiccough?due, in my opinion, to liver and kidneys being kept back from their work, and hence were best relieved by a 4-gr. dose of calomel at once, and the following mixture

:?

Chlorodyne

1888.

[Julit,

???

,,

m.

4 such

doses,

to be

x

3j

...

one

ordered

x x

repeated

dose

one

every

hours. I used here Liq. Lyttae, because there was no tincture cantharidis or any other suitable preparation at hand, and it is astonishing to mention that, invariably a few doses of the above mixture acted so efficiently that in not a single case had I ever to regret the loss of a patient for suppression of urine, nor cantharis ever too much wns it noticed that irritated the kidneys. In fact, some irritation of the kidneys was just what was wanted to make them act, assisted, of course, by hot mustard poultices to the loins. The liver and kidneys being put in order, there was no other trouble during the rest of convalescence. Of course, all the cases were not as easy as above described. Some of the cases that were received iu the stage of collapse, were only treated by the above stimulant oil and mustard. The shortest time in Avhich a case died was 6 hours, and the shortest that recovered was 12 hours, from the time of attack. The severity of the symptoms, of course, depended on the amount of poison introduced into the system, the worst being those that went on sinking in spite of all treatment, and never rallied. I also used a few outside specific medicines, but I am sorry to say there was nothing specific, whether they call it cholera-killer or by any other name. Cholera here lasted only up to the 15th of August, and during this time, there were altogether 65 cases that were treated by the dispensary, of which 32 recovered, and 33 died. Of these there were only 6 cases that came to the hospital as in-patients, and the rest were treated and attended to at their homes, by the dispensary compounders and myself. The difficulty of constant attention to outpatients, and that is surely needed for cholera cases, must be known to every sensible man. The majority of cases coming into our hands, when the disease was far advanced, and the want of proper nourishment, from general scarcity of provisions, from a severe form of cattle disease of the same type and at the same time, must also be taken into consideration, two

to account

for

our success

only

at par.

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