and tics.

cai

bolic,

with

astringents

and

aroma-

The treatment of cholera, according to Lauder Bruuton, is firstly, to neutralize the injurious effects of poisons absorbed into the blood ; secondly, to remove the microbes and the poisons they have formed ; and thirdly, to stop the growth of any microbes which may still remain and to destroy tliem. The first process is effected by administering atropine in such a manner that it shall be quickly absorbed into the circulation, atropine being the antidote for muscariu, an alkaloid which produces toxic symptoms analogous to those of cholera; and muscariu is also found as a ptomaine of the decomposition of albumen by the microbe. Morphia is combined with atropine to check vomiting, and thus to allow the intestinal disinfectants to pass the pylorus. The second indication is fulfilled by giving intestinal disinfectants which are either acids themselves, or have an acid reaction, as the microbe exists only in an alkaline soil. These disinfectants may be phenol combined with sulphuric acid, which latter lias the propert}' of neutralizing partially the poisonous effects of the carbolic acid ; a good combination of the two being the new drug aseptol ; or salol which splits up into carbolic and salicylic acids, and betol which divides into salicylic acid and betapthol, by the action of the pancreatic juice, all drugs given by the mouth passing unchanged into the duodenum in cholera. The intestinal disinfectants can be combined with an aromatic such as cinnamon, camphor, cajeput, cloves, all of which are antiseptic. In the treatment I have adopted, I add gallic acid and catechu (tannin) to the disinfectant, on account of the property gallic acid possesses, of uniting with albumen and forming an iusoluble substance, thus rendering alkaloids less soluble.

i

Finally, by keeping the patient on rice water and ice, to starve out the bacilli, by stopping their nutriment, for the same reason that thin barley water is given in infantile diarrhoea and the growth of the microbes arrested. The treatment of cholera therefore is, first, to give a hypodermic injection of morphia and atropine in the epigastrium, to check the vomiting ; next, to administer an acid intestinal disinfectant, (carbolic and sulphuric acids notes on cholera treatment. By

Surgeon-Major G. Civil Surgeon, Itawal

c.

Ross,

Pindi.

The treatment of cholera that I advocated last June has been somewhat misunderstood. What I recommended was an hypodermic injection of atropine with morphia in the epigastric region and then, when the stomach could contain it, a mixture ot acids, sulphuric ^

most

easily

obtainable) astringent,

combined

being

with an and then crushed ice

aromatic and and congee water, iced if possible. If this procedure is adopted, cholera will be found to give a far lessened death rate, a matter which is of considerable importance to the Indian public. For the distribution of cholera remedies by vaccinators in villages, I would recommend powders of gallic acid, with two of ^

drops

THE INDIAN MEDICAL GAZETTE.

108

crea90te in

chlorodyne,

each, wrapped if other and

dies cannot be obtained.

in oil paper, and more

effectual

some reme-

[April

1890.

Notes on Cholera Treatment.

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