Nicholson in the article above quoted the so-called cholera bacillus of Koch, the researches of the German Cholera Commission only shewed that the comma bacillus " was, probably," the cause of the disease ; that a close connection existed between cholera and its presence, but the experimental proof absolutely In necessary in all such cases was wanting. fact it lias not been proved that the comma bacillus is the cause of cholera, and it hence follows that experiments founded 011 the hypothesis may be erroneous and lead to 110 satisfactory therapeutical result in relation to cholera. It will be remembered that the German Cholera Commission, consisting of Messrs. Koch, Gaffkey and Fischer, came to Calcutta about the end of 1883. The full report of this Commission has since been published. On the point above referred to, the following short extract will be of importance from Dr. Koch's report of 2nd February 1884. " It would, of course, be desirable to succeed in artificially inducing upon animals, by the employmentof these bactaria, a malady analogous to cholera, in order to afford ocular denionstrarion of their casual relation to the disease. This, however, has not succeeded, and it must accordingly be considered questionable whether it will ever succeed, since, according to all appearances, brutes are not susceptible of choleraic infection."* It should also not be forgotten that the labours of the English Cholera Commission showed that the German Commission proved too much; for the former having gone over the same ground as the Germans shewed that the comma bacillus was found in other cases besides those of cholera, and that it exists in tanks from which people use water for domestic purposes without taking cholera.
Major
on
% JPliiTor of losjitat ? petite. THE SALOL TREATMENT OF
CHOLERA.
\/
Bv Surgeon J. STEVENSON. M.B., Medical Staff.
F.R.C.S.E.,
The attention of the profession having been directed to the treatment of cholera by means of salol in the September number of the Indian Medical Gazette, by the interesting account of its usefulnessgiven by Surgeon-Major F. C. Nicholson, I venture to think the notes of four cases treated by this remedy may prove of interest at the present time. Two of the four were treated in the Station Hospital, Calcutta, and the others occurred in the practice of a friend. All proved fatal, but the drug appeared to have some influence in lessening the severity of the symptoms. Fortunately cholera is not the fatal disease it once was amongst the troops stationed here, and so we have not many cases to record. It is well, that all such cases as are treated by a moreover, new and untried preparation should be placed on record, so that the extent to which such remedy can be depended on may be known as early as possible. In reference to the experiment of Prof. Lowenthal, late of the Medical Academy of Lausaune and now of Paris, of which
recently
so
interesting
an
account
was
giveu by Surgeon-
Case 1.?No. 1465 Private P.
Morrisv, aged
21 years, was admitted from Barracks, I?ort William, at 11 P. m., 27th April 1889. He stated
that he felt quite well 011 the 26th after dinner ; He the 27th he felt sick and began to vomit. has been 1T7_ years in India out of a total Soon after feeling sick service of 3 years. diarrhoea set in, accompanied with cramps and o-riping pains. His condition when admitted to the Station Hospital was as follows :? on
The surface of the skin was dusky, cold, clammy and moist; the voice weak ; patient restless and uneasy; respiration sighing; stools frequent, passed involuntarily, have the usual ricewater appearance ; urine small in quantity ; sunken and cramps in abdomen and legs; eyes surrounded by a dark ring cramps in the muscles of the legs; pulse weak, 140, difficult to count. Temp. 97'40. To get Salol 3 grs. every two hours, ice to suck, brandy and beef tea at suit* Cholera: What can the State do to prevent it ? J. M. Cuningliam, M. d,, Calcutta, 1884.
By
May
THE SALOL TREATMENT OF CHOLERA.
1890.]
able intervals, and if nutritive enemata.
vomiting persists.,
to have
April 28.?To-day patient appears better, skin not so livid, pulse although rapid, stronger ; voice stronger; temp; 98'4?. The stools are not so frequent, there is little pain, but they are still characteristic of the disease. Towards evening there was little change in the general symptoms, except that the pulse again became weak and continued fast, 140. Suppression of urine continues. To receive grs. xv Salol every two hours. April 29.?To-day patient appears much improved, cyanosis gone ; he had a fteculent stool at 10 p. M. last night; only vomited twice during the night, passed two drams of urine at 10-30 A. M.; stool thin yellowish, mixed with bile. Slept none either during the night or day; P. 120, Drinks milk and beef-tea freely. 98*4.? Temp. Seems very uneasy and sighs frequently.?A little urine passed which shews with H N. 03. About 2 p. m., became untest | albumen. conscious ; at 5. P. M., respirations shallow, 36 per minute ; pulse cannot be felt, surface became dusky and pupils dilated; vomited about 4 oz. of dark fluid blood. Throughout the afterabout one motion every two hours, noon had very little pain, fajculent, passed in bed. The temperature rose steadily till death, which occurred at G-26 p. M. Temp, at 4 p. m. 105'4?, pulse unsteady, very rapid ; at 6-26 P. M., time of death, 106*4? and two hours after death 104?. During the progress of the case patient took about 7 drams of Salol in 43 hours. The bulk of the notes were taken by Assistant Apothecary Jackson, Madras Medical Estab-
lishment.
of cholera in the taken by Assistant Apothecary F. W. Barker.?No. 1125 Private William Baker, 1st E. Surrey Regiment, age 26, total service 6 years. Indian service, 5 years. Case II.?Notes
Station
on
a
case
Hospital, Calcutta,
Brought to Hospital at 3-30 P. m. on the 29th December 1889. Took ill 9 A. M., this day with looseness followed by vomiting. State on admission.?Voice husky ; face pinched ; watery motions very frequent, vomiting ; pulse thready, temp. 97'2?. No urine since 6 a. m.
passed
R
Mist. Stimul ans 3-30
5i. p. m.
Hot-water bottles to extremities ; sinapisms to abdomen and lumbar region; milk and sodawater to 5 p.3i.
drink.
Chlorodyne m. 40. Brandy 5iii. To be given in two lots. 5-30 p.m. Vomiting less. 6 p.m. Expressed a desire to pass urine, but R
could not pass any.
R
6 p.m.
6-30
Salol
143
grs. 30.
Mucilage q. s. No vomitiug.?States p.m.
cramps easier.
lie feels the at 7 p.m. Chlorodjne m. 40.
Ou accouut of
clilorodyne draught repeated. Brandy 3ii. Iu two draughts. 7-5
p.m.
Vomited.
pain
Hot-water tins
to hands and feet.
applied
No vomiting since 7-5 P. M. R Salol grs. 30. 9 p.m. Crampless. No vomitiug. 11 p.m. R Salol grs. 30.
8 p.m.
12 Midnight. Cramps returning?Pulse very feeble. Is very loose. 1 a.m. Is still loose. Cramps continue. Pulse very feeble. Sinapism to heart. Turpentine friction. Salol grs. 30. Passes his motions in bed. 2 a.m. Pulse 3 a.m. Pulse 4 -a.m. 5 a.m.
better?Cramps continue. better?Breathing easier. Is easier?Cramps less. Appears better?Pulse easily felt.
30th December 1889,6 a.m. Is looking better? has had very little sleep. No urine passed. No vomiting since 7-5 P.M. One motion just now which is tinged with bile and scanty. Passed catheter ; no urine in bladder. Did not pass motion iu bed ; but asked for the bedpan. 7 a.m. One motion again, scanty and bile tinged. Pulse felt easily. Brandy and Sodawater.
Expressed a desire to pass water not pass any. could but again, 9 a.m. Salol grs. 30. Pulse easily felt. Dry ginger friction. Three motions since 6 a.m. 10 a.m. Doing fairly well. 11 a.m. Dozes for a few minutes at a time. Salol grs. 30. 12 noon. One stool since 9 ^.M. Cramps 8
a.m.
coming
on
again.
Salol grs. 30. Cramps again. Complains of feeling his breathing getting difficult. 2 p.m. Pulse getting bail again. 1 P.M.
Pulse very feeble again. Brandy, clilorodyne, sodawater. 3-30 p.m. Respirations greatly increased. No urine passed at all. No cramps. No pulse. 4 p.m. Is worse. Is slightly delirious. No pulse. 4-30 p.m. Breathing more hurried. 3 p.m.
Is delirious. 5-10 P.M. Died. 3-30 p.m., 97' 2?. Temp. 29th January 1890, 6 ? ? 30th a.m., 97' 8?. ? 4 ? 100- 4?. *-M., ?, T Extras, 29th January 1890.
Brandy?6
ozs.
Sodawater?G bottles. Beef Tea?One pint. Milk?4 pints. Ice?As much
as
required.
144
THE INDIAN MEDICAL GAZETTE.
Case III.?E. C., European lad, aged 7 years, retired to bed about 7 p.m. on the 8th February 1890, after a supper of toast and tiparee jam ; feeling perfectly well. At 10 p.m. he was attacked with diarrhoea and vomiting, which his parents attributed to his having partaken rather freely of the jam. The lad had previously been subject to occasional attacks of bilious vomiting and diarrhoea ; and often complained of nausea after food; for which he had been under treatment As the diarrhoea at Simla for some months. and vomiting continued, and cramps had supervened, the father called in medical aid between 3 and 4 a.m. on the 9th. Symptoms of cholera were now well marked; temp, in mouth 96*4? F. Ordered Salol grs. v. suspended in barley gruel every two hours, and a mixture, of spts chloroformi m.xv. spts. ammon. arom m.xv, spts. nsther nitrosi m v in peppermint water every hour. Extremities rubbed with powdered ginger, hot bottles to sides and feet, and a sinapism to epigastrium. Ice to suck, and barley water and milk flavored with salt as diet. No improvement was observed during the day, throughout which he was seen frequently; and about noon collapse set in, although vomiting and diarrhoea The treatment had ceased two hours previous. was continued, and enemata of brandy ^ii. in barley water 5vi. given every two hours; but in spite of all the lad sank and died about 4 p.m. Case IV.?K. N. B., native female, aged 30, was attacked about 6 P.M. on the 11th January 1890 with diarrhoea and vomiting; medical aid was not called in until about 10 p.m. All the symptoms of cholera were then present, and the patient was approacing the stage of collapse, the pulse being but faintly perceptible at the wrist. Salol, grs. xv suspended in sago gruel, was ordered every three hours, and a mixture of spts. Eetlieris m. xv, spts. ammon. arom. m. xx, spts. asther nitrosi m. x in peppermint water every hour. Tlie extremities were rubbed with powdered ginger, and sinapisms applied to epigastrium, and calves of legs, and hot bottles to sides The patient was again seen at 6 a.m. and feet. when collapse had set in ; vomiting and cramps had ceased, but the diarrhoea was now involuntary, complete suppression of urine. Temp, in mouth. 96? F. Treatment continued, and allowed ice to suck, with thin sago gruel prepared in water, and flavored with salt as diet. No change in the symptoms was observed after this ; and the patient gradually sank and died at 2 a.m. on the 13th. REMARKS. Case I?Shewed improvement in the general symptoms after the Salol during the first twenty-
four hours and
gradual relapse
after this
period;
towards the end the stool became foeculeut and greenish-yellow, urine suppressed, thin scanty, and very albuminous.
Case II.?The uotes
frequent intervals.
[May are
copious
1890
and taken
at
There was some amelioration of the sympAfter fifteen hours a bile tinged motion was passed, but suppression of urine continued; after nineteen hours symptoms still less severe After twentyand appeared to be doing well. one hours the cramps returned, the breathing became difficult, and the pulse began to fail: these symptoms were followed by delirium and death in about twenty-six hours. In both these cases any signs of reaction which were present were accompanied by rise of temperature. Case III?Exhibits the regular progress of the disease, apparently uninfluenced by the
toms.
remedy.
Case IV?Was that of a Native woman who, when seen, had all the symptoms of cholera well developed and had just entered.in the stage of collapse. The Salol did not appear to influence Death occurred in the course of the disease.
twenty-four hours. Fort William, Calcutta: 17th April 1890.
Major
on
% JPliiTor of losjitat ? petite. THE SALOL TREATMENT OF
CHOLERA.
\/
Bv Surgeon J. STEVENSON. M.B., Medical Staff.
F.R.C.S.E.,
The attention of the profession having been directed to the treatment of cholera by means of salol in the September number of the Indian Medical Gazette, by the interesting account of its usefulnessgiven by Surgeon-Major F. C. Nicholson, I venture to think the notes of four cases treated by this remedy may prove of interest at the present time. Two of the four were treated in the Station Hospital, Calcutta, and the others occurred in the practice of a friend. All proved fatal, but the drug appeared to have some influence in lessening the severity of the symptoms. Fortunately cholera is not the fatal disease it once was amongst the troops stationed here, and so we have not many cases to record. It is well, that all such cases as are treated by a moreover, new and untried preparation should be placed on record, so that the extent to which such remedy can be depended on may be known as early as possible. In reference to the experiment of Prof. Lowenthal, late of the Medical Academy of Lausaune and now of Paris, of which
recently
so
interesting
an
account
was
giveu by Surgeon-
Case 1.?No. 1465 Private P.
Morrisv, aged
21 years, was admitted from Barracks, I?ort William, at 11 P. m., 27th April 1889. He stated
that he felt quite well 011 the 26th after dinner ; He the 27th he felt sick and began to vomit. has been 1T7_ years in India out of a total Soon after feeling sick service of 3 years. diarrhoea set in, accompanied with cramps and o-riping pains. His condition when admitted to the Station Hospital was as follows :? on
The surface of the skin was dusky, cold, clammy and moist; the voice weak ; patient restless and uneasy; respiration sighing; stools frequent, passed involuntarily, have the usual ricewater appearance ; urine small in quantity ; sunken and cramps in abdomen and legs; eyes surrounded by a dark ring cramps in the muscles of the legs; pulse weak, 140, difficult to count. Temp. 97'40. To get Salol 3 grs. every two hours, ice to suck, brandy and beef tea at suit* Cholera: What can the State do to prevent it ? J. M. Cuningliam, M. d,, Calcutta, 1884.
By
May
THE SALOL TREATMENT OF CHOLERA.
1890.]
able intervals, and if nutritive enemata.
vomiting persists.,
to have
April 28.?To-day patient appears better, skin not so livid, pulse although rapid, stronger ; voice stronger; temp; 98'4?. The stools are not so frequent, there is little pain, but they are still characteristic of the disease. Towards evening there was little change in the general symptoms, except that the pulse again became weak and continued fast, 140. Suppression of urine continues. To receive grs. xv Salol every two hours. April 29.?To-day patient appears much improved, cyanosis gone ; he had a fteculent stool at 10 p. M. last night; only vomited twice during the night, passed two drams of urine at 10-30 A. M.; stool thin yellowish, mixed with bile. Slept none either during the night or day; P. 120, Drinks milk and beef-tea freely. 98*4.? Temp. Seems very uneasy and sighs frequently.?A little urine passed which shews with H N. 03. About 2 p. m., became untest | albumen. conscious ; at 5. P. M., respirations shallow, 36 per minute ; pulse cannot be felt, surface became dusky and pupils dilated; vomited about 4 oz. of dark fluid blood. Throughout the afterabout one motion every two hours, noon had very little pain, fajculent, passed in bed. The temperature rose steadily till death, which occurred at G-26 p. M. Temp, at 4 p. m. 105'4?, pulse unsteady, very rapid ; at 6-26 P. M., time of death, 106*4? and two hours after death 104?. During the progress of the case patient took about 7 drams of Salol in 43 hours. The bulk of the notes were taken by Assistant Apothecary Jackson, Madras Medical Estab-
lishment.
of cholera in the taken by Assistant Apothecary F. W. Barker.?No. 1125 Private William Baker, 1st E. Surrey Regiment, age 26, total service 6 years. Indian service, 5 years. Case II.?Notes
Station
on
a
case
Hospital, Calcutta,
Brought to Hospital at 3-30 P. m. on the 29th December 1889. Took ill 9 A. M., this day with looseness followed by vomiting. State on admission.?Voice husky ; face pinched ; watery motions very frequent, vomiting ; pulse thready, temp. 97'2?. No urine since 6 a. m.
passed
R
Mist. Stimul ans 3-30
5i. p. m.
Hot-water bottles to extremities ; sinapisms to abdomen and lumbar region; milk and sodawater to 5 p.3i.
drink.
Chlorodyne m. 40. Brandy 5iii. To be given in two lots. 5-30 p.m. Vomiting less. 6 p.m. Expressed a desire to pass urine, but R
could not pass any.
R
6 p.m.
6-30
Salol
143
grs. 30.
Mucilage q. s. No vomitiug.?States p.m.
cramps easier.
lie feels the at 7 p.m. Chlorodjne m. 40.
Ou accouut of
clilorodyne draught repeated. Brandy 3ii. Iu two draughts. 7-5
p.m.
Vomited.
pain
Hot-water tins
to hands and feet.
applied
No vomiting since 7-5 P. M. R Salol grs. 30. 9 p.m. Crampless. No vomitiug. 11 p.m. R Salol grs. 30.
8 p.m.
12 Midnight. Cramps returning?Pulse very feeble. Is very loose. 1 a.m. Is still loose. Cramps continue. Pulse very feeble. Sinapism to heart. Turpentine friction. Salol grs. 30. Passes his motions in bed. 2 a.m. Pulse 3 a.m. Pulse 4 -a.m. 5 a.m.
better?Cramps continue. better?Breathing easier. Is easier?Cramps less. Appears better?Pulse easily felt.
30th December 1889,6 a.m. Is looking better? has had very little sleep. No urine passed. No vomiting since 7-5 P.M. One motion just now which is tinged with bile and scanty. Passed catheter ; no urine in bladder. Did not pass motion iu bed ; but asked for the bedpan. 7 a.m. One motion again, scanty and bile tinged. Pulse felt easily. Brandy and Sodawater.
Expressed a desire to pass water not pass any. could but again, 9 a.m. Salol grs. 30. Pulse easily felt. Dry ginger friction. Three motions since 6 a.m. 10 a.m. Doing fairly well. 11 a.m. Dozes for a few minutes at a time. Salol grs. 30. 12 noon. One stool since 9 ^.M. Cramps 8
a.m.
coming
on
again.
Salol grs. 30. Cramps again. Complains of feeling his breathing getting difficult. 2 p.m. Pulse getting bail again. 1 P.M.
Pulse very feeble again. Brandy, clilorodyne, sodawater. 3-30 p.m. Respirations greatly increased. No urine passed at all. No cramps. No pulse. 4 p.m. Is worse. Is slightly delirious. No pulse. 4-30 p.m. Breathing more hurried. 3 p.m.
Is delirious. 5-10 P.M. Died. 3-30 p.m., 97' 2?. Temp. 29th January 1890, 6 ? ? 30th a.m., 97' 8?. ? 4 ? 100- 4?. *-M., ?, T Extras, 29th January 1890.
Brandy?6
ozs.
Sodawater?G bottles. Beef Tea?One pint. Milk?4 pints. Ice?As much
as
required.
144
THE INDIAN MEDICAL GAZETTE.
Case III.?E. C., European lad, aged 7 years, retired to bed about 7 p.m. on the 8th February 1890, after a supper of toast and tiparee jam ; feeling perfectly well. At 10 p.m. he was attacked with diarrhoea and vomiting, which his parents attributed to his having partaken rather freely of the jam. The lad had previously been subject to occasional attacks of bilious vomiting and diarrhoea ; and often complained of nausea after food; for which he had been under treatment As the diarrhoea at Simla for some months. and vomiting continued, and cramps had supervened, the father called in medical aid between 3 and 4 a.m. on the 9th. Symptoms of cholera were now well marked; temp, in mouth 96*4? F. Ordered Salol grs. v. suspended in barley gruel every two hours, and a mixture, of spts chloroformi m.xv. spts. ammon. arom m.xv, spts. nsther nitrosi m v in peppermint water every hour. Extremities rubbed with powdered ginger, hot bottles to sides and feet, and a sinapism to epigastrium. Ice to suck, and barley water and milk flavored with salt as diet. No improvement was observed during the day, throughout which he was seen frequently; and about noon collapse set in, although vomiting and diarrhoea The treatment had ceased two hours previous. was continued, and enemata of brandy ^ii. in barley water 5vi. given every two hours; but in spite of all the lad sank and died about 4 p.m. Case IV.?K. N. B., native female, aged 30, was attacked about 6 P.M. on the 11th January 1890 with diarrhoea and vomiting; medical aid was not called in until about 10 p.m. All the symptoms of cholera were then present, and the patient was approacing the stage of collapse, the pulse being but faintly perceptible at the wrist. Salol, grs. xv suspended in sago gruel, was ordered every three hours, and a mixture of spts. Eetlieris m. xv, spts. ammon. arom. m. xx, spts. asther nitrosi m. x in peppermint water every hour. Tlie extremities were rubbed with powdered ginger, and sinapisms applied to epigastrium, and calves of legs, and hot bottles to sides The patient was again seen at 6 a.m. and feet. when collapse had set in ; vomiting and cramps had ceased, but the diarrhoea was now involuntary, complete suppression of urine. Temp, in mouth. 96? F. Treatment continued, and allowed ice to suck, with thin sago gruel prepared in water, and flavored with salt as diet. No change in the symptoms was observed after this ; and the patient gradually sank and died at 2 a.m. on the 13th. REMARKS. Case I?Shewed improvement in the general symptoms after the Salol during the first twenty-
four hours and
gradual relapse
after this
period;
towards the end the stool became foeculeut and greenish-yellow, urine suppressed, thin scanty, and very albuminous.
Case II.?The uotes
frequent intervals.
[May are
copious
1890
and taken
at
There was some amelioration of the sympAfter fifteen hours a bile tinged motion was passed, but suppression of urine continued; after nineteen hours symptoms still less severe After twentyand appeared to be doing well. one hours the cramps returned, the breathing became difficult, and the pulse began to fail: these symptoms were followed by delirium and death in about twenty-six hours. In both these cases any signs of reaction which were present were accompanied by rise of temperature. Case III?Exhibits the regular progress of the disease, apparently uninfluenced by the
toms.
remedy.
Case IV?Was that of a Native woman who, when seen, had all the symptoms of cholera well developed and had just entered.in the stage of collapse. The Salol did not appear to influence Death occurred in the course of the disease.
twenty-four hours. Fort William, Calcutta: 17th April 1890.
