iflftiions. THE TREATMENT OF
(A
Paper
read before the
CHOLERA.
Medical Society,
Prague),
ttttT7T)T)I7
By Dr.
FERDINAND IIUEPPE.
to be kept in mind with referthis treatment that not the cholera, but a human being suffering with eholera,is under con-
It
ought strictly
ence to
Dec.
HUEPPE ON THE TREATMENT OP CHOLERA.
1890.]
that the etiological indications are based upon the unquestionable fact that the morbid processes go on in the bowel itself, and that the germs produce their effects from there alone. Two groups of medicaments present themselves as available for the direct destruction of the cholera-bacteria in the rectum, that is for internal disinfection by substances taken
sideration, and
Firstly, we have bodies which pass the acid juices of the stomachun changed, and which produce their effects only when they come into contact with the alkaline intestinal secretions. To this group belong, for example, tribromphenol and trichlorphenol, but only very few clinical reports have been made of their value. The second group comprises bodies which similarly pass unchanged through the gastric liquids, but which are split up in the large intestine into their native constituents, and so reach the seat of the disease in a nascent and most effective condition. The type of these bodies is salol, the salicylate of phenyl discovered by Nenoks. Abundant clinical experiences with this substance are attainable, and we have a mass of information with regard to dosage and general therapeutical value. This clinical point of view, based on experiences with patients, is so noteworthy that I recommend this particular salol against
per
os.
through
cholera.
already whole this first, and of
We know, however,
series of salols analogous them I recommend
to
a
para-cresalol (salicylate
of
paracresy 1), because cresol has some advantages over phenol for internal administration in point of
anti-bacterial
action and harmlessness to the
human organism. I should advise that of bismuth salicylate should be added
3
grains
to eveiy dose of salol. Si nee with the salols the poison is combated by destruction of the poison-former, they fulfil the most important indicatio causalis This must always form the first consideration in a correctly based etiological therapy,at any rate where such a direct attack gives promise of success. In many instances this direct treatment can only be commenced when already further effects have to be dealt with, which arise from the formation of general and specific toxines. If it is possible to and eliminate suffi-
8
grains
destroy ciently early the poison-former itself, that is the comma-bacillus, these secondary indications disappear,
or
remain
altogether
unseen.
The later
the direct conflict with the comma-bacillus in the intestine is delayed, the more prominent will be the indications of the formation of poison. In our present ignorance of the specific poison, atropine is, perhaps, most to be recommended indications. for these Salol lias, moreover, a decided and favorable action, as I gather from communications which reached me from India on the renal symptoms and their consequents which are produced by the specific
373
poisoning. The administration of salol per os is not attended with many disadvantages even in the presence of the inclination to vomiting, which is best treated by giving small pieces of ice to suck. In any case, cresol dissolved in aqueous solution of salicylate of soda can be employed for irrigation per anum. Associated with the renal symptoms which are to be regarded as due to direct poisoning are also the pains and condition of shock due to the loss of epithelium on the part of the mucous membrane of the rectum, and the loss of water, with the consequent thickening of the blood. Against the first symptoms opium is the sovereign and indispensable remedy, and remains so, although the somewhat artificial experiments with infected guinea-pigs led to a tendency for a time to take exception to this drug. Whether the opium be given by the mouth or as an addition to an enema or by irrigation must be decided according to circumstances. When, for special reasons, the use of opium is contra-indicated, I should order codeine suppositories.
The disadvantages of the loss of water, the organism can more readily overcome if the skin retains its power of reaction. This is best retained and strengthened, if it threatens to sink
of the in clothes moistened with water as hot as possible. Hypodermic injections of sterilized feebly alkaline normal salt solution_ can only be conveniently carried out in hospitals, and can now be entirely dispensed with if the sympor
is
already collapsed by envelopment
patients
only correctly considered. a or entevaclysma proceeding which removes from the organism the products toms are
??
Irrigation
of disease which
taneously
a
are
exerts simulupon the loss of from If to 3^
present?-also
beneficial
effect
For each irrigation of water at 38??40? C. are necessary, and as an addition to the water tannic acid in the proportion of i to 1 per cent, is of value. Whether the tannin actually has an anti-bacterial action or forms a more or less insoluble tannate, or whether simply the free washing out of the intestine has a mechanical action is still an open question. Very little importance is in these days attached to the removal of the morbid products, but it may well be questioned whether the neglect is justified. Next to tannic acid, I might name acetate of lead in 1 per mille solution, which, though little tried in cholera, is systematically applied in dysentery with qnite extraordinary effects. To these solutions, warm, 20 to 30 drops of opium tincture can be added. The feeling of thirst and nausea are best, combated by pieces of ice, while to drink alkaline natural waters, and good sodawater prepared from distilled water are most commendable. It is still impossible to decide how far the intenser water.
pints
THE INDIAN MEDICAL GAZETTE.
374
anti-bacterial action observed in certain cases is dependent upon a greater alkalinity of the tissue juices. As a stimulant in severe cases, I recommend the discovery of the landlord of Pussier, a drink of which it is said in the song that one may The forimbibe it
(A
Paper
read before the
CHOLERA.
Medical Society,
Prague),
ttttT7T)T)I7
By Dr.
FERDINAND IIUEPPE.
to be kept in mind with referthis treatment that not the cholera, but a human being suffering with eholera,is under con-
It
ought strictly
ence to
Dec.
HUEPPE ON THE TREATMENT OP CHOLERA.
1890.]
that the etiological indications are based upon the unquestionable fact that the morbid processes go on in the bowel itself, and that the germs produce their effects from there alone. Two groups of medicaments present themselves as available for the direct destruction of the cholera-bacteria in the rectum, that is for internal disinfection by substances taken
sideration, and
Firstly, we have bodies which pass the acid juices of the stomachun changed, and which produce their effects only when they come into contact with the alkaline intestinal secretions. To this group belong, for example, tribromphenol and trichlorphenol, but only very few clinical reports have been made of their value. The second group comprises bodies which similarly pass unchanged through the gastric liquids, but which are split up in the large intestine into their native constituents, and so reach the seat of the disease in a nascent and most effective condition. The type of these bodies is salol, the salicylate of phenyl discovered by Nenoks. Abundant clinical experiences with this substance are attainable, and we have a mass of information with regard to dosage and general therapeutical value. This clinical point of view, based on experiences with patients, is so noteworthy that I recommend this particular salol against
per
os.
through
cholera.
already whole this first, and of
We know, however,
series of salols analogous them I recommend
to
a
para-cresalol (salicylate
of
paracresy 1), because cresol has some advantages over phenol for internal administration in point of
anti-bacterial
action and harmlessness to the
human organism. I should advise that of bismuth salicylate should be added
3
grains
to eveiy dose of salol. Si nee with the salols the poison is combated by destruction of the poison-former, they fulfil the most important indicatio causalis This must always form the first consideration in a correctly based etiological therapy,at any rate where such a direct attack gives promise of success. In many instances this direct treatment can only be commenced when already further effects have to be dealt with, which arise from the formation of general and specific toxines. If it is possible to and eliminate suffi-
8
grains
destroy ciently early the poison-former itself, that is the comma-bacillus, these secondary indications disappear,
or
remain
altogether
unseen.
The later
the direct conflict with the comma-bacillus in the intestine is delayed, the more prominent will be the indications of the formation of poison. In our present ignorance of the specific poison, atropine is, perhaps, most to be recommended indications. for these Salol lias, moreover, a decided and favorable action, as I gather from communications which reached me from India on the renal symptoms and their consequents which are produced by the specific
373
poisoning. The administration of salol per os is not attended with many disadvantages even in the presence of the inclination to vomiting, which is best treated by giving small pieces of ice to suck. In any case, cresol dissolved in aqueous solution of salicylate of soda can be employed for irrigation per anum. Associated with the renal symptoms which are to be regarded as due to direct poisoning are also the pains and condition of shock due to the loss of epithelium on the part of the mucous membrane of the rectum, and the loss of water, with the consequent thickening of the blood. Against the first symptoms opium is the sovereign and indispensable remedy, and remains so, although the somewhat artificial experiments with infected guinea-pigs led to a tendency for a time to take exception to this drug. Whether the opium be given by the mouth or as an addition to an enema or by irrigation must be decided according to circumstances. When, for special reasons, the use of opium is contra-indicated, I should order codeine suppositories.
The disadvantages of the loss of water, the organism can more readily overcome if the skin retains its power of reaction. This is best retained and strengthened, if it threatens to sink
of the in clothes moistened with water as hot as possible. Hypodermic injections of sterilized feebly alkaline normal salt solution_ can only be conveniently carried out in hospitals, and can now be entirely dispensed with if the sympor
is
already collapsed by envelopment
patients
only correctly considered. a or entevaclysma proceeding which removes from the organism the products toms are
??
Irrigation
of disease which
taneously
a
are
exerts simulupon the loss of from If to 3^
present?-also
beneficial
effect
For each irrigation of water at 38??40? C. are necessary, and as an addition to the water tannic acid in the proportion of i to 1 per cent, is of value. Whether the tannin actually has an anti-bacterial action or forms a more or less insoluble tannate, or whether simply the free washing out of the intestine has a mechanical action is still an open question. Very little importance is in these days attached to the removal of the morbid products, but it may well be questioned whether the neglect is justified. Next to tannic acid, I might name acetate of lead in 1 per mille solution, which, though little tried in cholera, is systematically applied in dysentery with qnite extraordinary effects. To these solutions, warm, 20 to 30 drops of opium tincture can be added. The feeling of thirst and nausea are best, combated by pieces of ice, while to drink alkaline natural waters, and good sodawater prepared from distilled water are most commendable. It is still impossible to decide how far the intenser water.
pints
THE INDIAN MEDICAL GAZETTE.
374
anti-bacterial action observed in certain cases is dependent upon a greater alkalinity of the tissue juices. As a stimulant in severe cases, I recommend the discovery of the landlord of Pussier, a drink of which it is said in the song that one may The forimbibe it
