264
THE INDIAN MEDICAL GAZETTE.
TREATMENT OF CHOLERA. WITH SALOL. By Surgeon Major F. C. Civil
NICHOLSON, Surgeon, Patna.
m.
b.,
A short time ago I noticed a paper in the Indian Medical Gazette by Surgeon-Major G. C. Ross, Civil Surgeon of Rawal Pindi, on the Treatment of Cholera by the hypodermic injection of morphia. I can bear strong testimony to the success of this method of treating cholera, as I have been in the habit of using it, and recommending it for the last 8 or 9 years. In the early stage of cholera prior to the onset of collapse, I have found this treatment almost uniformly successful, but after the stage of collapse is pronounced, I believe, it is of very little, if any, use. Cases of cholera in the collapse stage, however, are very often met with by medical men, in fact more often, I believe, than in the first stage ; especially, if native hospital practice is taken into account. This being the case, it is apparent, the morphia hypodermic treatment of cholera, though very useful in appropriate cases, is of very little use in the great bulk of cases of cholera that practitioners are called upon to deal with. The ordinary treatment of the collapse stage of cholera, moreover, is highly unsatisfactory, and hence it behoves us to trj and find some means, by which results as good as those induced by the hypodermic injection of morphia in the first stage can be produced in patients suffering from cholera in the stage of collapse.
this, some months ago, I came of the laboratory experiments of report Prof. Lowenthal, of Lusanne, on the cultivation of the cholera bacillus, preserving its toxic effects and suggestions by him on the subject of the prevention and cure of cholera in the human being. His experiments were entirely conducted in the laboratory, and at the time of making his suggestion, he had no clinical experience in support of his views. I determined to test the drug he suggested on the first opportunity, and I have done so with very satisfactory results so far, which I will detail later.' Before doing this, I think it would be as well for me to give a brief account of Lowenthal's experiments, and the conclusions and suggestions he has made. According to Lowenthal the cholera virus is a ptomaine, the product of Koch's bacillus. The power of producing this ptomaine is destroyed by cultivating the cholera bacillus in the ordinary nutrient media. Lowenthal after many fruitless trials discovered, that if the cholera bacillus were cultivated in a paste containing fresh pancreatine, it recovered its pathogenic properties, and began again to secrete its viruIn
view of
across a
[Sept.,
1889.
lent ptomaine, which, when inoculated in mice either killed them, or made them intensely sick By varying the elements of his culture mixture Lowenthal fully satisfied himself that it is the pancreatic juice, which in presence of albumenoid and peptonised substances, determines the poison-secreting action of the bacillus. This peculiar action of the pancreatic juice being under-, stood, Lowenthal asserts, gives us an explanation of the phenomena of cholera in man. The bacilli, after being ingested, escape the stomach, and entering the intestine produce there with the help of the pancreatic juice, the same toxic matter, which is produced in the pancreatic paste, the latter being a coarse imitation of the contents of the duodenum ; this toxic matter is absorbed and the restoration or death of the patient depends on the quantity of the poisonous ptomaine absorbed, and the power of resistance of the organism. This point being once determined, Lowenthal asked himself, if there might not be some substance inoffensive to man, which introduced medically would prevent the development of the cholera poison in the intestine. To determine this, he first experimented with his pancreatic paste, trying various antiseptic agents, which lie thought might prevent the iictive functional operations of the bacilli and After a conthe genesis of the toxic ptomaine. siderable number of trials, lie hit upon salol, the salicylate of phenol which is a powerful antiseptic, and which passes through the stomach unchanged and is split up in the duodenum into carbolic and salicylic acids by the action of the pancreatic juice. He asserts that salol in the presence of fresh pancreatic juice in his laboratory experiments, was always fatal to the cholera He had, however, no opportunity of bacillus. trying his suggested remedy clinically. As soon as the cholera season began in Patna, I instructed my assistants, Assistant-Surgeon Ram Kali Gupta and Assistant Asdar Ali Khan, to use salol in the treatment of all cholera patients admitted into the Temple Medical School Hospital, Bankipore. For the last seven or eight weeks this has been done. I suggested that salol should be given in 15grain doses, suspended in gum Avater, to which a few drops of spirit chloroform were to be added. This dose was to be given every three or four hours according to the urgency of the case. Up to date 15 cases of cholera have been thus treated consecutively in the hospital, and so far without a single death. Besides these cases three others were treated by Assistant-Surgeon As(^u* Ali Khan iu his private practice with equally satisfactory results. Thus in all eighteen cases of cholera have been treated with this drug, and so far every one treated with it has recovered.
Sept., 1889.]
Dr. NICHOLSON ON TREATMENT OP CHOLERA WITE-I SALOL.
Of the fifteen cases treated in the hospital ten admitted in the stage of collapse, and five in the first stage. Of the three cases treated by Asder Ali Khan, one was in the stage of collapse, and the other two in the first stage. Many of the collapsed cases were extremely severe, and such as, I think, under the usual treatment, would have succumbed to the diswere
ease.
It is impossible in this paper to give the whole fifteen cases treated in hospital in detail, as it would take up too much space to do so. I give, however, the details of five of the cases as good samples of those treated. These will serve to give a good idea of the general run of collapsed cases which were treated, and also illustrate fairly the course of the disease taken under the salol treatment. The cases treated iu hospital were looked after by Assistant-Surgeon Asder Ali Khan, Teacher of Medicine, who devoted much time and attention to the work. Case I.?Ghura, male, Mahomedan, attacked with purging and vomiting on the 17th July, and admitted into hospital at 9 A.M. on the morning of the 19th July iu an advanced stage of collapse. Face sunken, voice whispering. Vomiting and passing rice-water stools incessantly. Very restless and thirsty. Had passed no urine for 24 hours. Pulse imperceptible at wrist. Respiration sighing. Temperature in axilla 96?F. Treatment?Ice to suck. R,
Salol Chloric sether Mucil.
Aqua Every
bile-tinged
...
gr.
xv
m.
xx
ad.
gi ?i
...
...
4 hours.
motions since
previous report. Still no urine. Slept off and on. Pulse much improved. Still no urine. Continue Salol mixture. 22nd July, 7-30 A.M.?Motions reduced to four in number. No vomiting. Passed some very high coloured and offensive smelling urine for the first time. Much less restless. No congestion
of
hunger.
the eyes.
Continue
ture in axilla 97? F. Appears much better, Omit salol mixture, ami instead give R Soda Bicarb. gr. x m. xx JEther Chloric ...
...
Spt.
aetli. nit.
Aqua
Every Also
give
m.
xv
ad.
3i
...
4 hours.
thin sago, cooked in
water
with sait,
every 4 hours. From this date he
steadily improved,
convalescent by the 31st July.
He as he
and was
was
kept
in hospital until 22nd August, was very weak aud pulled down after the severe attack he had had. Case II.?Nanki, female, Hindu, age 20, attacked with purging and vomiting at one o'clock on the morning of the 23rd July and brought to hospital, collapsed at noon the same day. Face pinched, eyes sunken, pulse scarcely perceptible. Body cold and clammy. Had constant vomiting and purging of rice-water matter. Urine suppressed for six hours. Treatment?Salol mixture and ice. 24th July, 8 A.M.?Still collapsed. Stools frequent. Vomiting stopped. Stools rice-water, and passed in bed clothes. No urine. Pulse improved, fairly perceptible. Temperature 96? F. Great thirst and restlessness. Continue medicines. 25th July, 8 A.M.?Stools still numerous and
rice-water like;
vomiting stopped. Still very and restless. No urine, but general condition improving. Pulse stronger. Temperature 96.-4? F. 26th 27th July.?Remained much in the same state, very thirsty and restless, and tossing about constantly and difficult to keep in bed. Stools lessening in frequency. Pulse still improving. Temperature 97.?F. Still no urine or change in the colour of motions. Continue Salol mixture* 28th July, 8 a.m.?Patient better, stools much less frequent, aud now are bile-stained. Passed Has pain in .aburine copiously in the night. domen and bearing down. Also slight bloody thirsty
?
...
20th July, 8 A.M.?Vomiting less frequent. Stools less in quantity, and only eight in number, and bile-tinged. Face less sunken and anxious. Still thirsty. No urine. Pulse perceptible. Temperature in axilla 97? F. Continue salol mixture. 21 st July, 8 A.M.?Appearance much better. Face filling out and looking less anxious. Had ?ix
265
Complains
of thirst and
Salol mixture.
23rd July, 8 A.M.?Has had no stool since last report. Hus passed urine freely. Feels kungry. Slept well. Pulse good. Tempera-
vaginal discharge. In the evening miscarried
of a foetus at about Passed more urine during the day. Ordered thin sago, made with water and flavoured with salt. Continue the Salol and ice. 29th July, 8 A.M.?Since last report has had four yellow coloured thin motions. Passed water Ireely. Lochia bloody. Seems very weak and exhausted. Pulse soft and thin. Temperature the 4th month.
97?F. Continue medicine and diet. 30M July, 8 a.m.?Pulse improving. Temperature 97.6? F. No Stool. Urine copious, but micturition painful. Lochia scanty. Continue medicine and diet. 35
266
?
THE INDIAN MEDICAL GAZETTE.
31s* July.?Improving steadily. No stool. Urine free. Lochia free. Pulse getting fuller. ls? August, 8 A.M.?Still improving. Medicine changed to soda mixture. Rum siven with the sago. T This patient began to convalesce steadily from this date, and with the exception of a parotid abscess, had no further bad symptoms, and was discharged cured on the 11th August. Case III.?Mankii, Hindu female, age 25, admitted at 9 A.M., on the 23i'd July, suffering from cholera, being in the stage of collapse. The attack began eight hours previous to admission with violent purging and vomiting. On admission body cold. were Cramps complained of in legs and hands. Eyes sunken, face pinched. Pulse imperceptible at wrist Temperature 97?F. Passed 4 motions within an hour of admission. Vomiting incessantly. Put on salol treatment and ice. 24th July.?Stools less copious and frequent, but still like rice-water. Pulse becoming perceptible. Temperature 97*6? F. Very thirsty and restless. Vomiting much less. R
Pot. Nit.
iEth.
Chloric.
Spt. iEth. Aqua
grs.
v.
m.
xx.
in.
xv.
given.
26th July.?Has had pain in the stomach, cramps in the legs and felt sick. Later, vomiThen had 2 loose stools ted 4 round worms. Urine free. Pulse coloured greenish yellow. good. Sago diet. Omit salol and give soda mixture. 27th July.?Had three loose yellow motions, Urine free. and vomited 3 round worms. TemPulse good. Reaction fully established. perature 98? F. Sago diet. Soda mixture. Vo28th July.?Had one thin yellow stool. the this time From patient miting stopped. steadily improved, and was discharged cured on the 4th August. Case IV.?Mussamut Foolia, Hindu female, admitted on the 4th August, 24 hours after the onset of the attack. On admission, face pinched, eyes sunken, body cold and clammy, fingers blue. Constantly vomiting and purging Pulse imperceptible at rice-watery matter. wrist. Great thirst and restlessness. Urine suppressed for 6 hours. Salol treatment.
5th very
in
August.?Vomiting constantly.
now
just
Stools
and passed in bed. Rice-watery No urine. Pulse improving and perceptible. Continue salol.
frequent
character.
salol.
August.?Still improving,
8th Urine
No
stool.
passed freely. Pulse good. Reaction is thoroughly established. Stop salol and give
soda mixture.
Cooked in water and flavoured From this time the patient steadily improved, but being weak was not discharged from hospital until the 27th August.
Diet.?Sago
with salt.
Hindu male, 35, Case V.?Ram Kissen, admitted into hospital on 24th August, at 8 p. M., 24 hours after being first attacked with purging and vomiting. He was very much collapsed on admission. Pulse hardly percepHad been purging and vomiting contible. stantly. No urine passed for 4 hours. Salol was
treatment.
25th colour. ture
To be taken alternately with the Salolmixture* 25th July.?Since last report has had thin stools, more consistent, and tinged yellow with bile. Also passed water copiously. Still vomiting slightly. Temperature 97? F. Sago cooked in water aud flavoured with salt
1889.
6th August.?Stools less frequent and altered in colour to yellowish green. Vomiting stopped. No urine. Pulse still improving. Continue salol. No urine. Much 1th August.?No stools. thirst. Pulse good. Reaction set in. Continue
Colour
ji.
[Sept.,
August.?Passed
Had six stools
changed
98? F.
to
urine of a very high during last 24 hours,
greenish yellow. Temperais fairly good. Contiuue
Pulse
salol. 26tli August.?Passed urine 3 times. Had 3 stools of greenish-yellow tinge. Temperature Con98? F. Pulse fair, reaction set in well. tinue salol.. Passed urine 4 27th August.?No stool. Omit salol and give soda times. Pulse good. mixture. Diet.?Sago cooked in water and flavoured with salt. From this time convalescence steadily advanced, and he was discharged cured on September 8th. The patients to whom salol was adminstered, a as rule, began to show signs of amelioration of their symptoms after taking three or four doses. There was lessening of the urgency of the purging, and vomiting followed by a return of the pulse slowly and gradually. In cases of collapse the pulse became percepThe chartible usually in less than 24 hours. acter of the stools was changed in 10 of the The rice-water evacuacases within 48 hours. tions were changed to thin, yellow or yellowishgreen stools. In three cases this alteration in the motions took place within 24 hours, but these cases were admitted into hospital in the first stage of
cholera. In two instances this change in the character did not begin for 3 and 4 days. The urinary secretion in two cases was established in 24 hours; in 7 cases in 48 hours ; and in 6 cases between the 3rd and 5th dny.
Sept., 1889.] THREE FATAL
Usually, immediately altered, the established. In only 4
the motions
?
HEAD "CASES WITH POST-MORTEM EXAMINATIONS.
after the character of secretion of urine was cases
was
there
more
than 24 hours difference. The stage of reaction in all cases treated with salol began very gradually and was slowly established. In no case was the reaction stage at all severe, or accompanied by fever, or an) signs of uramic poisoning. In some cases a diuretic mixture was given to aid in the establishment of the urine. This was only necessary in a few cases ; but most of the patients who once tasted the diuretic mixture used, wanted to have it again, possibly because the alkalies it contained were grateful to them. All the patients, moreover, recovering from cholera craved for salt in their food, I suppose for much the same reasou as their liking the diuretic mixture. I think the treatment of these of cholera here with salol under my direction, affords strong clinical testimony in favor of the value of Lichventhal's suggestion as to the prevention and cure of cholera which he worked out experimentally in the laboratory ; for they certainly indicate, that salol is a valuable drug in the treatment of cholera, though In
18
conclusion,
cases
they
are
not
perhaps sufficiently
prove that it is worthy to be called this dread disease.
numerous
a
specific
to
for
To determine the exact value of the salol of cholera, and how far it is a specific, if at all, further clinical experience is necessary; and as my opportunities for further testing the drug are very limited, 'I have been induced to write this paper to call attention to the subject, in the hope that others may be induced to try the drug, and thus more rapidly put it to the test of clinical experience, than I, can, working alone.
treatment
267
THE INDIAN MEDICAL GAZETTE.
TREATMENT OF CHOLERA. WITH SALOL. By Surgeon Major F. C. Civil
NICHOLSON, Surgeon, Patna.
m.
b.,
A short time ago I noticed a paper in the Indian Medical Gazette by Surgeon-Major G. C. Ross, Civil Surgeon of Rawal Pindi, on the Treatment of Cholera by the hypodermic injection of morphia. I can bear strong testimony to the success of this method of treating cholera, as I have been in the habit of using it, and recommending it for the last 8 or 9 years. In the early stage of cholera prior to the onset of collapse, I have found this treatment almost uniformly successful, but after the stage of collapse is pronounced, I believe, it is of very little, if any, use. Cases of cholera in the collapse stage, however, are very often met with by medical men, in fact more often, I believe, than in the first stage ; especially, if native hospital practice is taken into account. This being the case, it is apparent, the morphia hypodermic treatment of cholera, though very useful in appropriate cases, is of very little use in the great bulk of cases of cholera that practitioners are called upon to deal with. The ordinary treatment of the collapse stage of cholera, moreover, is highly unsatisfactory, and hence it behoves us to trj and find some means, by which results as good as those induced by the hypodermic injection of morphia in the first stage can be produced in patients suffering from cholera in the stage of collapse.
this, some months ago, I came of the laboratory experiments of report Prof. Lowenthal, of Lusanne, on the cultivation of the cholera bacillus, preserving its toxic effects and suggestions by him on the subject of the prevention and cure of cholera in the human being. His experiments were entirely conducted in the laboratory, and at the time of making his suggestion, he had no clinical experience in support of his views. I determined to test the drug he suggested on the first opportunity, and I have done so with very satisfactory results so far, which I will detail later.' Before doing this, I think it would be as well for me to give a brief account of Lowenthal's experiments, and the conclusions and suggestions he has made. According to Lowenthal the cholera virus is a ptomaine, the product of Koch's bacillus. The power of producing this ptomaine is destroyed by cultivating the cholera bacillus in the ordinary nutrient media. Lowenthal after many fruitless trials discovered, that if the cholera bacillus were cultivated in a paste containing fresh pancreatine, it recovered its pathogenic properties, and began again to secrete its viruIn
view of
across a
[Sept.,
1889.
lent ptomaine, which, when inoculated in mice either killed them, or made them intensely sick By varying the elements of his culture mixture Lowenthal fully satisfied himself that it is the pancreatic juice, which in presence of albumenoid and peptonised substances, determines the poison-secreting action of the bacillus. This peculiar action of the pancreatic juice being under-, stood, Lowenthal asserts, gives us an explanation of the phenomena of cholera in man. The bacilli, after being ingested, escape the stomach, and entering the intestine produce there with the help of the pancreatic juice, the same toxic matter, which is produced in the pancreatic paste, the latter being a coarse imitation of the contents of the duodenum ; this toxic matter is absorbed and the restoration or death of the patient depends on the quantity of the poisonous ptomaine absorbed, and the power of resistance of the organism. This point being once determined, Lowenthal asked himself, if there might not be some substance inoffensive to man, which introduced medically would prevent the development of the cholera poison in the intestine. To determine this, he first experimented with his pancreatic paste, trying various antiseptic agents, which lie thought might prevent the iictive functional operations of the bacilli and After a conthe genesis of the toxic ptomaine. siderable number of trials, lie hit upon salol, the salicylate of phenol which is a powerful antiseptic, and which passes through the stomach unchanged and is split up in the duodenum into carbolic and salicylic acids by the action of the pancreatic juice. He asserts that salol in the presence of fresh pancreatic juice in his laboratory experiments, was always fatal to the cholera He had, however, no opportunity of bacillus. trying his suggested remedy clinically. As soon as the cholera season began in Patna, I instructed my assistants, Assistant-Surgeon Ram Kali Gupta and Assistant Asdar Ali Khan, to use salol in the treatment of all cholera patients admitted into the Temple Medical School Hospital, Bankipore. For the last seven or eight weeks this has been done. I suggested that salol should be given in 15grain doses, suspended in gum Avater, to which a few drops of spirit chloroform were to be added. This dose was to be given every three or four hours according to the urgency of the case. Up to date 15 cases of cholera have been thus treated consecutively in the hospital, and so far without a single death. Besides these cases three others were treated by Assistant-Surgeon As(^u* Ali Khan iu his private practice with equally satisfactory results. Thus in all eighteen cases of cholera have been treated with this drug, and so far every one treated with it has recovered.
Sept., 1889.]
Dr. NICHOLSON ON TREATMENT OP CHOLERA WITE-I SALOL.
Of the fifteen cases treated in the hospital ten admitted in the stage of collapse, and five in the first stage. Of the three cases treated by Asder Ali Khan, one was in the stage of collapse, and the other two in the first stage. Many of the collapsed cases were extremely severe, and such as, I think, under the usual treatment, would have succumbed to the diswere
ease.
It is impossible in this paper to give the whole fifteen cases treated in hospital in detail, as it would take up too much space to do so. I give, however, the details of five of the cases as good samples of those treated. These will serve to give a good idea of the general run of collapsed cases which were treated, and also illustrate fairly the course of the disease taken under the salol treatment. The cases treated iu hospital were looked after by Assistant-Surgeon Asder Ali Khan, Teacher of Medicine, who devoted much time and attention to the work. Case I.?Ghura, male, Mahomedan, attacked with purging and vomiting on the 17th July, and admitted into hospital at 9 A.M. on the morning of the 19th July iu an advanced stage of collapse. Face sunken, voice whispering. Vomiting and passing rice-water stools incessantly. Very restless and thirsty. Had passed no urine for 24 hours. Pulse imperceptible at wrist. Respiration sighing. Temperature in axilla 96?F. Treatment?Ice to suck. R,
Salol Chloric sether Mucil.
Aqua Every
bile-tinged
...
gr.
xv
m.
xx
ad.
gi ?i
...
...
4 hours.
motions since
previous report. Still no urine. Slept off and on. Pulse much improved. Still no urine. Continue Salol mixture. 22nd July, 7-30 A.M.?Motions reduced to four in number. No vomiting. Passed some very high coloured and offensive smelling urine for the first time. Much less restless. No congestion
of
hunger.
the eyes.
Continue
ture in axilla 97? F. Appears much better, Omit salol mixture, ami instead give R Soda Bicarb. gr. x m. xx JEther Chloric ...
...
Spt.
aetli. nit.
Aqua
Every Also
give
m.
xv
ad.
3i
...
4 hours.
thin sago, cooked in
water
with sait,
every 4 hours. From this date he
steadily improved,
convalescent by the 31st July.
He as he
and was
was
kept
in hospital until 22nd August, was very weak aud pulled down after the severe attack he had had. Case II.?Nanki, female, Hindu, age 20, attacked with purging and vomiting at one o'clock on the morning of the 23rd July and brought to hospital, collapsed at noon the same day. Face pinched, eyes sunken, pulse scarcely perceptible. Body cold and clammy. Had constant vomiting and purging of rice-water matter. Urine suppressed for six hours. Treatment?Salol mixture and ice. 24th July, 8 A.M.?Still collapsed. Stools frequent. Vomiting stopped. Stools rice-water, and passed in bed clothes. No urine. Pulse improved, fairly perceptible. Temperature 96? F. Great thirst and restlessness. Continue medicines. 25th July, 8 A.M.?Stools still numerous and
rice-water like;
vomiting stopped. Still very and restless. No urine, but general condition improving. Pulse stronger. Temperature 96.-4? F. 26th 27th July.?Remained much in the same state, very thirsty and restless, and tossing about constantly and difficult to keep in bed. Stools lessening in frequency. Pulse still improving. Temperature 97.?F. Still no urine or change in the colour of motions. Continue Salol mixture* 28th July, 8 a.m.?Patient better, stools much less frequent, aud now are bile-stained. Passed Has pain in .aburine copiously in the night. domen and bearing down. Also slight bloody thirsty
?
...
20th July, 8 A.M.?Vomiting less frequent. Stools less in quantity, and only eight in number, and bile-tinged. Face less sunken and anxious. Still thirsty. No urine. Pulse perceptible. Temperature in axilla 97? F. Continue salol mixture. 21 st July, 8 A.M.?Appearance much better. Face filling out and looking less anxious. Had ?ix
265
Complains
of thirst and
Salol mixture.
23rd July, 8 A.M.?Has had no stool since last report. Hus passed urine freely. Feels kungry. Slept well. Pulse good. Tempera-
vaginal discharge. In the evening miscarried
of a foetus at about Passed more urine during the day. Ordered thin sago, made with water and flavoured with salt. Continue the Salol and ice. 29th July, 8 A.M.?Since last report has had four yellow coloured thin motions. Passed water Ireely. Lochia bloody. Seems very weak and exhausted. Pulse soft and thin. Temperature the 4th month.
97?F. Continue medicine and diet. 30M July, 8 a.m.?Pulse improving. Temperature 97.6? F. No Stool. Urine copious, but micturition painful. Lochia scanty. Continue medicine and diet. 35
266
?
THE INDIAN MEDICAL GAZETTE.
31s* July.?Improving steadily. No stool. Urine free. Lochia free. Pulse getting fuller. ls? August, 8 A.M.?Still improving. Medicine changed to soda mixture. Rum siven with the sago. T This patient began to convalesce steadily from this date, and with the exception of a parotid abscess, had no further bad symptoms, and was discharged cured on the 11th August. Case III.?Mankii, Hindu female, age 25, admitted at 9 A.M., on the 23i'd July, suffering from cholera, being in the stage of collapse. The attack began eight hours previous to admission with violent purging and vomiting. On admission body cold. were Cramps complained of in legs and hands. Eyes sunken, face pinched. Pulse imperceptible at wrist Temperature 97?F. Passed 4 motions within an hour of admission. Vomiting incessantly. Put on salol treatment and ice. 24th July.?Stools less copious and frequent, but still like rice-water. Pulse becoming perceptible. Temperature 97*6? F. Very thirsty and restless. Vomiting much less. R
Pot. Nit.
iEth.
Chloric.
Spt. iEth. Aqua
grs.
v.
m.
xx.
in.
xv.
given.
26th July.?Has had pain in the stomach, cramps in the legs and felt sick. Later, vomiThen had 2 loose stools ted 4 round worms. Urine free. Pulse coloured greenish yellow. good. Sago diet. Omit salol and give soda mixture. 27th July.?Had three loose yellow motions, Urine free. and vomited 3 round worms. TemPulse good. Reaction fully established. perature 98? F. Sago diet. Soda mixture. Vo28th July.?Had one thin yellow stool. the this time From patient miting stopped. steadily improved, and was discharged cured on the 4th August. Case IV.?Mussamut Foolia, Hindu female, admitted on the 4th August, 24 hours after the onset of the attack. On admission, face pinched, eyes sunken, body cold and clammy, fingers blue. Constantly vomiting and purging Pulse imperceptible at rice-watery matter. wrist. Great thirst and restlessness. Urine suppressed for 6 hours. Salol treatment.
5th very
in
August.?Vomiting constantly.
now
just
Stools
and passed in bed. Rice-watery No urine. Pulse improving and perceptible. Continue salol.
frequent
character.
salol.
August.?Still improving,
8th Urine
No
stool.
passed freely. Pulse good. Reaction is thoroughly established. Stop salol and give
soda mixture.
Cooked in water and flavoured From this time the patient steadily improved, but being weak was not discharged from hospital until the 27th August.
Diet.?Sago
with salt.
Hindu male, 35, Case V.?Ram Kissen, admitted into hospital on 24th August, at 8 p. M., 24 hours after being first attacked with purging and vomiting. He was very much collapsed on admission. Pulse hardly percepHad been purging and vomiting contible. stantly. No urine passed for 4 hours. Salol was
treatment.
25th colour. ture
To be taken alternately with the Salolmixture* 25th July.?Since last report has had thin stools, more consistent, and tinged yellow with bile. Also passed water copiously. Still vomiting slightly. Temperature 97? F. Sago cooked in water aud flavoured with salt
1889.
6th August.?Stools less frequent and altered in colour to yellowish green. Vomiting stopped. No urine. Pulse still improving. Continue salol. No urine. Much 1th August.?No stools. thirst. Pulse good. Reaction set in. Continue
Colour
ji.
[Sept.,
August.?Passed
Had six stools
changed
98? F.
to
urine of a very high during last 24 hours,
greenish yellow. Temperais fairly good. Contiuue
Pulse
salol. 26tli August.?Passed urine 3 times. Had 3 stools of greenish-yellow tinge. Temperature Con98? F. Pulse fair, reaction set in well. tinue salol.. Passed urine 4 27th August.?No stool. Omit salol and give soda times. Pulse good. mixture. Diet.?Sago cooked in water and flavoured with salt. From this time convalescence steadily advanced, and he was discharged cured on September 8th. The patients to whom salol was adminstered, a as rule, began to show signs of amelioration of their symptoms after taking three or four doses. There was lessening of the urgency of the purging, and vomiting followed by a return of the pulse slowly and gradually. In cases of collapse the pulse became percepThe chartible usually in less than 24 hours. acter of the stools was changed in 10 of the The rice-water evacuacases within 48 hours. tions were changed to thin, yellow or yellowishgreen stools. In three cases this alteration in the motions took place within 24 hours, but these cases were admitted into hospital in the first stage of
cholera. In two instances this change in the character did not begin for 3 and 4 days. The urinary secretion in two cases was established in 24 hours; in 7 cases in 48 hours ; and in 6 cases between the 3rd and 5th dny.
Sept., 1889.] THREE FATAL
Usually, immediately altered, the established. In only 4
the motions
?
HEAD "CASES WITH POST-MORTEM EXAMINATIONS.
after the character of secretion of urine was cases
was
there
more
than 24 hours difference. The stage of reaction in all cases treated with salol began very gradually and was slowly established. In no case was the reaction stage at all severe, or accompanied by fever, or an) signs of uramic poisoning. In some cases a diuretic mixture was given to aid in the establishment of the urine. This was only necessary in a few cases ; but most of the patients who once tasted the diuretic mixture used, wanted to have it again, possibly because the alkalies it contained were grateful to them. All the patients, moreover, recovering from cholera craved for salt in their food, I suppose for much the same reasou as their liking the diuretic mixture. I think the treatment of these of cholera here with salol under my direction, affords strong clinical testimony in favor of the value of Lichventhal's suggestion as to the prevention and cure of cholera which he worked out experimentally in the laboratory ; for they certainly indicate, that salol is a valuable drug in the treatment of cholera, though In
18
conclusion,
cases
they
are
not
perhaps sufficiently
prove that it is worthy to be called this dread disease.
numerous
a
specific
to
for
To determine the exact value of the salol of cholera, and how far it is a specific, if at all, further clinical experience is necessary; and as my opportunities for further testing the drug are very limited, 'I have been induced to write this paper to call attention to the subject, in the hope that others may be induced to try the drug, and thus more rapidly put it to the test of clinical experience, than I, can, working alone.
treatment
267
