32 EEVIEW — TROPICAL MEDICINE, ETC. 



Cholera— From a paper by O'Gorman' one picks out the following practical points as likely to be of 



continued service. Noto the stage when called to a case, as the treatment varies with the stages of the 

 illness. Look for a blood-shot condition in the eyes, sometimes the only outward 

 indication of reaction. Take the temperature in the axilla in preference to the mouth or 

 rectum (dangerous and unnecessary). Eemember the differential diagnosis from arsenical 

 poisoning. The author recommends as a routine practice in every case and at any stage the 

 exhibition of calomel and sodium bicarbonate in doses of 3 to 6 grains and G to 12 grains 

 respectively, repeated if rejected, until retained. The calomel increases the flow of bile, 

 acts as an intestinal antiseptic, is sedative to vomiting, especially in frequently repeated 

 fractional doses, gr. 1/10 to gr. 1/20, every quarter or half-hour, is diuretic, antiphlogistic, 

 and, taken continuously in doses short of toxic, stimulates the faculties, physical and mental. 

 Soda aids its action, prevents salivation and supplies a vital element to the blood. 



In the first stage he also recommends the administration of intestinal antiseptics such as 

 sulpho-carbolate of zinc, copper arsenite, acetozone, medical izal or medical cyllin. 



For the rest, stop food, give fluids and try to prevent collapse. Carminatives, sedatives 

 and astringents are useful and should be given. He mentions chlorodyne, camphor and 

 opium amongst the drugs, and states that nuclein may prove very valuable owing to the 

 increase of polynuclears it produces and its stimulation of cell growth. 



In the stage of collapse he utters a warning against alcohol, and states that there are 

 only two great remedies, namely, atropine and strychnine. He regards these as sheet 

 anchors in cholera. 



In the case of both drugs small doses frequently repeated are best, and the strychnine 

 should be pushed and any ill effects neutralised by chloral. The value of heat, sinapisms 

 and warm rectal injections is mentioned. In the stage of reaction, he points out that the 

 occurrence of urination is a favourable sign and where there is danger of urtemia, 

 pilocarpine may be tried. It is, however, risky, and diaphoretics and hot cofl'ee are safer 

 and often efficient. 



The article concludes with advice as to diet, sanatogen, somatose and plasmon being 

 mentioned. This treatment certainly does not err in the way of doing too little, and 

 possibly the writer is over-fond of medicaments and expects too much from them, but he has 

 evidently had large experience of cholera and gives definite and apparently sensible reasons 

 for his recommendations. 



It is curious he does not mention the red iodide of mercury treatment in extreme 

 collapse, so strongly advocated by Duke (with whom he is otherwise more or less in 

 agreement), who gives dilute sulphuric acid in the early stage together with cannabis indica, 

 and for suppression of urine recommends subnitrate of bismuth and turpentine with cupping 

 to the loins, and, if required, pilocarpine controlled by strychnine. 



Both mention the necessity of an early aperient dose in some cases, the one 

 recommending sulphate of magnesia, the other castor oil with tincture of belladonna. 



Choksy- has a paper advocating cyanide of mercury in doses of 1/lOth of a grain every 

 two or three hours as a germicidal agent. He reports favourably on its use, the only 

 drawback being a tendency to stomatitis during convalescence. In other directions his 

 treatment is like that of O'Gorman. In acute delirium during the reaction stage bromide 

 and hyoscyamus are indicated. 



McCombie' reports very favourable results from employing subcutaneous injections of 

 salt solution (60 grains to a pint of boiled water) at a temperature of from 115° F. to 110° F., 

 repeated whenever the pulse tended to fail. The addition of adrenalin chloride (1 in 1000) 

 to the pint of salt solution also seemed beneficial. 



Eogers and Mackelvie' speak highly of the value of large quantities of hypertonic salt 

 solutions in transfusion for cholera. The strength they employ is just about two drachms 

 to the pint, and they inject, as a rule, four pints at a time, intravenously. Subcutaneous 

 injections are only of benefit in mild cases. By this new procedure they believe the 



» O'Gorman, P. W. (November, 1905), " How to Cure Cholera." Iiidian Medical Gazette, p. 414, Vol. XL. 



' Choksy, Khan Bahadur, N. H. (April 20th, 1907), " Some ladications for the Treatment of Cholera." Lancet, 

 p. 1077. 



" McCombie, P. C. (May 26th, 1906), "A Note on the Treatment of Cholera by Saline Injections." 

 Lancet, p. 1468. 



■• Rogers, L., and Mackelvie, M. (May, 1908), "Note on the Value of Large Quantities of Hypertonic Salt 

 Solutions in Transfusion for Cholera." Indian Medical Oazctlc. 



