A.CUTE INFECTIOUS DISEASES. 



thrown aside. Hence we must content ourselves with striving to nil 

 fil the symptomatic indications, and we shall do this the more success- 

 fully, the more closely we attend to and combat those symptoms on 

 which the others depend. The symptomatic treatment which, in the 

 first epidemics, consisted in attempts to elevate the fallen temperature 

 by vapor-baths, and by having the patient drink hot teas during the 

 algid stage, but not allowing them a drop of cold water, and in at- 

 tempting to draw blood from all cases of cholera asphyxia, was cer- 

 tainly incorrect. Depression of the temperature of the body is a late 

 occurrence in the series of symptoms induced by the cholera infection ; 

 warm tea, which is more readily vomited than any other drink, is not 

 nearly so well borne as small quantities of cold water; venesection 

 cannot raise the depressed action of the heart, on which the venous 

 congestion depends. The symptomatic treatment of cholera requires, 

 first of all, attention to the intestinal disease, the arrest of the acute 

 catarrh and extensive transudation of serum from the intestinal capil- 

 laries, the source of all the other symptoms and of the danger. The 

 second symptomatic indication is, to replace the water lost from the 

 blood. If we succeeded in making a cholera patient sweat while the 

 transudation into the intestines continued, we should injure him by 

 the increased abstraction of water. Lastly, the third indication, which 

 we must bear in mind from the first, is to combat the threatening 

 paralysis of the heart. We shall not discuss whether opium (the most 

 frequent prescription in genuine intestinal catarrh, and the last refuge 

 in all other diarrhoeas), besides retarding the movement of the intes- 

 tines, also lessens the secretion of the intestinal mucous membrane, 

 and the increased transudation from the intestinal capillaries ; at all 

 events, it owes its frequent use in cholera to its antidiarrhceic action. 

 Even after satisfying themselves that, in many cases, opium has had no 

 effect on cholera diarrhoea, most physicians seek its aid in new cases, 

 because they have sometimes found it of undoubted benefit even in 

 this affection. I fully agree with this treatment, and, before trying 

 other methods, I give opium for cholera diarrhoea, although not in the 

 form of cholera drops but in the shape of Dover's powder, or as tinc- 

 ture in mucilage, without the addition of any ethereal substance. If 

 the patient has taken a number of doses of opium (half a grain to a 

 grain) in the course of a few hours, and the diarrhoea has improved, it 

 is well to continue it hi smaller doses till a formed stool shows that the 

 excessive transudation into the intestines has ceased. If, on the other 

 hand, in spite of the repeated doses of opium, the diarrhoea continues or 

 grows worse, if the patient collapses visibly, if his skin grows cool, and 

 the dejections lose their color, I regard the continuation of opium as 

 aontraindicated ; while, in such cases, I have had the best results from 



