CHOLERA ASIATICA. 721 



cold compresses frequently applied to the abdomen, and from the ad- 

 ministration of calomel (a grain every hour). In regard to the speedy 

 favorable effect of this treatment, especially of the application of cold 

 compresses to the abdomen, on most patients, in regard to its favor- 

 able influence on the entire disease, and the principles which induced 

 me to employ it, I refer to my brochure already mentioned, "Die 

 Symptomatische Behandlung der Cholera," Magdeburg, 1848, and would 

 only mention that, in 1854, when Pfeufer was commissioned to instruct 

 the Bavarian physicians in the treatment of cholera, he recommended 

 my method as being the most successful, according to his experi- 

 ence. Nitrate of silver, which has been recommended by many per- 

 sons, especially by Levy of Breslau, and which I have frequently em- 

 ployed, because, a priori, it seemed the most efficient, did not succeed 

 with me. The second indication, to replace the loss of water from the 

 blood by supplying water, is best attained by giving the patient small 

 portions of ice-water, or small pieces of ice to swallow at short inter- 

 vals. Large quantities of liquid, especially of warm drink, are usually 

 vomited at once. At all events, since cholera patients have been 

 almost universally allowed to drink cold water, they suffer less than 

 when, in spite of the torturing thirst, they were allowed no drink, or, 

 at most, warm tea. As the paralysis of the heart disappears, as the 

 transudation from the capillaries ceases, and the normal functions of the 

 stomach and intestines are restored, the circulation usually becomes 

 normal at once, and, without the use of any stimulant, the action of 

 the heart, even where reduced to a minimum, may become greater 

 than normal within a few hours. But this does not prove that stimu 

 lants are useless or unnecessary in the treatment of cholera ; in the 

 earlier epidemics, they were almost exclusively employed. As soon 

 as the pulse grows small and the patients are evidently in collapse, 

 stimulants should be given from time to time, to try and prevent com- 

 plete paralysis of the heart, until the termination of the acute disease 

 in the intestines. Among the stimulants, champagne that has stood 

 on ice is preferable to most others, especially to the ethereal oils, car- 

 bonate of ammonia, etc., because, along with its stimulant action on 

 the nervous system, it has no irritant effect on the gastric and intes- 

 tinal mucous membrane. In poor practice, rum or arrack, diluted with 

 water, is best. In some cases it is well to alternate the administra- 

 tion of ice and ice-water with a few cups of hot strong coffee. It is 

 often vomited again, but frequently not till the pulse has become fuller, 

 and the temperature somewhat elevated. If the evacuations upward 

 and downward have ceased, while the continuance of the symptoms 

 of collapse shows that paralysis of the intestinal muscles, and not arrest 

 of the transudation, has induced this change in the disease, stimulation 



