THE ABORTIVE TREATMENT OF CHOLERA. 175 



not being effected. Viewing this fact in the light of the discovery that 

 ozone, the more active form of oxygen, is absent from the atmosphere 

 in cholera times, we may ask if in any degree, and how far these facts 

 are related, and whether especially they stand as cause and effect. At 

 any rate it may be useful to set on foot some plan for the develope- 

 ment of ozone in cholera sheds, and in the rooms of patients threaten- 

 ed with the severe stages of the disease. It has often been advanced 

 that the want of oxygen in the blood is the cause of cholera, but if 

 this be not conceded, we must acknowledge that, the effect of such 

 want must be to exaggerate vital depression. The secretion of bile 

 and urine, both of which require oxygen for their formation, is arrested 

 in collapse, and their reappearance is a proof of oxidization being re- 

 established, and is consequently a most favourable sign in the following 

 stage. 



As fever follows the cold stage of ague, where life is not lost already, 

 so the blue stage of cholera is followed by one of reaction or consecu- 

 tive fever, ushered in usually by returning warmth and circulation, 

 injected conjunctivae, restlessness, and symptoms more or less severe of 

 cerebro-meningeal congestion or inflammation. Yet some cases are more 

 insidiously fatal in this stage, the patient settling down into a sleepy 

 state, which while apparently refreshing and salutary, ends in coma, 

 or death. 



The modes of death in cholera are not uniformly identical. When 

 it occurs with little or no gastro intestinal discharge, and before the 

 reactive stage has come on it is probably due chiefly to spasm of the 

 pulmonary artierial system, actively preventing the process of blood 

 aeration. This form, a malignant one, should be met by chloroform, 

 inhalation to the point of relaxing the spasm, but not carried so far as 

 to prevent the inhalation of sufficient air^to effect thejnecessary blood 

 changes. 



Where the blood has become highly inspissated from loss of serum, 

 and this thickening of the vital fluid is considered to be the cause of 

 the obstruction, any means that will even partially restore its wonted 

 fluidity, is certainly indicated. In this way, the free exhibition of 

 liquids by the mouth, while grateful to the patient may prove very 

 useful. 



The patient's demand for cold water is very great, and it is cruel to 

 deny it. If vomiting is severe, small lumps of ice given frequently, 

 and swallowed, may be better than copious drinks for allaying it, but 



