THE ABORTIVE TREATMENT OF CHOLERA. 177 



previous administration of free doses of opium and brandy is made 

 manifest. 



But, for the purpose of rousing the system from collapse, the most 

 'powerful means appears to be cold affusion. The shock of cold 

 water upon the head and upper part of the body has a most decided 

 effect in restoring a patient from collapse. It should be repeated 

 many times in quick succession, if found beneficial, until a sufficient 

 effect is produced, whilst, at the same time, the rest of the body and 

 extremities must be kept moderately warm. In hot weather, in India, 

 it was not found necessary to use warmth, but friction only, to the 

 limbs. 



The application of ice to the spine would seem to be a remedy of 

 the same character, though the theory of Dr. Chapman, that cholera 

 depends upon hyperamia of the spinal cord and its membranes, would 

 give a different explanation to its utility. It has long been known 

 that there is congestion found in the meninges after death; but this 

 may be an effect of the deficient exhalation of carbon, and of the re- 

 tarded circulation, and not the cause. If the application of ice to 

 the spine has the effect of rousing a patient from collapse, it has the 

 advantage of not disturbing him so much as the cold affusion, and 

 may prove a better remedy in the consecutive fever. 



The management of the stage of reaction must be conducted on 

 general principles. It is the testimony of all writers, that those who 

 have taken the least brandy or opium, previously, have the best 

 chance of surviving this stage. On this question, I may refer to the 

 treatment at Guy's Hospital, as it appears in the " Lancet " for 

 August, 1849. 



A mode of death, then, that may occur in this stage, is from con- 

 gestion, caused by uraemia, to a great extent ; and, as the action of 

 alcohol and opium is, undoubtedly, to retard the secretion of oxydised 

 products : bile, urine, &C.5 it may be seen how their free administra- 

 tion, when collapse is at hand, produces increased difficulty after- 

 wards. Still, the judicious use of these powerful remedies, in the 

 early stages, may be justified — especially with regard to small doses 

 of a soluble form of opium — one that is immediately available. It is 

 asserted by many that where, in such stages, a stimulant is needed, 

 that a few minims of chloroform, in a suitable vehicle, repeated every 

 ten minutes to an hour apart, form a better remedy of this class than 

 ordinary alcoholic liquors. In reaction, urea is formed in the blood 

 with great rapidity. The want of circulation, during collapse, has 



