THE TREATMENT OF ASIATIC CHOLERA. 85 



just above the internal malleolus, or sometimes one of the veins of the arm 

 was selected for the injection. If a needle was used it was either thrust directly 

 into the vein, or more commonly a small incision was made, the vein exposed and 

 then the needle inserted. If a canula was used the vein was dissected from the 

 surrounding tissue, the grooved director inserted beneath it, and the vein 

 ligatured at its distal end. A small, longitudinal incision was then made in 

 the vein above the ligature, the canula inserted, and the salt solution allowed 

 to flow. At the close of the operation the vein was tied above the incision, a 

 dry gauze dressing applied and the part bandaged. In some cases iodoform 

 powder was dusted on the wound before bandaging. On the average about 1,500 

 cubic centimeters of saline solution were injected at a time, although the amount 

 employed was controlled entirely by the condition of the patient. If the in- 

 troduction of 500 cubic centimeters of saline solution was sufficient to give rise 

 to a good strong pulse the injection was discontinued ; on the other hand, 2,000, 

 2,500, or 3,000 cubic centimeters were sometimes employed to produce this 

 result. Sometimes it was very difficult to get the solution to enter the veins, 

 owing to their extremely collapsed condition, but by rubbing the limb toward 

 the trunk this difficulty was eventually overcome. If the same patient was 

 given several injections the same vein was frequently used twice. In this case 

 the second operation was conducted in a similar manner to the first except that 

 it was performed from an inch to an inch and a half higher up on the vein. 

 After the vein was opened it was pressed upon to expel any clot that might 

 have formed from the previous operation. 



This method of intravenous injection of saline solution is considered 

 to be the most advantageous yet adopted; the advantages derived from 

 its use in overcoming collapse as compared with those from the employ- 

 ment of the subcutaneous injections are its directness, simplicity, and 

 minimum of discomfort for the patient and minimum of time and at- 

 tention for the physician. As most of the patients came to the hospital 

 in collapse, the injection was usually given at once and repeated as often 

 as the pulse seemed to be failing. 



The administration of saline solution in cholera is often called sympto- 

 matic treatment, but if the symptoms are in part due, as they seem 

 to be, to a loss of the body fluids, the treatment is to this extent specific. 

 Whether or not the loss of the fluid is due to the mechanical irritation of 

 the cholera vibrio in the intestines or to the toxins of the organism, or 

 to both acting together, the restoration of the fluid in the vascular system 

 is indicated. Attempts to stimulate the heart with strong stimulants. 

 such as strychnine, digitalin, spartein, camphor, etc., do no good, because 

 the heart has nothing to act on. There must be sufficient fluid in order 

 that the heart may carry on its functions. We became so convinced 

 of this in the treatment of cholera that whenever a failing pulse was 

 noticed or a case was admitted into the hospital in collapse we hastened 

 to give an intravenous injection of saline solution rather than a hypo- 

 dermic injection of strychnine. The results were often dramatic. The 

 respirations which formerly were rapid and difficult became easier, the 

 pulse good, and the general comfort and condition of the patient greatly 

 improved. The almost lifeless individual became again able to speak 



