86 NICHOLS AND ANDREWS. 



iuul to observe what was going on about liim. In some instances this 

 transformation was very striking. The only untoward effects noticed 

 after the injections were occasional chills, but these passed off without 

 any apparent ill effects. We do not wish to convey the idea that stim- 

 ulation in addition to the liberal use of salt solution is never necessary, 

 for it is essential sometimes and must be used. Cramps in the ex- 

 tremities result from lack of fluid in the tissues and were treated by an 

 intravenous injection of saline solution and not by a hypodermic injection 

 of morphine. 



In giving the intravenous injections the pulse and respirations were 

 watched carefully and at the least untoward symptoms the injection 

 was stopped. Sometimes after the solution had been flowing for a few 

 minutes the patient would take a few shallow breaths, gasp, swallow 

 and act as though choking. The introduction of the solution was stopped 

 immediately, the patient allowed some time to rest, and if necessary 

 treated again later. 



In the intravenous introduction of saline solution there seems to be 

 a point up to which the solution can be given and good results obtained, 

 if this is gone beyond, the fluid passes out through the intestines almost 

 as fast as it is injected. It is not always easy to determine when the 

 injection should be discontinued. In collapse, the fluid part of the 

 blood is withdrawn and its organic constituents concentrated. Now, 

 if we could recognize when we had injected just sufficient fluid to 

 restore the normal ratio between the solid and fluid parts of the blood 

 this might be the signal for stopping the injection; going beyond this 

 point might increase the fluidity beyond normal and set the current the 

 other way. 



Besides the introduction of saline solution either subcutaneously or 

 intravenously, hot saline enemata, consisting of two liters of fluid, were 

 given every six to eight hours. In this manner the lower part of the 

 intestines was kept washed out and a good effect on the kidneys produced. 

 For a while for excessive diarrhoea chlorodyne was given in 1 to 2 

 cubic centimeter doses every three to four hours, but it seemed to do 

 little good and was not used much in the latter part of the epidemic. 

 Hot tannic acid enemata (1 per cent,) were frequently given for diarrhoea 

 and seemed to check the condition better than any other treatment. The 

 warmth of the patient was sustained by hot water bottles. 



The patients w.ere encouraged to drink copiously of water so long as 

 it did not induce vomiting, but at the first sign of nausea the liquid was 

 restricted and given only in very small quantities or small pieces of ice 

 were administered by the mouth. A solution of cocaine (0.016 gram 

 to 4 cubic centimeters of water) was given to control vomiting and 

 usually proved efficacious. Hiccough was often quite troublesome and 

 obstinate to overcome. Aromatic spirits of ammonia (4 cubic centi- 



