88 NICHOLS AND ANDREWS. 



In dividing the treatment of Asiatic cholera into that of collapse 

 and of urajmia, the writers wish to emphasize the importance of the 

 latter condition as a sequela, which the text-hooks speak of as the 

 "reaction stage" or state of "cholera typhoid." In the recent epidemic, 

 at any rate, the symptoms of this stage were those of uraemia and consisted 

 of a bounding pulse, labored breathing, flushed face, and coma. The 

 treatment of uraemia should begin, if possible, before the clinical signs 

 appear. As stated above, the severe cases of collapse may be expected to 

 develop some urjemia and as soon as reaction had occurred mild diuretics 

 were administered to these cases; large rectal injections of hot saline 

 solution were also given, and in addition cupping over the kidneys was 

 employed. The patient was encouraged to drink large amounts of water 

 and of lemonade. A little later, as the pulse began to bound, hot packs 

 were given in some cases, but because the patients sometimes became 

 frightened by this procedure, and because of the mental disturbance 

 produced causing the patient to struggle violently against it, the pack 

 was discontinued. As the native people become more used to hospital 

 methods, the pack can probably be used to greater advantage in the 

 treatment of cholera. 



In the early part of the epidemic, sweet spirits of nitre was given as 

 a matter of routine from the time of the entrance of the patient into the 

 hospital until convalescence had been established. Toward the close 

 of the epidemic an effervescing solution of potassium bicarbonate and 

 citric acid was given after the kidneys had begun to secrete urine. No 

 benefit could be noticed from the use of any medicinal diuretic. Of all 

 the measures used to induce the kidneys to secrete, that one of giving large 

 rectal injections of hot saline solution was the most successful and gave 

 the best results. Many times enemata of 4 to 6 liters were given five 

 or six times in the twenty-four hours, instead of three or four times as 

 in the case of the ordinary enemata. The patient was given as much 

 as he could hold comfortably of these large injections and then allowed 

 to pass it, then more was given. 



In the most severe cases all measixres, such as venesection with in- 

 travenous injection of salt solution and constant stimulation by hypo- 

 dermic injections, were of no avail ; and to us the most "grievous picture 

 of the disease" did not constitute the thready pulse, sighing respiration, 

 shrunken features, and clammy skin of collapse, but instead the bounding 

 pulse, the labored breathing, swollen face, and wandering mind of 

 uraemia. 



Among the less severe cases of collapse it was impossible to tell which 

 would develop uraemic symptoms, although careful attention was paid to 

 the urine. A systematic examination of the urine was started in the 

 hope of finding some indication of the approaching uraemia, but the 

 epidemic terminated before enough cases were studied. The results as 

 far as they were determined are as follows : 



