THE CHOLERA b 



are required for an adult male, but the case must be carefully 

 watched, and the injection stopped if any distress of increased 

 frequency of respiration is noted. These injectioiis may have to be 

 repeated several times, and therefore the cannula must be left in situ. 

 At the same time, hypodermic injections of strychnine, provided 

 there are no severe cramps, with or without atropine, should also be 

 given, and warm rectal injections. 



During this treatment the bladder must be carefully watched to 

 see whether urine is being passed or not, and if suppression occurs, 

 dry-cupping should be performed over each loin. 



In some cases, especially when anuria has developed, an alkaline 

 solution acts better, and Rogers recommends the following: Sodium 

 chloride, 4 grammes; sodium bicarbonate, 10 grammes; water, 

 500 c.c. Bayliss' solution (6 per cent, gum acacia in 0-9 per cent, 

 sodium chloride solution) may be used. 



When the stage of reaction sets in, a mixture containing salicylate 

 of bismuth gr. xv., bicarbonate of soda gr. v., liquor opii sedativus 

 -min. v., mucilage q.s., and chloroform water i ounce, should be 

 given, and later one containing alkalis and digitalis is useful. 



With regard to symptoms, the persistent vomiting may be 

 Relieved by small pieces of ice or by -J grain of cocaine dissolved in 

 a teaspoonful of water, or by a dose of ip minims of mistura pepsini 

 cOmposita et bismutho every half-houi: until four doses have been 

 given, or by one or two drops of tincture of iodine in water. Cramps 

 are treated by massage, assisted by rubbing with dry powdered 

 ginger, b)y hypodermic injections of morphia, or by inhalations of 

 a mixture of chloroform and oxygen. Prostration must be com- 

 bated by hypodermic injections of strychnine or of camphor in 

 ether. Delirium must be relieved by bromides with tincture of 

 hyoscyamus. 



The treatment of complications, such as pneumonia, etc., must be 

 conducted on the lines laid down in textbooks on general medicine. 



Other methods of treatment may be briefly mentioned. Many disinfectants 

 are recommended by different authors — e.g., a mixture of sulphocarbolates 

 of zinc, 2 grains; soda, 2 grains; calcium, 3 grains, dissolved in peppermint. 

 Acetozone, alphazone, and medical cyllin are recommended by O'Gorman, 

 and both he and Waters advise the administration of 1 5 minims of medical 

 izal dissolved in i ounce of water every two hours. Salol has been strongly 

 recommended by some writers, and Brown and Banerji praise an emulsion 

 of eucalyptus oil with mucilage and syrup of lemons, of which 5 minims are 

 given for a dose. O'Gorman advises copper arsenite for infants, while Duke 

 recommends red iodide of mercury in the algide stage, and Choksy cyanide 

 of mercury in ^^^-grain doses in syrup and water every two or three hours, but 

 says this is apt to cause stomatitis during convalescence, which can be avoided 

 by regulating the doses. Cantani long ago advised slow intestinal injections 

 of 3 to 4 pints of a I per cent, solution of tannin, with or without 20 to 40 

 drops of tincture of opium, and warmed to 100° F. and given every three to 

 four hours. Denier's serum treatment has been found useless by Strong, 

 but KoUe's serum promises to be more useful. Berdnikoff gave 30 to 50 c.c. 

 of Schurupon's serum intravenously and subcutaneously with success. Salim- 

 beni? used 100 to 350 c.c. Pasteur Institute serum together with saline 

 injected subcutaneously and intravenously. Macfadyen and Hewlett have 



