ON THE TREATMENT OF CHOLERA AND DIARRH(EA. 
99 
many persons. The public would be far safer if physicians would order their medicine 
in draughts, or single dose bottles, as they used to do in all important cases thirty years 
since, or in the graduated four or six dose bottles, now in general use. 
“ Yours most obediently, 
“ Fleet Street , July 20th. “ George S. Pedler.” 
SIR THOMAS WATSON, M.D., ON THE TREATMENT OF CHOLERA AND 
DIARRHCEA. 
“ I find it necessary to modify considerably some advice which I formerly gave my 
auditors as to the treatment of a disorder which appears to be again increasingly pre¬ 
valent throughout the country.” The form and features of this dreaded pestilence have, 
he says, “ been the same in all its visitation to this country. Must we still, as hereto¬ 
fore, make the mortifying confession that our art is unable to cope with it successfully ? 
Not so, I trust. Among the many and discordant expedients which have been brought 
forward and fairly tried for the cure of cholera, one, long since suggested, and almost 
scornfully rejected, has emerged of late into clearer significance and more intelligible 
and ascertained value. I mean the method—recognized as legitimate and reasonable 
in various other maladies—of ‘ elimination,’ of which the main advocate has been Dr. 
George Johnson, Professor of Physic in King’s College.” After commenting upon the 
facts and principles involved, Sir Thomas Watson lays down the following rules, in lan¬ 
guage partly his own and partly that of Dr. George Johnson:—“Diarrhoea ought not 
to be neglected even for an hour. One important and guiding rule of treatment is not 
to attempt by opiates, or by other directly repressive means, to arrest a diarrhoea while 
there is reason to believe that the bowel contains a considerable amount of morbid and 
offensive materials. The purging is the natural way of getting rid of the irritant cause. 
We may favour the recovery by directing the patient to drink copiously any simple 
diluent liquid—water (cold or tepid), toast-water, barley-water, or weak tea; and we 
may often accelerate the recovery by sweeping out the alimentary canal by some safe 
purgative, and then, if necessary, soothing it by an opiate. Castor-oil, notwithstanding 
its unpleasant taste, is, on the whole, the safest and best purgative for this purpose. It 
has the advantage of being very mild and unirritating, yet withal very quick in its 
action. A tablespoonful of the oil may be taken floating on cold water, or any other 
simple liquid which may be preferred by the patient. A mixture of orange-juice or 
lepion-juice with water forms an agreeable vehicle for the oil. If the dose be 
vomited it should be repeated immediately, and the patient should lie still, and 
take no more liquid for half an hour, by which time the oil will have passed 
from the stomach into the bowels. Within an hour or two the oil will usually have 
acted freely. Then a tablespoonful of brandy may be taken in some thin arrowroot or 
gruel; and if there be much feeling of irritation, with a sense of sinking, from five to ten 
drops of laudanum may be given in cold water. These means will suffice for the speedy 
arrest of most cases of choleraic diarrhoea. If the patient have an insuperable objection 
to castor-oil, or if the oil cannot be retained on the stomach, 10 or 15 grains of powdered 
rhubarb, or a tablespoonful of the tincture of rhubarb, or a teaspoonful of Gregory’s 
powder, may be substituted for the oil. If the diarrhoea has continued for some hours, 
the stools having been copious and liquid; if there be no griping pain in the bowels, no 
feeling or appearance of distention of the intestines, the abdomen being flaccid and 
empty, and the tongue clean, we may conclude that the morbid agent has already purged 
itself away. There will, therefore, be no need for the castor-oil or other laxative, and 
we may immediately give the brandy in arrowroot and the laudanum as before directed. 
The rule in all cases is not to give the opiate until the morbid poison and its products 
have for the most part escaped,—not to close the door until 4 the enemy ’ has been ex¬ 
pelled. While there are some cases in which the evacuant dose is not required even at 
the commencement of the attack, there are many more in which the opiate is unneces¬ 
sary in the later stage. In some cases of severe and prolonged diarrhoea it may be ne¬ 
cessary to repeat the oil and laudanum alternately more than once at intervals of three 
or four hours. Practical skill and tact are required to discriminate these cases. It must 
be borne in mind that when the choleraic secretions are being actively poured out from 
H 2 
