THE TREATMENT OF CHOLERA. 
171 
request, the opinion of the College, viz. that which relates (1) to the necessity of avoid¬ 
ing purgative medicines during the prevalence of cholera, and (2) the measures to he 
adopted when cholera appears on board ship, the committee think— 
“ 1. That when opening medicine is required, the mildest should be selected, as castor 
oil or rhubarb. Glauber’s salts and Epsom salts are dangerous. The common belief 
that prolonged costiveness should not be interfered with during the prevalence of cholera 
is erroneous. 
“ 2. That the master should ascertain by inquiry, morning and evening, whether any 
of the crew are labouring under diarrhoea, and if so the following recommendations are 
subjoined for his guidance :— 
“ 3. That if a man be attacked with diarrhoea, he should, whenever it is possible, be 
sent to bed and kept warm, and some aromatic and astringent medicine, containing a 
small quantity of opium, should be given to him at once, and should be repeated every 
hour or two, according to the severity of the purging. 
“ It is suggested that ten grains of the aromatic powder of chalk and opium (of the 
British Pharmacopoeia) should be so given in half a glass of peppermint water or weak 
brandy and water. Should this medicine not be at hand, five measured drops of lauda¬ 
num may be substituted for each dose of the powder. 
“ Large doses of opium or of ardent spirits should be avoided. 
“If the diarrhoea should result from bad or obviously indigestible food, or if the dis¬ 
charges are unnaturally offensive and attended with griping pain, it would be desirable 
to give a dose of either of the gentle laxatives above named before administering the 
opiates. 
“ The diet should consist mainly of beef-tea or broth, gruel, or rice. 
“ If the discharges become colourless and watery (the purging being of the kind com¬ 
monly called ‘ rice-water purging ’) and be accompanied with vomiting and coldness, the 
opiates should no longer be persisted in, and spiiituous liquors should be avoided. The 
patient should be strictly kept in the recumbent position, he should be allowed to drink 
water freely, and should be abundantly supplied with fresh air. Warm applications 
should be used to the feet and legs, and a mustard poultice should be applied to the pit 
of the stomach. Cramps may be treated by rubbing the affected parts with the warm 
hand. 
“In all cases, medical advice, when obtainable, should be obtained as soon as 
possible.” 
The following, in a communication to the ‘ Times ’ of August 3rd, is recommended by 
Sir John Fisher, late chief surgeon to the metropolitan police :—• 
“Aromatic confection, six drachms; tincture of opium, one drachm; tincture of 
catechu, two ounces; aromatic spirit of ammonia, one ounce; chloric ether, two 
drachms ; peppermint water, thirteen ounces : mix. Three tablespoonfuls to be taken 
every three or four hours, until the diarrhoea ceases.” 
The writer observes, “ This medicine may be said to have been invariably successful 
when taken on the first appearance of diarrhoea, and I have had in one season 2000 or 
3000 cases. It was found in the seasons of cholera to prevent diarrhoea running into 
that disease.” 
Similar treatment, with slight modification, has been advocated by numerous writers 
in the daily papers and in the medical journals; but there are two eminent exceptions ta 
this mode of treatment, one advocated by Dr. George Johnson, the other by Dr. Billing. 
The former, in ‘ Notes on Cholera,’ so far from striving to stop the diarrhoea by opiates 
or by astringent drugs, advocates what is called the “ evacuant plan,” and gives a dose 
of either castor oil or rhubarb to promote the expulsion of the morbid secretions, after 
which, if found necessary, an opiate may be given. Dr. Billing, ‘ On the Treatment of 
Asiatic Cholera,’ on the other hand, looking upon cholera as a species of fever, is in 
favour of what is called the “ indirect treatment,” and gives the following remedy:— 
Water, half a pint; tartar emetic, two grains ; sulphate of magnesia, half an ounce: 
mixed. The dose is, for an adult (from fifteen years upwards), a tablespoonful every 
half-hour; for a child of a year and a half or two years, a teaspoonful; and for the 
intermediate years, a proportionate dose. When the above cannot be quickly obtained, 
the following may be substituted:—^Water, half a pint; a large tablespoonful of common 
salt; a large tablespoonful of flour of mustard; mixed. The doses the same as of the 
former. 
