From this knowledge the aims of treat ment would be as follows: 1. To restrain the development of the germs in the intestine and to neutralize the poisons to which they- give rise there. 2. To counteract the poison which has pene trated into the blood-current. 3. To mitigate the effects of the twofold (local and general) action of the germs.
1. To restrain the development of the crerms in the intestine and neutralize the specific toxins, no better means is at our disposal than acids, whose microbicidal properties against cholera bacilli are well shown. Therefore, internal use of acids under the form of hydrochloric, citric, or tartaric lemonade is highly to be recommended, together with the in jection into the intestine, by means of a special irrigator (enteroclysma) of a warm solution of tannic acid (11/4 to 5 drachms for 1 V, to 2 quarts of water or infusion of chamomile). These injec tions were proposed by Cantani, who gave the preference to tannic acid on account of its neutralizing the alkaline reaction of the intestine, corrugating blood-vessels (and so restraining the ab sorption of poisons), and acting as an antidote against the toxins. They lutist be repeated four times a day, and, in g,rave cases, after each alvine evacuation. The beneficial effects of this treatment I was able to observe in the cholera epi demic of 1SS4 in Naples, and my experi ence is that, if it be resorted to at the first appearance of premonitory diar rhcea, the course of the disease may be aborted, while in declared cholera many lives may be saved through its aid, when general poisoning has not yet taken place. French authors replace the hydrochloric, citric, etc., acids by the lactic lemonade, prepared with 2 V, drachms of lactic acid to a quart of water. On the other hand, Genersicb has modified Cantani's method by in jecting a larger quantity of fluid (5 to 15 quarts of a 1- to 2-per-cent. solution of tannic acid) under a g-,reater pressure; so that the liquid may irrigate the whole intestine and be at least partly ejected by the stomach. This method, to which lie gave the name of dyaclysis, has for its object to cause the remedial substance to act upon the whole mucous membrane of the gut; but its practical application is rendered very difficult, and it is not well borne.
Effort to cleanse the digestive tract of its pathog,enie elements by the fol lowing, procedure: Every patient at once made to drink as many tumblerfuls as possible of hot water, containing each 3 drops of hydrochloric acid. As soon as the patient had successively imbibed 6 or S tumblerfuls. manual abdominal pressure was resorted to in order to expel the liquid. Ten minutes after the vomit ing had ceased the whole cleansing pro cedure was repeated. Sometimes a third washing was performed three hours later. Simultaneously the intestines were cleansed by means of enemata, made of from 12 to 18 tumblerfuls of a hot 2.5 per-cent. aqueous solution of tannin, or, in the absence of the drug, of the same amount of plain, hot water. The injec tion was usually followed by decrease of diarrlicea: but sometimes a second enema became necessary, being then ad ministered about two hours after the first. 'When practicable, the measures. were supplemented by' a hot general bath, and a, successive application of ab dominal compresses soaked in hot, strong solution of kitchen-salt, and wrapping the whole body with hot sheets and blankets. Internally, the patients were given claret (boiled with cinnamon and sugar) and lemonade made of hydro chloric acid (10 drops to each tumbler ful), a mouthful every ten minutes. In addition, some stimulant remedy (cam phor, ether, caffeine with benzoate of sodium) was administered hypodermic ally. But 10 eases out of 66 thus treated lost. I. F. Shorr (Yiijno-Riisskoia Med. Gaz., No. 13, '92).
Introduction of a soft-rubber tube one metre in length into the rectum, causing it to pass through the sigmoid flexure and enter the descending colon, and carry liquid as far. at least, as the ileo-cweal valve. A large quantity (2 or 3 gallons) of warm soap-water thus introduced ef fectively eleanses the intestinal canal; the secondary effect of irrigation of the eolon is to cleanse and relieve the small intestine of its eontents. Of 26 eases thus treated, 23 recovered. Elmer Lee (Med. Rec., Dee. 17, '92).