To avoid the danger of heart-paral ysis, so far as this depends upon the thickening of the blood aiad. the empti ness of the vessels, we may have recourse to the same watery injections; but if they do not succeed, and whenever car diac weakness is directly produced by the action of the toxins, the heart must be stimulated by hypodermic injections of sulphuric ether, camphorated oil, caffeine, strychnine, or quinine.
Quinine recommended, 11/, grains given every 2 hours for 24 hours, and repeated during a second 24 hours if necessary. If vomiting be present and beyond con trol, the drug should be injected beneath the skin. Huberwald (Jahrbuch far Kinderh. u. phys. Erziehung, B. 35, H. 3, '93).
Quinine, in doses of about 10 grains an hour, has given best continuous results yet obtained. Fullerton (Med. Record, July 0, '95).
Treatment adopted in 944 cases with a mortality of only 20.7 per cent. 1. (a) Internal administration of Botkin's anti cholera drops:— Tineturx quininm compositm, Spiritus anodyni Hoffmann', of each, 1/.2 ounce.
hydrochlorici, 1 drachm. Acidi hydrochlorici diluti, '/2 drachm. Tinetiirte opii simplicis, 1 drachm. Olei menthx piperitm, 10 drops.
AI. Sig.: Give from 15 to 20 drops every two hours.
(b) Cantani's high enemata with tannic acid; (e) internal use of salol with sub nitrate of bismuth; (d) calomel in small doses.
2. In severe cases stimulate and sus tain the cardiac and cutaneous action: Repeated and prolonged general hot baths, heating the patient's body by any available means; free administration of wine, hot tea, or coffee with brandy; and subcutaneous injections of camphor. Sokoloff (Boluitchnaja gazeta Botkina, Nos. 1, 2, '03).
The internal use of brandy, rum, champagne, liquor ammonim, tions of oxygen, etc., may also prove of advantage in cardiac failure.
Ammonia internally and ether hypo dermically, besides the free administra tion of alcohol, highly recommended, the aim being to support the failing heart. Giacich (Berliner klin. Woch., Sept. 5, '92).
Hydrochlorate of ammonia reC0111 mended for the same purpose. Besides the return of heat and perspiration caused by this salt, it increases diuresis, and therefore increases the elimination of the toxic elements of the disease.
Durnontpailier (Le Bull. McId., Oct. 10, '92).
For the same purpose, and to restore the warmth of the skin, hot baths (sim ple or sprinkled with mustard) and the application of heat in every form (warm coverings, hot-water bottles or hot bricks around the body, Turkish baths, etc.), dry, energetic frictions, application of sinapisms, electric fiagellations, etc., have proved very valuable.
The state of the bladder should be carefully watched, and if examination shows the presence of residual urine, it should be emptied through the catheter. True choleraic anuria is best combated by hot, exciting drinks, hot baths, and hypodermic injections of caffeine and pilocarpine, a solution of the latter of 1/5 grain to 20 minims of distilled water being employed.
During the whole disease no food should be allowed to patients; at the most, if any food is believed necessary and the stomach is not altogether in tolerant, some iced milk can be given.
The treatment of the period of reac tion, when it runs a regular course, is only a hygienic one. Feeding must be carefully regnlated, only liquid food being allowed the first few days, then passing gradually to more substantial nourishment. When, however, the dis ease assumes the typhoid form, hygienic rules must be assisted by symptomatic treatment; if adynarnia supervene, cold packs and stimulants must be used; when, on the contrary, symptoms of nervous excitement prevail, lukewarm baths with cold affusions on the head, afford great relief. Cerebral congestion is best combated by the application of ice to the head, by local blood-letting, etc.
Hydrotherapy successful in curing a large number of patients already suffer ing from cramp in the calves, vomiting, cold extremities, and discolored stools. Friction of the skin with a piece of linen soaked in the coldest water; then a sitz-bath, at a temperature of 44.4° to 59° F. during fifteen or thirty minutes. The parts of the body not in contact with the cold water are enveloped in woolen coverim-,,,,s, and the abdomen is energetic ally rubbed. Winternitz (Blatter f. klin. Hydrotherapie, etc., Oct. 10, '92).