CHOLERA ASIATICA.
Preventive treatment is of vital importance; in epidemics the purity of the drinking water must he assured. I loiling and filtration afford perfect protection as regards this source of infection; the addition of even amounts of alcoholic liquors is useless without heat. All foods and drinks should he quite recently cooked or boiled; fruits must be most sparingly used, and only those in best condition eaten. Water for cleansing pur poses should be boiled. Rigid isolation of those suffering from the disease and disinfection of their apartments, linen, and clothing, and free bathing in weak disinfectant solutions arc necessary. The excretions from the body should he destroyed instantly, and the greatest personal cleanliness in every respect insisted upon; every possible method should be employed to prevent the pollution of the water supply in wells and reservoirs, and in India excellent results have been obtained by the routine practice of adding Permanganate of Potash to the water in the wells. Everything that lowers the vitality of the healthy, as over-work, fashionable dissipa tion, irregular meals, &c., is to be guarded against.
Recent research has demonstrated that the disease is largely propagated by " carriers," in whose excretions the vihrios arc easily detected; these individuals should be rigidly isolated when possible and their fieces de stroyed.
Diarrlicea, constipation and indigestion are to be met by appropriate agents without delay in cholera times. The use of astringents like Catechu, Kino, Tannin, &c., in combination with Laudanum or Chlorodyne is gener ally approved of for the preliminary diarrlwea, but such agents are useless when the disease has already set in.
Inoculation with cultures of the vibrios causing the disease has been successfully employed during epidemics as a prophylactic. The usual method is to inject a dose of an attenuated culture, which should be fol lowed in 5 days by a dose of the germs intensified by being grown in the peritoneal cavity of the guinea-pig. The protection from the vaccine usually lasts for about a year, but Haffkine advocates the plan of at once resorting to the injection of pure culture in the presence of an active epidemic. In the Balkan War Savas states that in Greece only i per cent. of those receiving two injections contracted the disease, and when the malady did attack those inoculated it ran a mild course. Kolle's vaccine consists of a standardised emulsion of the killed germs preserved in weak carbolic solution, and consequently possesses advantages over Haffkine's, which must be freshly prepared. As regards Eastern statistics, Colonel G. Thomson remarks shrewdly that it is the individuals who least require protection who most readily avail themselves of the injections; these are largely immune owing to their social environment.
Intestinal antiseptics of the old type have proved futile in the treatment of the established disease, the only one worth trial being Calomel when given early, and it is probable that in those cases where the drug has proved valuable its good effects were due to its purgative action in clearing out of the alimentary canal the germs and their products, as Castor Oil and Salines do when administered at the beginning of the attack. Rogers believes in the value of Permanganate of Calcium by the mouth; he gives a 2-gf. keratin-coated pill every 15 to 3o minutes till the stools become green; by this treatment in combination with intravenous hypertonic injections uremia is prevented and the mortality has been reduced to less than one-third its former rate.
A good plan is to wash out the bowel by a copious enema of a warm solution of Tannin (I in 8o), and Catani maintained that by a careful manipulation the liquid could be made to pass into the small intestine and so flush out the intestinal tract from the stomach to the anus.
The same flushing principle is more effectually applied by administering a full dose of morphia hypodermically, which relieves vomiting, cramps, &c., and permits the patient to swallow and retain a large quantity of water if administered in small amount at a time at brief intervals. Saline Solution is employed with great advantage in the collapse stage, and the mortality has certainly been considerably reduced by it. Owing to the condition of the bowel it is of little use attempting to introduce the solution by the rectum, and even the hypodermic or subcutaneous method must be laid aside for the intravenous one. There is a difference in practice as regards the strength of the saline; most authorities recommend the so called normal, physiological or isotonic solution of .9 per cent., whilst O'Meara employs a .625 per cent. saline and insists upon its very slow injection till the normal S.G. of the blood is reached. The density of the saline was thought not to be a material point, since the mortality seemed to have been reduced equally by the use of the different strengths of the solutions when these are injected at about ro5° F. Rogers, however, maintains that the hypertonic intravenous injections have reduced the mortality when urielnic symptoms supervened from i r to 3.4 per cent. His fluid is !nude by dissolving roo grs. Sodium Iiiearbonme and Go grs. Sodium Chloride in 20 oz. water. In a later report he claims that, owing to the alkalinity of the blood being nearly always greatly reduced in severe cases cholera, the routine administration of Sodium Bicarbonate has reduced the death-rate front post-choleraic urwmia to one-fourth its former rate. 'lie' results show the close relationship between acidosis and the later staes of severe cholera. Under the action of the saline the pulse returns in the radial, the urine begins to flow and all the symptoms improve: opium and calomel must not lie given at this stage, and any food. antiseptic or astringent drug, if swallowed, is either rejected or remains unabsorbed in the intestines. The hot saline injection usually renders the hot baths or hot packs unnecessary, but when the algid condition is very marked they may be also used.
In the reaction stage little should be done in the administration of drugs, the patient being left to nature's method of rAolution, which requires absolute repose, it little iced milk or meat jnicv being occasionally given. When the typhoid supervenes upon the algid or collapse stage the symp toms must be met by the administration of drugs, sponging and saline injections, or diuretics upon recognised principles indicated in the treat ment of typhoid or other long-continued fever.
Thus the disease may be best treated throughout the entire attack by small quantities of liquid administered by the mouth at short intervals, one preliminary dose (5 grs.) Calomel. one or more hypodermic doses of Alorphia and the intravenous injections of Alkaline Saline Solution, and should Cardiac failure threaten, Strychnine hypodermically and Oxygen inhalation when respiration becomes difficult. Vomiting and hiccough may sometimes be relieved by minute doses of Cocaine.