Volume 1

A system of medicine / edited by J. Russell Reynolds.

Date:
1866-1879
Catalogue details

Licence: Public Domain Mark

Credit: A system of medicine / edited by J. Russell Reynolds. Source: Wellcome Collection.

    197/976 (page 177)
    Coma is always dangerous. Want of progress in the symptoms of improvement, and continuance of diarrhoea or vomiting, are unfa able. Pink or bloody stools or haemorrhage from the stomach l aie almost always fatal signs. Disproportionate muscular strength uit or^°corre^OTding improvement in other functions is not necessarily favourable^ Allusion has already been made to this under the head of “Varieties.” Treatment —This is most successful when commenced early; before collapse. In full collapse it is pretty certain, as remedies cannot he absorbed, that they cannot be of much use. Still, it must not be supposed that all treatment is useless m Cholera, or even that it is useless in all the states of the stage of collapse It cannot do much o-ood in perfect and complete collapse, but in all the other stages of the disease it is as beneficial as in any other severe and dangerous illness. Excluding collapse, judicious management, free from routine, and adapting the treatment to the individual case, is of great im- portance. Cholera is not merely a disease of vomiting and purging, and this will have been apparent from the foregoing pages. The treatment should be considered in relation to the evacuation, collapse, and reaction stages. Evacuation Stage.—The discharges should be checked, if possible. I believe that the great object of treatment is to restrain the passage of exudation from the blood into the intestines. The remedies used for this generally check the vomiting and purging, so that in the condition of these, taken with the state of the pulse, we have a sort of indication of the degree in which the transudation is interfered with ; a sort of indication, because there is not always any close relation between the time of the transudation and the discharges from the bowels. The first medicine given should be a full dose of opium—to adult 2 grains; in India, 1 to 5 grains of calomel are generally an combined with it. I do not know that the calomel does good, it does no harm. If this dose is retained, probably little more medicine will be required. We must not expect the purging to cease immediately that the medicine is swallowed. Perhaps one or two motions will pass away after the dose has been given. Soon after the opiate, if it has been retained, say in half an hour, in my own practice, I give an astringent, generally the following mixture : ID plumbi acetatis, gr. xxx; acid. acet. llfix ; aquae destillatae, gvj—1 oz. or | oz. every half hour or hour. At the end of an hour from the administration of the first dose of opium, if the purging persists, I give one grain of opium and continue the astringent. The sugar of lead mixture may bp. m'vp.n pvpvv half bnnr nr hmir if flip, rmrrn'nrr prm+innaa o m n >v