Page:Tropical Diseases.djvu/528

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486
CHOLERA
[CHAP.

as they are likely to provoke vomiting, are usually condemned. It does not follow from this that they are harmful; the emesis contributes to the elimination of germ and toxin. Cramps may be relieved by gentle frictions with the hand or with ginger-root, by a small hypodermic injection of morphia, or, these failing, by short chloroform inhalations. The surface of the body should be kept dry by wiping it with warm dry cloths, and the surface heat maintained by hot- water bottles or warmed bricks placed about the feet, legs, and flanks. The patient must not be allowed to get up to pass his stools; a warmed bed -pan should be provided for this purpose. All food should be withheld while the disease is active.

If the pulse fail or disappear at the wrist, stimulants by the mouth, or, if there is much vomiting and these do not appear to be absorbed, hypodermic injections of ether or brandy, may be given. No improvement ensuing, intravenous or subcutaneous injection of normal, or hypertonic, saline fluid may be had recourse to. As regards the former, a suitable injection may be quickly prepared of common salt 60 gr., carbonate of soda 60 gr., boiled water 1 quart. Of this, from one to three quarts at a temperature of 100° F. may be slowly introduced by gravitation into a vein, the effect being carefully watched. The pulse can generally be quickly restored temporarily by this means and life prolonged, possibly in a few instances saved; too often, however, the fluid so introduced rapidly escapes by the bowel, and collapse once more sets in. Dr. Cox, of Shanghai, has had some encouraging results from continuous, prolonged, slow, intravenous injection of saline fluid, the fluid gravitating from a vessel placed 2½ ft. above the level of the patient's arm. The flow is kept up for several hours, and as long as it is deemed that there is any risk of collapse.

Rogers has recently introduced a method of treating cholera by intravenous injection of hypertonic saline solution, which promises well. He claims that since the introduction of his method the case-mortality from this disease in the Calcutta Medical