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THE TREATMENT OF CHOLERA AND…

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THE TREATMENT OF CHOLERA AND DIARRRCEA. Sir Thomas Watson, Bart, M.D., whose lectures on medicine have most influenced the practice of this half-century, writes this week in the British Medical Journal:—' I find it necessary to modify considerably some advice which I formerly gave my auditors as to the treatment of a disorder which appears to be again increasingly prevalent throughout the country.' The form and features of this dreaded pestilence have, he says, 'been the same in all its visitations to this country.' Must we still, as heretofore, make the mortifying confession that our art is unable to cope with it successfully ? Not so, I trust. Among the many and discordant experiments which have been brought forward, and fairly tried, for the cure of cholera, one, long since suggested, and almost scorn- fully rejected, has emerged of late into clearer signi. ficance and more intelligible and ascertained value. I mean the method—recognised as legitimate and reasonable in various other maladies-of elimina- tion of which the main advocate has been Dr George Johnson, Professor of Physic in King's Col- lege.' After commenting upon the facts and prin- ciples involved, Sir Thomas Watson lays down the following rules in language partly his own and partly that of Dr George Johnson. I Diarrhma ought not to be neglected, even for an hour.' • One important and guiding rule of treatment is not to attempt by opiates, or by other directly re- pressive means, to arrest p, diarrhoea, while there is reason to believe that the bowel contains a consider- able ativeunt of morbid and offensive materials.' I The purging is the natural way of getting rid of the irritant cause. We may favour the recovery by directing the patient to drink copiously any simple diluteat liquid water (cold or tepid), toast-water, or weak tea and we may oft-en accelerate the recovery by s'wceping out the alimentary canal by some safe purgative, and then, if necessary, soothing it by an opiate. Castor-oil, notwithstanding its unpleasant taste, is, on the whole, the safest and best purgative for this purpose. It has the advantage of being very uiiirritating, yet withal very quick in its action. A tablespoonful of the oil may be takpn, floating on cold water, or any other simple liquid, which may be preferred by the patient. A mixture of orange-juice or of lemon-juice with water forms an agreeable vehicle for the oil. If the dose be vomited, it should be repeated immediately, and the patient should lie still, and take no more liquid for half an hour, by which time the oil will have passed from the stomach into the bowels Within an hour or two the oil will usually have acted freely. Then a tablespoonful of 'brandy may be taken in some thin arrowroot or gruel; and if there be much feeling of irritation, with a sense of sinking, from five to ten drops of laudanum may be given in cold water. These means will suf- fice for the speedy arrest of most cases of choleraic diarrhoea. If the patient have an insuperable objec- tion to castor oil, or if the oil cannot be retained on the stomach, ten or fifteen grains of powdered rhu- barb, or a tablespoonful of the tincture of rhubarb, ora teaspoonful of Gregory's powder, may be sub- stituted for the oil. If the diarrhoea have continued for some hours, the stools having been copious and liquid if there be no griping pain in the bowels, no feeling or ap- pearance of distension of the intestines; the abdo- men being flaccid and empty, and the tongue clean -we may conclude that the morbid agent has already purged itself away. There will, therefore, be no need for the castor oil or other laxative; and we may immediately give the brandy in arrowroot, and the laudanum, as before directed. The rule in all cases is, not to give the opiate until the morbid poison and its products have for the most part escaped not to close the door until the enemy has been expelled. While there are some cases in which the evacuant dose is not required even at the commencement of the attack, there are many more in which the opiate is unnecessary in the later stage. In some cases of severe andd prolonged diarrhoea, it may be necessary to repeat the oil and laudanum alternately more than once at intervals of three or four hours. Practical skill and tact are required to discriminate these cases. It must be borne in mind that when the choleraic secretions are being actively poured out from the blood vessels, the bowel, though it may have been completely emptied by a dose of oil, may quickly again become filled with morbid secretions, and hence the need for an occasional repetition of the evacuant dose.' If the diarrhoea be associated with vomiting, this should be encouraged and assisted by copious draughts of tepid water. The vomiting affords relief, partly the stimulus which it gives to the circulation, but mainly by the speedy ejection of morbid secretions.' If there be nausea without vomiting, and more especially if the stomach be supposed to contain un- digested or unwholesome food or morbid secretions, an emetic may be given- either a teaspoonful of powdered mustard, or a tablespoonful of common salt, or twenty grains of ipecacuanha powder, in warm water. In all cases of severe diarrhoea, the patient should remain in bed.' — SCENE IN A GRAVE YARD IN IRELAND.—A scene of extraordinary excitement was witnessed on Friday in the ancient grave-yard of St. Mary's Drogheda. A Mr Strype, manager of the foundry of Messrs Gren- don, having died a few days ago, his friends desired to have him interred in the cemetery attached to the parish, in which he had resided for three or four years. When excavating about four feet below the surface the gravedigger came upon a tombstone, which was lifted, and was found to have cut upon it several figures, including a cross, a lamb treading upon a dragon, a key, and other devices, which led some Roman Catholics to suppose that it covered the remains of a dignitary of their church. A rumour quickly spread that the grave of a bishop was about to be desecrated. The people in the vicinity became greatly excited, and assembling in large numbers, provided with spades, they very soon filled up the grave, replaced the stone, and declared their deter- mination not to allow any one to disturb it again. The Rev Mr Duggan, the curate, who was looking on, entreated them to take the stone into the vestry of the church for preservation, but they indignantly refused to do so. The churchwardens were sent for and endeavoured to convince them of their error, but in vain. They insisted that another grave should be opened, and offered to dig one in the new ground where strangers were buried. At length, after the funeral had been delayed for some hours, the friends of the deceased offered to have another grave opened if the crowd quietly dispersed. They refused to do so, supposing, no doubt, that it was a stratagem to get them away. The Roman Catholic curate of the parish arrived, and strongly advised them to accept the proposal, but they still refused, and as matters were assuming a very threatening aspect it was found necessary to send for 80 men of the 21st Royal Scotch Fusiliers, under the command of Lieutenant Allen, who formed a cordon round the gravediggers to protect them while they opened a fresh grave. The Rev Mr Duggan, writing to the Express, states that it could not have been the grave of an ecclesiastic as the feet were in the direction of the east, as lay people are buried.

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