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The approach of collapse does not necessarily arrest the serous discharges, except in so far as the watery element of the blood becomes exhausted. Efforts to arrest the flow must still be kept up. Astringents, stimulants and irritants, and anæsthetics, of every conceivable kind and character, have been administered by stomach without any probable good results. Dr. Cantini has recommended and employed, and others have highly extolled, large injections of tannin, dissolved in tepid water, and thrown into and through the colon if possible. This may constrict the tissues and control the discharges as far as reached, and, while I have but little confidence in the treatment, I would employ it in absence of any more hopeful resources. Here every available stimulant, general and cardiac, are called into requisition, such only as can be used hypodermically are most serviceable, as the stomach is not in a condition to retain or appropriate remedies. Caffeine, digitaline, atropine, and sulph. ether may be given hy. podermically. Aromatic spts. of ammonia, camphor, and capsicum by the stomach, if that organ retains sufficient intergity to appropriate them. The use of alcoholic liquors, upon the theory that they are stimulants, I would discard, believing that they possess no elements calculated to restore tone or nutrition to the exhausted system. '
The idea of refilling the empty blood vessels with a fluid approximating the serum has long been attempted and practiced. Transfusion of blood and the injection directly into the venous system of milk and defibrinated blood have been tried and abandoned. The injection of water containing salines directly into the veins, for the purpose of refilling the vascular system and reëstablishing the liquefaction of the blood, has also been practiced with varying hope and disappointment. The most satisfactory method, probably, ever devised of accomplishing this end, is the injection into the connective tissue at points where it is most abundant, subcutaneously (usually in the subscapular region), of a solution consisting of 20 grains chloride of sodium to 1 pint of tepid water. This is immediately absorbed into the blood vessels; and the treatment has been highly lauded and is doubtless, often beneficial. The flagging circulation is aroused, the husky voice regains its force, the dull eye its luster, a sense of comfort and hope pervades the sufferer, and the effect is
often magical, but seldom permanent in these extreme cases. The profound toxæmia, or lesions in the brain, and delicate kidney structures by the blood condition are usually irreparable and death comes most frequently from uræmic coma. The Malpighian tufts and uriniferous tubules of the kidneys having become clogged up by this tenacious blood, seem unable to free themselves. Great quantities of casts are noticed in the small amount of urine voided, and the reëstablishment of kidney functions is one of the most difficult problems following cholera collapse.
Reaction. In all severe cases a period of reaction may be looked for, characterized by a subsidence of the severer symptoms of whatsoever character, and a feeling of relief. This is most frequently the beginning of a permanent improvement. It is, however, sometimes delusive, and proves to be the beginning of the end — the lighting up of the fires of life for a moment ere their final extinction. Favorable prognosis, then, should be guardedly given at this stage of the disease. It calls for a general nourishing and toning treatment. Observation demonstrates that cholera bacilli disappear very slowly from the intestines after an attack, and although crippled and incapable of producing virulent toxines at this stage, their presence in the bowels is a source of irritation and a barrier to free digestion and absorption, a protractor of the disease, and call for measures to remove them, as well as to repair the injury inflicted. Here the usual bitter tonics, with quinine in sustaining doses, should be kept up regularly. Spirits of turpentine is probably one of the best stimulants to intestinal glands, as well as a most efficient germicide, and is peculiarly applicable in this condition, given in 5-drop doses five or six times a day. Its effects are equally beneficial to the kidneys.
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Standard and Officinal Preparations for Physicians Only.
A POTENT AND RELIABLE REMEDY FOR THE CURE OF
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A Specific for Vomiting in Pregnancy,
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TO THE MEDICAL PROFESSION
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. Tr. Gelsemium, gtt. i.
. i 34.
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RHEUMATISM, GOUT, LUMBAGO, ETC.
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" THE USES OF COD-LIVER OIL IN THE ARTIFICIAL FEEDING OF INFANTS.”—The words of caution with which I concluded my article on the artificial feeding of infants in the last issue of the Doctor of Hygiene, namely, to watch closely the child's bodily weight, and in case the child did not thrive as it should, to try the effect of the administration of small doses of cod-liver oil in the form of some reliable emulsion, were given because even the best artificial food is necessarily deficient in one of the most important constituents of food—that is fat. Not alone is fat necessary to build up the tissues and to supply fuel to the fires of life, but it also plays a very important part in intestinal digestion, and taken in proper amounts it aids digestion in the stomach as well.
These facts were shown long ago by Lehman (Physiological Chemistry, Philadelphia, 1855.)
Fat constitutes the basis of the chyle, which is composed chiefly of firely divided oil, each globule of which is surrounded by a thin envelop of albumen.
This emulsion is formed by the aid of the biliary and pancreatic juices in the small intestine.
It has been shown that of all the oils or fats that which is ex. pressed from the liver of the cod is the best adapted to the digestive processes.
Food is designed to effect three distinct purposes : first, to build up the body in its growing state ; second, to replace the tissues that have been used up; third, to supply fuel to the flame of life, i. e., to impart force to the nervous and muscular system. The part performed by the fats is a most essential one, and consequently a diet that is deficient in fat is followed by decreased vitality in the person living upon such a diet.
But fortunately for mankind the converse of this is also true ; decreased vitality from almost any cause is remedied by the administration of fat in the form of cod-liver oil, and the list of