10                                              TREATMENT  IN  THIRD  STAGE  OR  COLLAPSE.
It is the opinion of every one, professional and unprofessional, that  early
treatment is of vital importance.    For this purpose it is essential that the
medicine should be distributed all over the barracks, city,  or district in which
the epidemic prevails.    It should be simple in form, not likely to deteriorate
by keeping, nor to prove injurious if given needlessly, and requiring simple
instructions as to its use.   It is of advantage that the remedy be easily procured,
and that it should be in a dry form in India in consequence of caste prejudices.
Numerous specific cholera medicines  have  been  vaunted.    They  are chiefly
composed of  brandy with opium, chloroform, aromatic spices, and essential
oils.    The looseness is often checked for a time by any of these remedies ; but
when the disease proceeds to collapse, in cases where much opium or alcohol
has been used, it generally terminates fatally.    The most common form used in.
the Bengal Presidency is the cholera pill, composed of carminatives, spices,
and opium.    What I have used since 1838, is composed of one part of opium,
two parts of black pepper, and three of assafœtida.    Its power in the earlier
stages is decidedly great,  and no injury follows its needless exhibition.    In
collapse it is powerless, and as it contains opium, its use is contra-indicated.
In addition to these ingredients, red pepper, camphor,   soda or calomel are
sometimes added.    The reports of the efficacy of these pills are highly satisfac-
tory.    I believe no other remedy is more efficacious or less dangerous.   Cholera
pills should be distributed in the barracks in phials, under charge of the N on-
Commissioned Officers, to be  given to every man  who  applies,  or  who  is
observed to visit the latrine more than once.    In the cities and villages in the
country, they should be distributed in charge of the Police.    I have seen very
satisfactory results from giving a pill with the grog,  on the evening of the
removal of   troops from cantonments to cholera camps.    It secures a good
night's sleep and calms anxiety, and I have seen its repetition the following
night eagerly requested.
TREATMENT  IN  THIRD  STAGE :-COLLAPSE.
The symptoms are extreme prostration, livid countenance, cold clammy
perspiration, feeble pulse, broken voice and oppressed breathing, burning pain
in the epigastrium generally accompanied by evacuations of a watery or congee-
like appearance (with a mawkish smell), and cramps of the extremities.
There are some cases where human skill is powerless, and there is a similar
advanced stage in all fatal cases ; but these are rarely met with without other
stages having been passed through, in which the course of the disease might
have been arrested, and this stage warded off. Even in the most hopeless cases,
though life may not be preserved, much distress or agony may be alleviated!
In less intense cases, many lives are saved by judicious treatment, where a fatal
result would have followed neglect or improper treatment.
When the poison has been removed from the body, or probably completed
its course of development, re-action takes place. The burning pain subsides,
the pulse returns, and the organs resume their ordinary functions. There are
few instances in which nature succumbs before an effort at re-action has shown
itself. It is at this critical period that exhausted nature again becomes sensible
to the action of remedies, which a few minutes or hours before were inert.
These are often accumulated in quantities which prove fatal by depressing, or
over-exciting, the system. The congee-like discharges are evidently very exhaus-
ting ; but they continue to remove the poison after the other less exhausting
processes have ceased. They are of an acrid or  irritating character to the
mucous membranes, and are rejected with violence by the stomach and bowels
Their discharge gives relief, though followed by exhaustion, and their sudden
cessation is alarming.
The indications of treatment in collapse are-
1st.-To relieve prominent symptoms, and restore warmth.
2nd.-To support the strength and avoid exhaustion.
1st.- To relieve prominent symptoms. Thirst-Burning thirst is the most
frequent and distressing symptom. It arises from the presence in the stomach
of the poison, or the secretions induced by it. The constant calls of the
patients for water indicate the natural course of treatment, There is no remedy