NOTES ON A FEW CASES OF CHOLERA TREATED BY VARIOUS METHODS OF

TREATMENT.

By SACHINDRA NATH CHATTERJEE, l.m.p.

Motipur, Musafferpur District.

On going through the October 1921 copy o:

the Indian Mcdical Gazette, p. 384, 1 made up my mind to use kaolin in cases of cholera, this being a very suitable method of treatment in village practice. I kept some kaolin in stock and decided to keep a record of the results of the cases treated with it whenever I got opportunity.

Again, I saw an interesting column in the December 1922 copy of the Indian Medical

Gazette, p. 474, about the use of essential oils in cholera cases. Later on, I also found an interest-

ing article in the June 1923 issue of the Indian Mcdical Gazette, p. 257, by Dr. Tomb which

gives a very suitable method of administering these oils. Then again I came across another

report in the Indian Medical Gazette for May 1924, p. 233, on the

"

Efficacy of the Essential Oils

"

by Dr. Tomb. Just then there was an out- break of cholera under my jurisdiction here

(Baruraj Thana). I began to use kaolin and the essential oils' mixture side by side in alternate cases as an experiment. Subsequently I received a circular from my Civil Surgeon instructing me to use kaolin, which I had started already. I decided to keep a record of cases treated by various methods of treatment in tabulated form with the

object of finding out the most suitable remedy which could be easily adopted in villages and could safely be entrusted to the hands of mostly illiterate villagers. I brought the matter to the notice of my superior authorities through Dr. S. K. Chowdhary, m.b., Inspector, Cholera Epide- mic, who made a note of it and encouraged me highly. With the help of my brother officer Dr.

S. R. Ghosh, on epidemic duty in my elaka, I worked and found that it is always a matter of

Nov., 1924.j CHOLERA TREATED BY VARIOUS METHODS. CHATTERjElt 555

great difficulty to get to know of a cholera case ia villages just at the onset, as the villagers always try to conceal an attack at the beginning on grounds of superstition. Moreover, the villages affected being situated at a great distance from the dispensary, prompt medical aid becomes lather difficult. There being no indoor accommo-

elation in the dispensary, treatment of cases from ihe very beginning to the end under careful and close observation becomes impracticable. Still we have made every effort to do so and after a "ood deal of trouble we have succeeded in secur- fn<r some cases which have been treated under close observation and are as tabulated below:?

Table I.

Kaolin.

Name, age, sex and

religion.

(1) Keshbar, 20, H.M.

(2) Kosalia, 19, H.F.

(3) M. L.Ishak, 37, M.M.

Village.

Junada

Narwara

Gopinath- pur.

(1) Iihagala Goala, 20, H.M.

(2) Girbal Singh, 10, H.M.

(3) Nauki Krha- rin, 50, H.F.

(0 R a m j o t i Kumar, 45, H.F.

(5) Sukhi Goala, 20, H.M.

(6) Agnu Singh, 49, H.M.

Chowkia

Ratanpura

Koai

Narwara

Koai

Chowkia

Condition of patient when received for treatment.

T reatment.

(4) Khakhar j Baruraj. N u n i a , 30, H.M.

(5)^Gola,n Mh., I Gahuma- 27, M.M. chak.

(6) Dular Gope, Purani 25, H.M. Motipur.

Comm e n c : n g According to

collapse, 3 Col. Ross's hours after instruction attack. to use viz., 2

drs. of kao- lin in 1 chittack of water, repeat- ed every i hour for 4 hours.

Early stage, af- ter 2 hours of attack.

At CDllapse stage 6. hours after attack.

Early stage, af- ter 2 hours of attack.

Comm e n c i n g collapse after 2 hours of attack.

Early stage, af- ter 2 hours of att.ck.

Effect upon symptoms.

Vomiting and purging checked af- ter 3 hours.

Do.

Do.

Do.

Do

Vomiting and

purging stop- p ed in 4 hours.

No effect.

Vomiting and

purginf stop-j ped 1? hours.

Vomiting and purging checkcd af- ter 4 hours.

Do. Everything checked in 2 hours.

Tabuc II.

Kaolin and Permanganate.

Early stage, af- ter 4 hours of attack.

Collapse stage, after 10 hours of attack.

Collapse stage, after 12 hours of attack.

Collapse stage, after 10 hours of attack.

Collapse stage after 12 hours of attack. Comm en c in s:

collapse after 3 hours of attack.

Pot. permg. Every symp

pill 2 grs., torn checked each cv ry | after 3 hours, hour and kao- lin 1 dr. to 1 oz. of water to drink when1 he likfS to sip ,

and drink.fre-' quently.

Do. I Every symp-

| torn chfcked

| after 4 hours.

Do. I Every symp- tom checked after 6 hours A 1 1 checked in 4 hours.

Do.

Do.

Do.

A 1 1 checked in 6 hours.

All symptoms checked i n 4 hours.

Complications and their treatment.

Retention of

urine; mustard plaster given on kidney region. Hiccough ;

mustard plaster on pit of stom- ach and other treatment.

Reten t i o n of urine treated as above.

Nil.

Nil.

Reten t i o n of urine and hic-

cough ; treated as above.

Nil.

Result.

Died.

Remarks.

Cured.

Died.

Cured.

Died.

Cured.

Cured 3

Died 3

Total 6

All cured cases received at early stage.

Nil. Cured.

Retention o f

urine, mustard

plaster and diuretic given.

Nil.

Nil.

Retention o f urine treated as abeve. Retention o f urine treated as above.

Cured.

Cured.

Cured.

Died.

Cured.

Cured .. 5

Died ., l

Total .. 6

Amongst cured re ceived ? <

Early .. 2 Late .. 3

Tots 1 .. 5

556 THE INDIAN MEDICAL GAZETTE. [Nov, 1924.

Table III.

Essential Oils' Mixture.

Name, age, sex and religion.

(1) Harnandan Goala, 20, H.M.

(2) Patia, 7, H.F.

(3) Mahanga Kumhar, 20, H.M.

(4) Domharu's son, 4, H.M.

(5) Rampatia, 25, H.F.

(6) Harkhit Kum- har, 49, H.M.

Village.

Sandha Domar.

Bakhra .

Sandha Domar.

Motipur..

Baruraj .,

Mahana ..

Condition cf

patient when received for treatment.

Collapse stage after 6 hours of attack.

Early stage within 3 hours of attack.

Collapse stage, after 3 hours of attack.

Collapse stage, after 12 hours of attack.

Early stage, 4 hours a f e r

attack.

Collapse stage, after 6 hours of attack.

Treatment. Effect upon symptoms.

Complications and their treatment.

According to

Dr. Tomb's formula.

Do.

Do.

All symptoms : K e t e n t i o n of checked after ; urine; treated hours. I accordingly.

I '

Nil.

Do.

"Do.

Do.

All symptoms checked in 5 hours.

No effect

All symptoms checked in 6 hours.

All symptoms checked in 4 hours.

All symploms checked in 6 hours.

Nil.

Retention of urine; treated accordingly.

Result. Remarks.

Died.

Cured.

Died.

Died.

Table IV.

Essential Oils and Permanganate.

(1) Sunder. 10, Motipore In commencing j Dr. Tomb's H.M. 1 i collapse after l formula to

I I hours of at- i take and per- 1

tack. ! manganate of ! potash to

drink (pink- coloured solu- tion).

(2) Rampeary j Musahari Kumar, 39, I II.F.

(3) Baruraj, 25, H.F. Sahitolla.

(4) Lakhan ! Nayatola. Kumhar;.?, H.M.

(5) Raira Kum- har, 14, H.M.

(6) Nathuni Goala, 35, H.M.

Do.

Sundar- sarai.

Collapse stage, after 8 hours of attack.

In early stage 4 hours after at- tack.

All symptoms j Hiccough ; trea-

checked in 3 ted accordingly hours of at- ! tack.

Do. All checked in j Nil.

j 4 hours.

Do. I All symptoms | Nil.

I checked in 4 j hours.

Collapse stage, | Do. AH checked in aftier 6 hours ! 6 hours, of attack.

Collapse stage. I Do. after 6 hours

'

of attack.

Collapse stage, after 8 hours of attack.

Do.

No effect

Checked after 9 hours.

Hyperpyrexia and delirium; treated accord-

ingly.

Nil.

Tympanites, re-

t ent ion/ of urine ; treated accordingly,.

Cured.

Cured.

Cured.

Died.

Djed.

Died.

Nil. ; Cured.

Hyperpyrexia Died, and delirium.

Cured .. 2

Died .. 4

Total 6

All cured cases

received at an

early stage.

Cured .. 3

Died .. 3

Total *

6

Amongst cured cases received?

Early .. 2

Late . 1

Total 3

Nov, 1924.J NOTE ON BLOOD CULTURES: SHANKS. 557

Tabids V.

Rogers' Treatment.

Name, age, sex and religion. Village.

(1) Jai Prasad, Jhitkaiah 6, H. AT.

(2) Kishori j Birpur Sonarin, 18, ! H. F. I

(3; Ramashray ; Koai Pd., 30, H. M.

'

(4) Shampatia, 6, H. F.

Sundar- sarai.

Condition of patient when received for treatment.

Collapse stage, after 7 hours of attack.

Collapse stage, after 6 hours of attack.

Collapse stage, after 10 hours of attack.

Collapse stage, after 8 hours of attack.

. Complications Treatment.

' Effect upo" ^ their symptoms. treatment.

Result.

Pot. Permg. pill All symptoms Nil Cured,

calcium,;perg. j checked in 7 drink, saline i hours. intravenous, ;

hypertonic.

Do. Checked after Coma. Died. 8 hours, but relapsed again.

Vomiting stop- Hyperpyrexia Died,

ped in 2 and delirium. hours but purging con-

tinued.

Do.

Do. Not checked. Nil. Died.

Remarks.

The cured case was received in late stage.

m , . , , ?n 1 Total cured, 14. Received in early stage, 9 only; late stage, 5 only. Total treated, 28 only. Total died, 14. Do. do. do. 2 only; do. do. 12 only.

Conclusions.

(1) . The essential oils mixture, though it has got diuretic properties and some stimulating effect, probably cannot prevent the absorption of toxins either chemically or mechanically and if there be such action it is not sufficiently strong, as is urgent- ly required in these cases; also it is doubtful whether it possesses any bactericidal property.

(2) Kaolin acts in two ways: firstly, it pre- vents absorption of toxins mechanically by coating the intestinal wall very quickly, which gives an opportunity of treating the complications, if any: secondly, most probably it inhibits the growth of proteolytic bacteria in the bowels and favours the growth of acid-forming bacteria?hence indirect- ly acting as bactericidal agent. On account of the above reasons, its cheapness

and its simplicity in administration, kaolin is to be preferred to the essential oils.

(3) It seems from the above table that kaolin acts very well when given with permanganate, and permanganate may also be pushed in massive doses even (as there is no chance of poisoning owinj to the formation of a coating upon the intestinal wall by kaolin which prevents absorption) with- out any risk.

In fact permanganate and kaolin is one of the most rational and simplest methods of treatment suitable for villages, for melds, and in combating the epidemic, etc.; it is applicable to cholera in all its stages and it is therefore better than the use of kaolin or essential oils alone, as these have proved of service only at the early stage of an attack.

(4) The intravenous injection is a long pro- cedure and cannot be repeated in village practice. It is however, found that rectal injection of tepid normal saline every 2 to 4 hours according to the

urgency of the case, with permanganate pills, sometimes are of tnore service, but it is also not

as practicable as kaolin and permanganate in

village use where the majority of the people are illiterate, and also it is almost impossible in the case of female patients. But further experiment is necessary before coming to a final decision that Kaolin and permanganate is the best and easiest

method of treating cases of cholera in village practice. J

In conclusion I am extremely grateful to my Civil Surgeon, Major A. H; Nlpier, i.m.s., for

his kind help in th? preparatioyfof this report.