In some cases the vomiting and diarrhœa set in simultaneously, and the other symptoms follow, as above described, in rapid succession. In others the cramping may be the first symptom, the others following it.
In a large proportion of cases, the disease takes the course first described above, the diarrhœa, called the premonitory symptoms, or sometimes cholerine, coming on several hours, if not a day or more, before any other symptoms.
The diarrhœa is not usually painful, hence the patient may not be alarmed so as to attend to it until the more dangerous symptoms appear. It begins in some cases with pain and some griping, the discharges rather consistent, having a bilious appearance, so that the patient supposes it to be an ordinary bilious diarrhœa, which is not dangerous, his fears being thus quieted. But however the diarrhœa begins, it becomes sooner or later, copious, watery, and light colored, (rice water) painless but rapidly prostrating.
TREATMENT.
In the early stages of the diarrhœa, Veratrum, taken about twice as often as the evacuations occur, will frequently arrest it in a few hours, especially if the patient lies down and keeps quiet. But if not, and it increases in frequency, or becomes more copious, or any sickness is felt at the stomach, the patient should, at once, be laid upon a bed and strong tincture of Camphor should be given in drop doses, once in five minutes, for one hour or more, and as the symptoms abate, once in ten, fifteen or twenty minutes, for six or eight hours.
A teaspoonful of the Camphor tincture may be put into a tumbler of cold water, ice water if at hand, and the water agitated until it becomes clear, giving a teaspoonful of this camphorated cold water as a dose, stirring the water each time. I think this is better than to give the pure tincture. After the patient becomes quiet and easy, Veratrum should be given in alternation with Camphor, a dose in four to six hours for several days, or oftener if he feels any symptoms like a threatened return of the disease. These two medicines serve as prophylactics (preventives) of Cholera.
If, however, the disease continues in spite of the Camphor and Veratrum, in the first instance, or later, (as the Camphor may be given in many cases with success in the advance stage,) you must resort to other remedies.
If vomiting comes on with burning in the stomach give Ipecac and Arsenicum in alternation as often as the vomiting occurs, and if the diarrhœa continues give Veratrum between the doses of the other two, in a violent case, as often as every ten to fifteen minutes, and at longer intervals when the disease is slow in its progress. If the vomiting and diarrhœa, or either, occur with a kind of explosion, the vomiting ceasing suddenly for the time, after the first gush, or the discharges from the bowels are involuntary, Secale is the specific remedy.
For the cramping, Cuprum and Veratrum are the remedies to be given alternately.
If, however, the cramping comes on as the first symptom, which is sometimes the case, the patient being suddenly seized with it before any other alarming symptoms occur, Camphor is the great remedy, and in this case it may be given in doses of double or treble the quantity before directed.