Reports as to the use of kaolin in treatment and as a prophylactic have been favorable. The suspension in water is given as a drink and as an enema.
Rogers has recently been administering 1/100 of a grain of atropine sulphate morning and evening. His statistics would indicate a reduction in mortality of about one-half. Cases treated with atropine also rarely show collapse. Injections of adrenalin solutions have been recommended.
A great objection to any form of oral medication is the tendency to vomiting. This can in a measure be controlled by cracked ice or by a small hypodermic of morphia. The latter drug also relieves the very painful cramps.
One danger which must always be borne in mind in giving more than one dose of any drug subcutaneously is that with the slowing or cessation of circulation, coming on with the algid state, we have no absorption but, when the stage of reaction sets in and the drug, whether morphine or toxic stimulant, begins to be taken up, there may ensue a fatal poisoning.
However the views of authorities may conflict as to special forms of treatment, there is universal acceptance of the employment of intravenous injections of fluid to combat collapse. Normal saline is the fluid usually used, but Rogers recommends his hypertonic solution which consists of 120 grains of sodium chloride, 6 grains of potassium chloride and 4 grains of calcium chloride to the pint of water.
In the Philippines the normal saline seemed to answer as well as the hypertonic solution.
Sellards had success in combating anuria, which is one of the most dangerous conditions encountered in cholera, and at the same time answered equally well with normal saline in relieving collapse, by giving 2% sodium bicarbonate injections.
There is a marked acidosis in cholera and this form of treatment seems indicated.
The objection to using sodium carbonate is that the salt has a lytic action on red cells in vitro and furthermore Sellards found that it tended to cause convulsions in one of his cholera cases. Sodium bicarbonate, even in 4 or 5% concentration, does not have any haemolysing effect on the red cells. Of course it is true that in sterilization the bicarbonate tends to be converted into carbonate but Sellards found that by sterilization in an autoclave connected with live steam, at 7 pounds pressure, this was minimized, only about 25% of the bicarbonate being converted into carbonate after 1 hour.
If the temperature by rectum is about normal or slightly below, the temperature of the fluid should be 102° to 104°F. and one usually gives about 2 quarts.