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Cholera Morbus.

Problems:

Synonyms.—Cholera Nostra; Sporadic Cholera.

Definition.—An acute affection characterized by nausea, vomiting of serous material, frequent watery stools, colicky pains, and severe muscular cramps, and attended by great prostration.

Etiology.—This is a disease of hot weather, beginning in June, increasing in frequency in July and August, and usually disappearing in September. Bad hygienic conditions predispose to cholera morbus, though the exciting conditions are unripe or overripe fruit, indigestible vegetables, such as cucumbers, radishes, egg-plant, etc. Drinking large quantities of ice-water when overheated, or tainted milk or water, may also be considered as excitants. It is more frequent among males than females, and among adults than in children, though cholera infantum may be considered the cholera morbus of children.

Pathology.—No characteristic anatomical changes take place. In some cases, catarrhal changes peculiar to gastro-enteritis are found, while in others no morbid changes are seen.

Symptoms.—The attack generally comes on suddenly, not infrequently in the night, and is announced by pain in the umbilical region, attended by nausea, which terminates in vomiting. At the same time the patient has an urgent call to stool, which is large, copious, and feculent in character. In a short time the retching and call to stool is almost constant, and the pain in the bowels is intense.

The stools vary in character; at first they are of a yellowish or yellowish-brown color, copious in quantity, and of a fecal character. As the disease progresses, however, they early lose their fecal character, and consist of a dirty water, even resembling the rice-water discharges of cholera.

Very early, cramping of the muscles of the legs, toes. and sometimes of the abdominal muscles, ensues, which is exceedingly painful, and causes the patient to cry out with his great suffering. In extreme cases, the spasmodic contraction of the muscles amount to opisthotonos.

The prostration is now extreme; the pulse is small, feeble, and frequent, the eyes sunken, the face blue and pinched, the extremities cold, the skin becomes relaxed and bathed in a cold, clammy perspiration. If not arrested, the patient's strength is gradually exhausted, he becomes dull and careless as to his condition, until finally coma and death result. Fortunately, this is a rare result, and before the alarming symptoms appear, the disease seems to have expended its force, the vomiting and diarrhea subside, and the patient makes a speedy and uneventful recovery, so that, after twenty-four or forty-eight hours, he is seemingly as well as ever.

Diagnosis.—We diagnose the disease by the large, copious, watery evacuations, pain in the abdomen, retching and vomiting, great prostration, and cramping of the muscles. Unless Asiatic cholera is prevailing at the time, it could hardly be mistaken for any other disease. Arsenical or ptomaine poisoning would be recognized by the history of the case.

Prognosis.—It is nearly always favorable if seen reasonably early. When the patient is old and feeble, or a sufferer from Bright's disease or structural heart lesions, the prognosis must be guarded. If not seen till the stage of collapse, a fatal termination may occur. The only fatality I ever knew in this disease was of this character.

Treatment.—Direct a mustard-plaster to the abdomen and hot-water bottles to the feet. Internally, from a half to a tea-spoonful of the compound tincture of cajuput every fifteen or twenty minutes will afford speedy relief. If the pain be severe, one teaspoonful of chlorodyne may be added to ten teaspoonfuls of water and a teaspoonful of the mixture given every fifteen, twenty, thirty, or sixty minutes; or, what is better and much quicker in its results, a hypodermic injection of sulphate of morphin. The dose will be from a fourth to a half grain, according to the severity of the symptoms. This will not only relieve the pain, overcome the cramps, but generally allays the vomiting and diarrhea.

For the diarrhea, nux vomica and subnitrate of bismuth will prove beneficial. Where there is coldness of the extremities, a relaxed skin and threatened collapse, active measures must be used. Hot applications are to be made to the feet, legs, and trunk, or the limbs are to be rubbed vigorously with dry mustard.

In extreme cases, the patient should be rolled in a blanket wrung out of hot mustard-water. Internally, compound tincture of cajuput should be given, and strychnia one-thirtieth of a grain given hypodermically; or, what is better still, a five-per-cent solution of camphor and ether administered hypodermically. The dose will be from twenty to thirty minims, as often as the heart's action demands its use.

At the same time a pint of normal saline solution should be given subcutaneously. The diet should be restricted for a few days following convalescence.


The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.



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