Cholera Morbus.
Synonym:—Cholera nostras.
Definition:—Cholera morbus is an acute, infectious disease, occurring especially in hot weather in temperate climates, and characterized by diarrhea and usually extreme cramp-like pains. Severe cases present symptoms identical with those of true cholera.
Etiology:—From the standpoint of etiology and pathology it is not possible to differentiate cholera morbus from acute catarrhal enteritis, but it is proper to regard it as a clinical entity. It especially occurs in extreme hot weather in temperate climates, is usually endemic, but is often epidemic, and is caused by the absorption of toxins elaborated by bacterial activity within the gastrointestinal tract. The ingestion of decomposing food, unripe fruit, raw vegetables and large quantities of ice water and alcoholic beverages in seasons of great heat are predisposing factors.
Symptomatology:—The symptomatology of cholera morbus in average cases does not differ from that of acute catarrhal enteritis. In severe cases, in addition to the usual symptoms of the above named disorder, there are profuse discharges from the bowels becoming watery, cramps in the abdomen and calves of the legs, headache and depression. Thirst is marked and anorexia is complete. The temperature is elevated, from 102° to 104° F. The skin is often cold and cyanotic, and finally, in severe cases, the prostration becomes extreme, and the symptoms are alarming in their severity. The pulse becomes small, rapid and feeble, perhaps wiry or irregular. The features are contracted or pinched, the eyes sunken, the extremities are cold, the nails blue, and the skin is covered with clammy sweat. The respiration is rapid and often jerky and irregular. In fatal cases, with all evidences of complete exhaustion, the patient becomes dull, is with difficulty aroused, mild delirium may occur, or finally coma and death. This is rare, however, as the condition is quite readily controlled and a favorable termination will usually occur.
Diagnosis:—The diarrhea, cramps and pains, gastric distress and tendency to vital depression, together with the season or the presence of an epidemic, will aid in a correct diagnosis. In regions where Asiatic cholera is present, or in persons recently coming from such regions, only a bacterial investigation of the stools can determine the nature of the disease. While a vibrio has been found in cases of cholera morbus, together with other bacteria, it is not the cholera vibrio.
Prognosis:—If seen in the early stages of the disease the prognosis is good in all but infants, the aged and the intemperate. When the disease has progressed for some time before being treated, the prognosis must be guarded.
Treatment:—An immediate comprehension of the possible seriousness of these cases is essential, and prompt treatment, calculated to allay the essential indications, is absolutely demanded. The pain is often so severe as to necessitate the immediate administration of one-fourth of a grain of morphin hypodermically. With this the patient should have a thorough hot foot bath, after which he may be put into a warm bed, and hot water bottles should be applied to preserve the external heat and antagonize the inclination to local congestion. The administration of morphin hypodermically may be necessitated also by the fact that the vomiting at first often prevents the administration of medicine by the somach. In my earlier experience I was taught to give a fourth of a grain of powdered capsicum in five grains of Dover's powder every half hour or hour until three doses were taken, whether the vomiting persisted or not. I found this very excellent treatment, and it was seldom that the third dose was needed. Some stimulant is usually needed, as prostration develops most rapidly. Heat should be kept applied, whatever medicine is given.
The severe pain may also be relieved by a small teaspoonful of the compound tincture of cajuput in a little water. If the vomiting is of a bilious character and the cramp-like pain is located in the stomach, the pain may be immediately relieved in some cases by the administration of a dram of specific dioscorea in two ounces of hot water. If relief is obtained in part from one dose, a second dose may be administered within half an hour. If no relief is obtained from the first or second dose, the agent may be discontinued.
If after the relief of the intense pain the patient becomes warm and comfortable and the symptoms abate, but little other treatment will be needed. It is an excellent plan, however, to thoroughly flush the intestinal tract, and to introduce a quart of the normal salt solution, hot.
With the abatement of active symptoms the patient usually recovers very promptly, and is often able to follow his usual occupation in a few days. Tn an occasional case, however, the condition may cause the occurrence of some other form of intestinal irritation or acute inflammation, which must be treated in accordance with its indications.
If treatment is not instituted in these cases until the disease is well advanced, every effort must be made to antagonize the extreme prostration, and in addition to the persistent application of heat it may be necessary to give brandy, strychnin, atropin or nitroglycerin hypodermically, and occasionally the normal salt solution should be administered by hypodermoclysis.
