BESIDES the above name, this fearful disease has been called epidemic cholera, malignant cholera, spasmodic cholera, and cholera asphyxia. It first attracted notice in Bengal in 1817, whence it spread westward through Europe, and in 1832 it reached Quebec, on this continent. It has since then visited Asia and Europe several times with great severity, and has even been present on our shores. But at the present day the strict vigilance of sanitary boards has done much to prevent its spread and mitigate its terrors. Through the investigations of Koch and others it is now known to be propagated by a microbe, called the comma bacillus, and the efforts of investigators is now being directed to the discovery of an agent that will destroy this germ and thus control the disease.
Symptoms. First Stage. The first, premonitory stage, is marked by derangement of the digestive organs, rumbling in the bowels, pain in the loins or knees, twitching of the calves of the legs, impaired appetite, thirst, and especially, a slight diarrhea; and these symptoms continue from a few hours to several days. 1 should add to these symptoms what is said to have been recently discovered, namely, that for several days before the attack, the pulse is down to forty or fifty beats in a minute. This, if it prove to be reliable, is a very valuable symptom.
Second Stage. This stage is marked by vomiting and purging a thin, colorless fluid, looking almost exactly like rice water; by severe cramps in the calves of the legs, which soon attack the bowels and stomach. These cramps are excessively painful, and draw the muscles into knots. The tongue is pale and moist; the pulse feeble, though sometimes full and firm; the breathing hurried, with distress about the heart; great thirst; a feeling of internal warmth, and the secretion of urine entirely stopped.
These thin, colorless discharges by vomiting and purging, are the serum or watery portion of the blood, which oozes through the sides of the blood vessels, and runs off rapidly, leaving the crassamentum, or red, solid part of the blood, stranded upon the inner surfaces of the arteries and veins. When so much of this is discharged that the blood cannot circulate freely, the patient sinks into the
Third Stage, which is characterized by great prostration; pulse hardly perceptible; skin cold and clammy; face blue or purple, and eyes much sunken; hands dark colored and sodden, looking like a washerwoman's; breathing short and laborious; a sense of great heat in the stomach ; and intense thirst. Recoveries from this stage seldom take place.
Treatment. In the first stage, the diarrhea should receive the most prompt attention. From five to ten drops of laudanum, repeated a few times, every three hours, will generally put a stop to it. Catechu (162) is also a suitable remedy. The compound syrup of rhubarb and potassa, with some other articles (343), in tablespoonful doses, every hour, till it operates gently, is worth a trial. The diet should of course be very carefully regulated at such a time, though not particularly changed, except to leave off any indigestible article which is known to be injurious, and to be made a little more sparing than in time of perfect health.
When the second stage has set in, or the stage of vomiting, purging, and cramps, the treatment must be energetic. The sinking powers must be sustained by chloroform, opium, and ammonia (119), or by camphor, opium, and cayenne (344), giving one pill every hour. Brandy may also be given freely.
The warmth of the surface must be promoted by all possible means, hot bricks and bottles, tincture of cayenne, friction, etc.
In the third stage, the remedies recommended above are to be pursued with increased energy, particularly the stimulants, and the efforts to promote the warmth of the surface,
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