Page:Encyclopædia Britannica, Ninth Edition, v. 5.djvu/698

Rh 684 CHOLERA dition. The pulse returns, the surface assumes a natural hue, and the bodily heat is restored. Before long the vomiting ceases, and although diarrhea may continue for a time, it is not of a very severe character and soon subsides as do also the cramps. The urine may remain suppressed for some time, and on returning is often found to be albu minous. Even in this stage, however, the danger is not past, for relapses sometimes occur which speedily prove fatal, while again the reaction may be of imperfect character, and there may succeed an exhausting fever (the so-called typhoid stage of cholera) which may greatly retard recovery, and under which the patient may sink at a period even as late as two or three weeks from the commencement of the illness. Many other complications are apt to arise during the progress of convalescence from cholera, such as diphtheritic and local inflammatory affections, all of which are attended with grave danger. When the attack of cholera is of milder character in all its stages than that above described, it has been named Cholerine, but the term is an arbitrary one and the disease is essentially cholera. The bodies of persons dying of cholera are found to remain long warm, and the temperature may even rise after death. Peculiar muscular contractions have been observed to take place after death, so that the position of the limbs may become altered. The soft textures of the body are found to be dry and hard, and the muscles of a dark brown appear ance. Ths blood is of dark colour and tarry consistence. The upper portion of the small intestines is generally found distended with the rice-water discharges, the mucous mem brane is swollen, and there is a remarkable loss of its natural epithelium. The kidneys are usually in a state of acute congestion. With respect to the mortality from cholera no very accurate estimate can be formed, since during the prevalence of the disease the milder cases are apt to escape notice, and it is certain that some epidemics are of a more virulent character than others. It is generally reckoned, however, that about one-half the cases of fully developed cholera prove fatal, death taking place in a large proportion of in stances in from twenty-four to forty-eight hours. It has been noticed that in cholera epidemics the mortality is rela tively greater at the commencement of the outbreak. The disease appears to be most fatal in children and aged persons. As illustrating the destructive effects of cholera, it may be mentioned that in the first epidemic in England and Wales 52,547 deaths were reported to the Board of Health, but this number was doubtless below the actual amount. In the second epidemic (1848-9) there were 55,181 deaths fromcholera inEngland alone, besides 28,900 from diarrhoea. The subsequent epidemics in this country have been much less fatal. The treatment of cholera embraces those sanitary measures requisite to be adopted with the view of preventing as far as possible the introduction of the disease into localities previously unaffected, or of checking its spread when intro duced, as well as the special medical management of those who have been attacked. These topics can be alluded to only in general terms. When cholera threatens to invade any place, however favourably circumstanced as to its hygienic condition, in creased vigilance will be requisite on the part of those en trusted with the care of the public health. Where the disease is likely to be imported by ships, quarantine regu lations will ba necessary, and, where practicable, measures of isolation should be adopted in the case of individuals or companies of people coming from infected localities, more especially if they have, or have recently had, any symptoms of cholera in their own persons. It is certain that cholera may be introduced into a community by one or more indi viduals who have themselves only suffered from the first or milder stage of the disease (cholera diarrhoea), since the discharges from the bowels abound in the infective matter, and where sanitary arrangements are deficient may readily contaminate the water or air of a locality. The utmost care will be demanded, particularly in popu lous districts, in cleansing and disinfecting places where accumulations of animal refuse are apt to occur. The condition of the drinking water and of the wells in which it is collected will always require inspection, as will also the quality of the food supplied, more especially to the poor. Where suspicion attaches to the water, it should be boiled before being used, and the same holds true of the milk. The establishment of cholera hospitals, with a thoroughly equipped staff of medical attendants and nurses, is one of the first and most important steps to be taken in any threat ened epidemic, as affording opportunity for the removal and isolation of those attacked at an early period, while every facility should be given to the poorer classes of obtain ing medical aid. Instructions should be issued by the authorities v/arniug all persons against the use of unwhole some food, unripe fruit, and excesses of every kind, and recommending early application for medical advice where there is any tendency to diarrhoea. House to house visita tion by members of a sanitary staff will be of great service, not merely in discovering cases of the disease, but in the important work of disinfection, which should not be left entirely to the inhabitants, but be done systematically by the authorities. The discharges from cholera patients should be disinfected with such substances as carbolic acid or sulphate of iron before removal, and special care be taken that they are riot disposed of in places where they may con taminate drinking water. Every article of clothing which has been in contact with a cholera patient should if possible be burnt, while infected apartments should be thoroughly disinfected with carbolic acid or by fumigation with sul phur. The early burial of those dying from cholera is obviously a matter of urgent necessity. The influence of fear in predisposing to attacks of cholera has been greatly exaggerated and is nowgenerally discredited. But apart from such considerations there can be no doub of the wisdom of those to whom it is practicable in remov ing from a place where cholera is raging. With respect to the treatment of cholera, it may be safely affirmed, that as to no disease has so much difference of opinion prevailed or so many extravagant notions been entertained regarding the value of remedies. There is a want of agreement as to fundamental principles of treat ment ; for while astringents have been regarded by some as their sheet anchor, others have condemned them as worse than useless, and rely on the elimination of the materies morbi by means of laxatives. Much evil has been done by the manner in which various systems of treatment have been extolled by over-sanguine practi tioners as possessing special curative value. Indeed to enumerate the different medicines which have been sug gested and employed for the treatment of this disease would be a work of no little difficulty. It is sufficient to state that no medicinal agent has yet been found to be of infal lible efficacy in the treatment of cholera. Nevertheless, much may be done, and many lives saved, by the timely application of certain well-approved remedies. The various stages of the disease demand special treatment. In the earlier period of the attack for the cholera-diarrhea the use of opium is of undoubted value. Given alone in small and oft-repeated doses, or in combination with other astrin gents, such as catechu, tannin, bismuth, nitrate of silver, or acetate of lead, it frequently succeeds in quelling this symptom, and thus arresting the disease at the outset.