Page:The New International Encyclopædia 1st ed. v. 04.djvu/782

* CHOLERA. 684 CHOLERA INFANTUM. the Ganges in 1826, passed through Persia and Astrakhan to Russia in 1830, and to Poland in 1831. Meanwhile it extended through Jlesopo- tamia, Arabia, Palestine, and Egjpt, and from Russia it passed into Germany. After invading Austria, Hungary, Wallaehia, and Turkey, it reaehed England in 1831. Brought by Irish im- migrants to Quebec in 1832, it entered th<' Iniled St.Ttes by way of Detroit, Jlieh., and thence it sjjread through the yest to the Pacific Coast and south to Xew Orleans. Subsequent epi- demics occurred in 1841, 1803, 1871, 188.3, 18!)1, and 1893. The disease prevailed in America in 1848 and 1852, and from 1865 to 1868. It ap- j)eared in New Orleans and the valley of the iMississip])i River in 1873, and in 1802 a few cases came to the port of Xew York from Ham- burg, Germany. In 1899 it was found by the United States troops in the Philippine Islands, where it has probably been often prevalent. Alost cases of cholera begin with nausea, rest- lessness, and chilly sensations, followed by vio- lent and frequently recurring diarrhcea, with vomiting and vertigo. In from one to six hours buzzing in the ears, palpitation of the heart, pressure over the stomach, an anxious, gray face, and blueness of the whole surface supervene. The bowels are emptied, painlessly, of discharges re- sembling rice-water. Pain in the stomach and in the region of the heart is often severe, and cramps occur in the calves and arms. The pa- tient suffers continually from thirst. The tem- perature remains about 95° F., and the pulse rarely exceeds 100, while the respiration is usually increased to 30 or 40. Urine may be suppressed. The patient may sink into a somno- lent and then a comatose condition and die, or else he may suddenly improve, and then either go on to convalescence or sink into fatal coma in a few days. Of the mild cases, about .50 per cent, die; while of those with subnormal tem- ])erature, cyanosis, and coma, 90 per cent. die. A mild form of true Asiatic cholera, known as cholerine, is rarely fatal, but is dangerously in- fectious. Lobar or lobular pneumonia, enteritis, nephritis, and neurasthenia may follow cholera. Asiatic cholera is due to a slightly curved ba- cillus which, from its shape, is called the comma bacillus {Spirillum choleras Asiaiicce). The ba- cillus, discovered by Koch in 1883, is a short mo- tile rod from one to two mieromillimeteTs long. A number of such bacilli are often found clinging to one another at their ends, and thus forming spirals of various lengths. The bacillus grows in the presence of oxygen, and does not produce spores, the temperature best adapted to its growth being about that of the human body. It is, however, quite resistant to cold, though it is readily destroyed by drying or boiling. Its defi- nite biological characteristics u.sually enable an expert to detenu ine its pressure or absence in intestinal evacuation even at the earliest stages of the disease. The bacilli are usually confined to the intestines, and during the active stages of the disease may be present in enormous numbers. The systemic effects seem to be due to absorption of toxins produced by the bacilli and are of the nature of a toxipmia. There are no pathological changes which are characteristic of the disease, and an autopsy shows those degenerative changes which usually accompany acute infection. In the small intestines, where the bacteria are usually present in the largest numbers, there are apt to be hemorrhages into the mucous membrane and a more or less intense congestion. The lymph follicles of the intestines are apt to be swollen and congested. The contents of the intestines may either consist of the characteristic rice- water fluid, or else may be dark-colored and bloody. Patients suffering from cholera should be thor- oughly isolated. Suspicious cases, too, should be isolated as soon as possible, and their dejections should be subjected to a careful bacteriological examination. The vessels receiving the dejecta should contain a 5 per cent, solution of carbolic acid, and should be cleansed with boiling water after being used. The bedding and clotliing of llie patient should be disinfected by steam, or soaked for one hour in a 5 per cent, solution of carbolic acid. The room used should be scrubbed with a similar solution, and all loose articles should be either burned or sterilized by steam or by formaldehyde vapor. Bodies of the dead should be promptly wrapped in a close sheet saturated with bichloride of mercury or carbolic acid solution, and buried at once. Nurses, physi- cians, and undertakers should disinfect their hands, faces, and clothes with the greatest care. According to a rule adopted in the United States and in Germany, all patients arriving from in- fected districts should be quarantined five days; if cases of cholera have broken out among them, the quarantine nuist be extended a week longer. As further preventive measures in time of dan- ger, all water used for drinking or for washing table-ware should be boiled, and all fruit, ice, and milk should be carefully inspected. The treatment of cholera consists in support- ing the patient by opium, astringents, stimulants, heat, etc. Some success has followed flushing the rectum with salt solution, and subcutaneous injections of the same. Anti-cholera inoculation has been used with considerable success, accord- ing to Haffkine's method. Artificial immuniza- tion is secured by subcutaneous injection of cultures of diminishe<l virulence followed by in- jections of cultures of increased virulence. In a series of experiments with Haffkine's cholera serum, made in Calcutta in 1900, where cholera has been especially fatiil among the coolies em- ployed by tea-planters, the results were as fol- lows: Of 654 uninoculated, 71 deaths; of 402 protected with anti-cholera inoculation, 12 deaths. Thus the proportion is 3.03 to 1, and the reduction of mortality shown is 72.47 per cent. See Seri'M Tiier.py. Consult Wendt, Treatise on Cholera (New York, 1898). CHOLERA INEAN'TUM (Lat., the cholera of children). A term used (o designate choleri- form diarrhtca in children. 'l"he disease is com- paratively rare and of infectious origin. Strik- ingly similar to .siatie cholera, it is caused mostly by feeding impure milk. Generally the disease follows an ordinary mild diarrhoea of a few days' or weeks' duration, but in some cases death ensues within a few hours of the beginning of the illness. The symi)toms are due to tlie specific poison of the disease acting upon the heart, the nerve-centres, and the intestinal vaso- motor nerves. The following are the most im- portant symptoms: Prostration, steady rise of temperature to 103° F.. or even to 108° P., almost constant vomiting of food, serum, mu- cus, and bilious material : twelve to fifteen passages from the bowels each day, first of 1