A text-book of the practice of medicine.

Anders, James M. (James Meschter), 1854-1936

Date:: 1913

Credit: A text-book of the practice of medicine. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$ami be repeated; in many instances, however, this stage is both pro- tracted and dangerous. It is aptly termed cholera typhoid, since a gen- uine typhoid state develops. The skin may present so-called choleraic eruptions (macular, roseolar erythema). Recovery may now take place, or a great diversity of local secondary inflammation may supervene. Acute neph7-itis may arise in this stage and lead either slowly or directly to uremic poisoning, as shown by the projection upon the scene of grave nervous phenomena—headache, vomiting, delirium or coma, and convulsions. A fatal result may be looked for. Complications.—In this place are to be enumerated the conditions due to secon(hiry inlection, including (commonly) septic and pyemic processes. Diphtheritic inflammations affecting mucous surfaces, but especially the throat, colon, and the external genitals, are among the more common. Bronchitis, pneumonia, and pleurisy may arise, and erysipelas and ])arotitis are not rare. During convalescence digestive disorders may show themselves, and indiscretions in diet may precipi- tate a relapse. Clinical Types.—{a) Premonitory Diarrhea.—This type has been outlined with suflficient fulness in the foregoing discussion. (/)) Cholerine, in which the symptoms are mild, resembling those of cholera nostras. Many of the symptoms characteristic of true cholera are also present, particularly the cramps and 2^'^'ostration, cold extremi- ties, and scanty albuminous urine. The stools, however, are not typical of the disease, but are feculent in character, as in ordinary cholera morbus. The duration is from seven to ten days, subject to relapses. (c) The more typical forms—both moderate and severe—have been described under the Clinical History [mipra). (d) The Foudroyant or Asphyxic Form.—This may kill instantly ; more frequently the patient lives for a fcAv hours, with or without vomit- ing and purging. Qholera sicca should be classed with this type. The virulence of the cholera-poison explains the intensity of the symptoms. Differential Diagnosis.—This is difficult in the absence of an epidemic unless bacteriologic and microscopic tests be made, and yet these alone differentiate a sporadic case. The disease most commonly mistaken for cholera (especially cholerine) is cholera morbus, and the fol- lowing points pertaining to the latter disease will eliminate it: 1. No connection with a previous case, but a frequent history of dietetic impru- dence. 2. Absence of rice-water stools, which remain turbid with feces or covered with bile or blood. 3. Presence of colicky pains, but absence of painful tonic cramps of legs and feet, 4. Absence of cyanosis and collapse, as a rule, and of urinary suppression. 5. No cholera spirilla in the stools. Arsenic-poisoning and other forms o^ gastro-enteritis must be discrimi- nated by the history, the character of the stools, the absence of violent muscle-cramps and of the effects of great loss of fluid (cyanosis, shrunken body, profound collapse). Chemical tests are not to be neglected. Prognosis.—This is dependent mainly on the type. Thus chol- erine is very rarely fatal. It is impossible to state the average mor- tality, since it varies with each epidemic, but it has been found to range from 20 to 80 per cent. Many sufferers perish during the latter part of the first day or during the algid period ; still more during the stage of reaction, the dangers of the latter period being as follows: asthenia,$

A text-book of the practice of medicine.

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