PART II.- ENGLISH CHOLERA AND DIARRHOEA.
DESCRIPTION – RELATION TO ASIATIC CHOLERA
SYMPTOMS IN ADULTS AND INFANTS & CAUSES.
WHILE in cold climates and winter weather the chief organs to suffer form atmospheric conditions are those of the chest, in hot climates and in summer the abdominal organs are mainly affected.
Many persons naturally, when they take cold, instead of suffering from cold in the head or cough, have diarrhoea; and in hot weather this is the more common result. Diarrhoea is, in fact, a catarrh of the intestinal mucous membrane, just as an ordinary cold is a catarrh of the mucous membrane of the nose. Children are more especially liable to suffer in this way. Even without any appreciable chill, an intensely high temperature is of itself sufficient to bring about a choleraic condition. All who have had the experience of voyaging through the tropics with very young children are aware of the risks they run in the confined spaces of ship’s cabins, or the ” `tween decks” allotted to emigrants.
In large cities a leading item in the summer bill of mortality is the diarrhoea of infants, or “cholera infantum,’ as it is called; there are also a considerable number of deaths among adults from ” choleraic diarrhoea,” ” sporadic cholera,” by all of which names the disorder has been called. Of late years there has been considerable dispute as to whether there is any essential difference between Asiatic or epidemic cholera and the fatal diarrhoea which is always with us in summer time. The dispute is not settled yet. In all probability there is a specific difference, though all attempts to find a single hither-to failed; the so-called “cholera bacillus,” the comma bacillus of Koch, not being found in all cases of true cholera, and bacillus indistinguishable from it in microscopic characters being also found in English cholera.
A disease answering to the description of cholera has been known from the time of Hippocrates, but there is no record of epidemics of the disease having occurred. It is not known to have spread through-out Hindustan before the year 1817, though it has exited there for centuries. The first invasion of Europe occurred in 1829. It came by way of Persia and Russia, and spread over the greater part of America. In 1845-46 it again visited Europe, reaching America in 1848. In 1853-54 was exceedingly fatal in Europe, and again in 1866.
The word cholera means ” bilious,” and is the term used by Hippocrates and his contemporaries to designate the choleraic disease known to them, which was probably identical with our own summer diarrhoea, and which they attributed to disorder of the liver. Whatever the actual relationship between Asiatic cholera and summer diarrhoea may be, extreme cases of the latter are indistinguishable from cases of the former. There is the same sudden collapse of strength, evacuation of great quantities of serous fluid by the stomach and bowels-vomiting and diarrhoea- with shrivelling of the tissues in consequence of the liquid drain; violent internal pains, cramps in abdominal muscles and in the limbs, with coldness and cold sweat on the forehead.
In children the onset of the symptoms is usually sudden, though there may be indefinite symptoms of illness for a day or two preceding, such as a pinched look about the features and dark circles round the eyes. The first actual symptom of the attack is generally vomiting of unaltered or cheesy milk soon after a meal; this is generally followed by the passage of some greenish-yellow fluid containing flakes, and often undigested lumps. There is thirst, restlessness, crying, and drawing up of the legs.
The tissues become drained of fluid; if the openings in the skull have not yet closed they will be found depressed; and if the progress of the disease is not arrested, twitchings occur in various parts, and finally convulsions and death. This is a picture of what occurs in typical cases, but there are all varieties and degrees of the complaint short of this extreme, just as in a cholera epidemic there are many persons who have bowel disorder which does not develop into actual cholera. The probability is that these persons are not fully susceptible to the disease, and consequently they only have it in a modified form.
Among the determining causes of an attack of summer diarrhoea a prolonged spell of hot weather must have the first place.
Next comes a sudden change from hot to cooler weather, and in the same category may be put any kind of chill or wetting. Close, overcrowded dwellings are a prolific source of the disease among the poor.
Errors in diet are answerable for many cases. A copious draught of cold water when overheated may bring on an attack; or eating fruit, and especially stone fruit, when not quite ripe, or when over-ripe. Fish, when there is the faintest suspicion of its not being fresh, is a dangerous food, and of all fish mackerel is the most dangerous. Even when fresh, mackerel will induce an attack with many people.
The most potent dietetic cause of summer diarrhoea in infants, is artificial feeding, as it is very difficult in hot weather to keep milk from turning sour and to keep bottles and tubes free from the germs of putrefaction. Unless special pains are taken about these matters, babies may be poisoned with their food. The practice of giving infants all kinds of ordinary food, “anything that is going.” as the people say, must also be mentioned as one of the causes of child’s cholera.
The epidemic of influenza-of which we are, as yet, not by any means clear-has been responsible for many cases of diarrhoea, some of them attended with choleraic symptoms.
In the autumn of 1891 I was asked to see a young unmarried lady of very delicate constitution, spare, and very active, who in her early years, passed in Australia, had been very subject to diarrhoea, and in whom the tendency had returned during the same year, 1891. She had also had typhoid fever some years before, which had still further tended to weaken the bowels. The occasion of my seeing her was an attack of influenza with failure of strength, depression, headache, fever, yellow tongue, oppression and tenderness at epigastrium, vomiting, increase in size of liver and spleen, with stitches in the spleen, and violent diarrhoea of light watery stools, accompanied with great pain in the back.
Podophyllum 30 in a few hours completely changed the aspect of the case, and after a little further treatment she became better than she had been for months previously.
The same medicine was the chief agent in changing the course of events in another and much more dangerous case of influenza in an elderly lady, who suffered from valvular disease of the heart. She had high fever, diarrhoea and sickness, intense breathlessness and attacks of heart failure. As she was living away from London at the time, an old school practitioner had been called in, and the medicines he gave for the heart had the effect of intensifying ten-fold the gastric symptoms.
At last she could retain nothing in her stomach-neither his medicine nor nourishment. I was written to about her, and sent a few doses of Podophyllum, which stopped the sickness and arrested the diarrhoea. She was able to take nourishment again, and gradually revived. But the convalescence was tedious.