CHOLERA (from x^7> bile, and pew, to flow). Two distinct forms of disease are included under this general term, namely, Simple Cholera and Malignant Cholera. Although essentially different both as to their causation and their pathological relationships, these two diseases may in individual cases present many symptoms of mutual resemblance.
Simple Cholera (synonyms, Cholera Europæa, British Cholera, Summer or Autumnal Cholera) is the cholera of ancient medical writers, as is apparent from the accurate description of the disease given by Hippocrates, Celsus, and Arataeus. Its occurrence in an epidemic form was noticed by various physicians in the 16th century, and an admirable account of the disease was subsequently given by Sydenham in describing an epidemic of cholera in London in 1GG9-72.
The chief symptoms in well-marked cases are vomiting and purging occurring either together or alternately. The seizure is usually sudden and violent. The contents of the stomach are first ejected, and this is followed by severe retching and vomiting of thin fluid of bilious appearance and bitter taste. The diarrhoea which accompanies or succeeds the vomiting, and is likewise of bilious character, is attended with severe griping abdominal pain, while cramps affecting the legs or arms greatly intensify the suffering. The effect upon the system is rapid and alarming, a few hours of such an attack sufficing to reduce the strongest person to a state of extreme prostration. The surface of the body becomes cold, the pulse weak, the voice husky, and the svhole symptoms may resemble in a striking manner those of malignant cholera, to be sub sequently described. In unfavourable cases, particularly where the disorder is epidemic, death may result within forty-eight hours. Generally, however the attack is arrested and recovery soon follows, although there may remain for a considerable time a degree of irritability of the alimentary canal, rendering necessary the utmost care in regard to diet.
Attacks of this kind are of frequent occurrence in summer and autumn in almost all countries. They appear specially liable to occur when cold and damp alternate with heat. Occasionally the disorder prevails so extensively as to constitute an epidemic. The exciting causes of an attack are in many cases errors in diet, particularly the use of unripe fruit and new vegetables, and the excessive drinking of cold liquids during perspiration. Outbreaks of this disorder in a household or community can sometimes be traced to the use of impure water, or to noxious emanations from the sewers.
In the treatment, vomiting should be encouraged so long as it shows the presence of undigested food, after which opiates ought to be administered. Small opium pills, or Dover s powder, or the aromatic powder of chalk with opium, are likely to be retained in the stomach, and will generally succeed in allaying the pain and diarrhoea, while ice and effervescing drinks serve to quench the thirst and subdue the sickness. In aggravated cases where medicines are rejected, enemata of starch and laudanum, or the hypodermic injection of morphia ought to be resorted to. Counterirrita- tion by mustard or turpentine over the abdomen is always of use, as is also friction with the hands where cramps are present. When sinking threatens, brandy and ammonia will be called for. During convalescence the food should be in the form of milk and farinaceous diet, or light soups and all indigestible articles must be carefully avoided.
In the treatment of this disease as it affects young children (Cholera Infantum), most reliance is to be placed on the administration of chalk and the use of starch enemata. In their case opium in any form cannot be safely employed.
Malignant Cholera (synonyms, Asiatic Cholera, Indian Cholera, Epidemic Cholera, Algide Cholera) is probably the most severe and fatal of all diseases. This form of cholera belongs originally to Asia, more particularly to India, where, as well as in the Indian Archipelago, epidemics are known to have occurred at various times for several centuries. It was not, however, till 1817 that the attention of European physicians was specially directed to the disease by the outbreak of a violent epidemic of cholera at Jessore in Bengal. This was followed by its rapid spread over a large portion of British India, where it caused immense destruction of life both among natives and Europeans. During the next three years cholera continued to rage all over India, as well as in Ceylon and others of the Indian islands. The disease now began to spread over a wider extent than hitherto, invading China on the east, and Persia on the west. In 1823 it had extended into Asia Minor and Russia in Asia, and it continued to advance steadily though slowly westwards, while at the same time fresh epidemics were appearing at intervals in India. From this period up till 1830 no great extension of cholera took place, but in the latter year it reappeared in Persia and along the shores of the Caspian Sea, and thence entered Russia in Europe. Despite the strictest sanitary precautions, the disease spread rapidly through that whole empire, causing great mortality and exciting consternation everywhere. It ravaged the northern and central parts of Europe, and spread onwards to England, appearing in Sunderland in October 1831, and in London in January 1832, during which year it continued to prevail in most of the cities and large towns of Great Britain and Ireland, and its disastrous effects are still in the recollection of many persons. The disease subsequently extended into France, Spain, and Italy, and crossing the Atlantic spread through North and Central America. It had previously prevailed in Arabia, Turkey, Egypt, and the Nile district, and in 1835 it was general throughout North Africa. Up till 1837 cholera continued to break out in various parts of the Continent of Europe, after which this epidemic disappeared, having thus within twenty years visited a large portion of the world.
About the year 1841 another great epidemic of cholera appeared in India and China, and soon began to extend in the direction traversed by the former, but involving a still wider area. It entered Europe again in 1847. and spread through Russia and Germany on to England, and thence to France, whence it passed to America, and subse quently appeared in the West Indies. This epidemic appears to have been even more deadly than the former, especially as regards Great Britain and France. A third great outbreak of cholera took place in the East in 1850, entering Europe in 1853. During the two succeeding years it prevailed extensively throughout the Continent, and fell with severity on the armies engaged in the Crimean War. Although widely prevalent in Great Britain and Ireland it was less destructive than former epidemics. It was specially severe throughout both North and South America. A fourth epidemic visited Europe again in 18G5-66, but was on the whole less extensive and destruc tive than its predecessors. Cholera has since appeared in the form of limited epidemics in various districts of Russia, Turkey, and Western Asia, while it still continues to main tain its footing in India, where sudden outbreaks are of frequent occurrence, being often connected with the assembling of crowds at native festivals.
its effects has naturally engaged the attention of scientific physicians in all countries. Investigations into the nature of cholera and the conditions favouring its propagation have
been extensively carried on in England, in Germany,