CHOLERA, a Greek term used in the Hippocratic writings, but of indeterminate etymology, being derived perhaps from Mole, bile, or from cholera, a water-spout or gutter. It is now universally employed in medicine as indicating one of two or three forms of disease, characterized by vomiting and purging, followed by great prostration of strength, amounting in severe cases to fatal collapse. The variety called cholera sieed (dry C.) by ancient writers (in which collapse and death take place without discharges) is comparatively rarely observed. The milder forms of C. occur almost every summer and autumn, even in temperate latitudes, and are hence termed by some—in reference to this country, and by way of contrast—British or summer C.; while the more devas tating and fatal forms of the disease are generally supposed to originate only in tropical countries—ftecially in India—and thence to be propagated epidemically over vast pop ulations, and in a somewhat regular geographical course, reaching this country usually through Persia, the steppes of Tartary, Russia, and the Baltic, at the same time extend ing to Egypt, Turkey, and the south of Europe. These very fatal forms of the disease are commonly called Asiatic, Oriental, or epidemic C.; sometimes cholera morbus, or pestilehtial cholera. The milder forms are sometimes also called bilious C.; and the severer, spasmodic C., from the character of the symptoms in each. Some writers of great authority are inclined to consider the two forms as one disease, varying in indi vidual cases and according to season. It is certain that it is not always possible to dis tinguish the one form from the other in particular instances; but the marked difference between the mortality of groups of cases of British C. on the one hand, and of Oriental or Asiatic C. on the other, renders it probable that there is something in the latter dis ease which amounts to a distinction in kind. Whether in the milder or severer form C. is usually ushered in by a period of premonitory symptoms, when the more distinctive characters of the disease are not established; the case resembling one of common diar rhea (q.v.) or looseness of the bowels. At this stage it is very apt to be neglected, and unfortunately, in the severer epidemic forms of the disease this is the only stage much under control. Whenever, therefore, there is a reasonable suspicion that epidemic C. is threatened, every person attacked with diarrhea should make a point of placing- himself under medical advice, and, if possible, of escaping from any situation in which epidemic disease is known to he prevalent. Ile should also be particularly attentive to diet, and especially to the purity of the water he drinks, and to its absolute freedom from con tamination by animal matters filtering through the soil, or thrown into water-courses by sewers, etc. If water absolutely cannot be had in a pure state, it should be boiled before being used for drink, or indeed for any domestic purpose. Many eases of C., and several local epidemics, have been traced in the most positive manner to organic impurities of the drinking-water; and no single cause of the disease has been established by so much evidence as this. Hence, in all probability, arises the well-known preference of C. for low situations, and particularly for the low-lying flats on the banks of rivers, especially where the inhabitants are supplied with water from streams polluted by sewerage, and into nto which the contents of drains are permitted to filter from a superior elevation.
—See Dr. Snow's work on the communication of cholera, 2d edition, 1855; also the report of the registrar-general of England on the cholera of 1848-49, and his 1701 annual report, for 1854.
It is hardly within the scope of a work such as this to present a minute description of fully developed C. in its severer or Asiatic variety. It is truly an appalling pesti lence* too easily recognized by a few leading features. After some hours or days of simple relaxation of the bowels, vomiting commences, and occurs again and again, accompanied by frequent and extremely copious discharges downwards, at first of matters colored with bile as usual, but in the end of colorless and turbid fluid resembling water in which rice has been boiled. These discharges (often to the extent of gallons of liquid), succeeding each other with the most alarming rapidity, act as a drain upon the fluids of the body generally; and by the changes they effect upon the blood, contribute to bring about the state called collapse. • In this condition, the patient lies motionless and apathetic, except when tormented by cramps, which are of frequent occurrence; the surface is cold; the finger-ends, lips, and tip of the nose become livid; the eyes are deeply sunk in the sockets, and often bloodshot; the tongue is clammy; the breath with out any sensible warmth when caught on the hand; the pulse is suppressed at the wrist, the breathing extremely slow and feeble, the heart just audible through the stethoscope. Purging and vomiting have ceased; even the urinary secretion has dried at its source. In fact, all the vital processes are nearly brought to a stand, and unless reaction comes, a few minutes, or at most a few hours, suffice to bring life to a close. Reaction in the most favorable cases is gradual and without accident; it is not unfrequently, however, accompanied by fever, closely resembling typhus, and constituting, at least in the tem perate zone, one of the chief dangers of the progress of cholera.
Medicine is almost powerless against C., except in the earliest stages, in which the treatment usually pursued in diarrhea (q.v.) has sometimes been found useful. Very remarkable temporary restorative effects have been found to follow the injection into the veins of dilute solutions of saline matter, resembling as nearly as possible the salts of the blood which are drained away in the discharges. Unhappily, these experiments have as yet only very imperfectly succeeded. The patient is restored to life, as it were, from the very brink of the grave; but he revives only for a few hours, to fall back into his former condition.
The true medicine of C., so far as we yet know, is preventive medicine. The meas ures to be adopted have been partly pointed out above; in addition, it may be said that personal cleanliness is of the first importance; and that all unnecessary contact with the sick should be avoided, as the disease is probably to some extent contagious, though by no means in the highest degree. In short, all the precautions are to be taken which are recommended in the case of epidemic disease (q.v.).