Signs of death in choleraic patients. The cessations of respiratory and cardiac movements are not certain signs of death in this disease. The author proposes the following: 1. With an cesophageal sound, introduce by the mouth an abun dant quantity of water into the digestiVe tiibe. The epithelial d(bris which covers the mucosa will become softened and the water be absorbed. 2. Place the body in a bath. at a surrounding temperature, the head naturally above water. 3. In a patient considered dead from cholera, make a small incision in the abdominal wall and inject an abundant quantity of wann water into the peritoneal cavity,— an operation which, in the event of re vival, would be inoffensive. Netter (-Re vue Med. de l'Est, Aug. 18, '92).
death does not take place during the algid stage, symptoms of improvement may show themselves: the cyanosis disappears, the skin gains some warmth, the urine begins to flow again and is deep colored, charged with urea and chlorides and very often albu minous; at the same time the pulse re sumes its strength, while its frequency decreases; the voice returns, breathing becomes regular, painful cramps disap pear, little by little the different func tions are re-established, and after some days the patient enters into a state of complete convalescence.
But the reaction does not always take such a favorable course. Many of the choleraic symptoms (anuria, cooling of the skin, difficult breathing, etc.) persist or reappear, and digestive troubles, head ache, nervous disorders, fever, and gen eral depression follow, ending in a form very like typhoid fever; whence its name of cholera-typhoid. Such cases may run toward a lethal termination, delirium or coma and adynamic symptoms superven ing; but they may also end in recovery. In other cases the reaction may be very sluggish, each function requiring a long time to become regular, and a remark able degree of weakness, somnolence, with scanty, albuminous urine, persist until convalescence sets in.
But how are the symptoms of cholera to be explained? Several theories have been proposed to solve the question; but it cannot be said to be definitely settled. It seems, however, that no better ex planation can be given than that of the effects of the cholera vibrios after their penetration into the intestine; that is, a direct injury to the mucous membrane of the gut and the elaboration there of one or more poisonous substances ("chol eraic toxins"), which enter the circula tion. The direct injury, under the form of a specific enteritis, gives rise to de hydration of the organism, for the great loss of water through vomiting and diar rhcea, which not only deprives the blood of its water, but indirectly subtracts from the tissues their water-component.
As a result, the blood can no longer get rid of the regressive products physio logically eliminated by it, nor perform the function of hmmatosis, while the anatomical elements are affected in their metabolism. On the other hand, the toxins, acting on the nervous system, mainly through a lesion of the sympa thetic system of the abdomen, exert a general depressing influence.
The cholera vibrio is considerably mod ified by micro-organisms which may sur round it. The immunity and suscepti bility depend upon other microbes in the intestinal tract. Koch's bacillus never theless remains the specific cause of cholera. Metschnikoff (Ann. de l'Inst. Pasteur, Paris, p. 529, '94); Fawitzky (Wratsch, Nos. 47, 51, '94); Rontaler (Mfinchener med. Woch., May 21, '95).
There is no antagonism between the cholera vibrio and the comma bacillus. Kempner (Centralb. f. Bakt. u. Para sitenk., B. 17, H. 1, '95).
Several complications may be observed during the period of reaction, among which the following are more common: Cutaneous eruptions (papulous ery thema, urticaria, miliaria, zona, roseola, petechiaz, vibices, boils, etc.), cedema of the glottis, diphtheritic angina, mumps, thrush, dysenteric enteritis, bronchitis, pneumonia, cerebral congestion, men ingoencephalitis, hmmorrhage, and soft ening of the brain, which may give, of course, a great variety of clinical aspects to the disease.
Cholera assumes an epidemic form of grave dimensions in Canton now and then. Small outbreaks have occurred since the great epidemic of 1S94. Dur ing this year that country suffered from prolonged drought and intense heat. A comparison of the clinical course of cholera and the effects of the treat ment has shown that the onset in every case was sudden, particularly in the earlier eases when the disease was most virulent, vomiting and diarrlicea being early signs. Delay in the treatment of this stage meant certain death, and the writer states that he has not seen one patient recover when treatment was de layed,—that is: during the early weeks of the epidemic, while toward the end of the epidemic the virulence of the dis ease decreased, and spontaneous recov ery sometimes took place. The earlier the onset of cramps, the worse the prog nosis, and experience shows that the pa tient does not recover when cramps are a -well-marked condition. W. J. Webb Anderson (Lancet, Sept. 27, 1D02).