Synonyms.—Cholera nostras, sporadic cholera, summer diarrhcea, choleraic diarrhcea.
Definition.—An acute affection chiefly involving the stomach and intestines and characterized by copious diarrhom and vomiting, first of the ordinary contents and afterward of serous fluid, accom panied by abdominal pains and rapidly increasing prostration. It was recog nized and clinically described with ac curacy at an early period in medical his tory, under the names of sporadic and endemic cholera. It frequently occurs in children and is frequently mistaken for cholera infantum per se, now re garded by pediatricians as a separate disorder.
Symptoms.—Cholera morbus is liable to occur at all periods of life, though much more frequently during infancy and early childhood than during adult age. For convenience of clinical descrip tion, we may divide the cases met with at the bedside into two groups. In those belonging to the first group the patient is attacked suddenly with copious vomit ing and purging, repeated at short in tervals. The first discharges contain the ordinary contents of the stomach and bowels; the second are generally stained with the coloring matter of bile, while the subsequent stools consist of little else than large quantities of simple serous or "rice-water" fluid. The countenance soon becomes pale; the eyes sunken; the extremities cold and shrunken; the pulse small, frequent, and feeble; the urine scanty and sometimes suppressed. Fre quent pains in the abdomen or cramps in the muscles of the extremities cause paroxysms of great suffering. The mouth is dry and the thirst sometimes marked; the voice may be husky or feeble and the mind dull and inactive.
In the most severe cases the foregoing symptoms develop with such rapidity and severity that a fatal collapse is reached in less than twenty-four hours. In much the larger number of cases, however, after the first few hours the discharges become less frequent and pro fuse; the paroxysms of restlessness diminish; the pulse is less frequent, and at the end of twenty-four hours all the more active symptoms have ceased, and the secretions from the kidneys and salivary glands have returned to a more natural standard. The patient remains
pale, languid, and weak for several days, during which much care is required in the regulation of diet, drink, and ex ercise to avoid a relapse.
In the second group of cases the symp toms commence less suddenly and are generally more persistent in duration. They quite uniformly begin with diar rhceal discharges, soon becoming copious and watery or semifluid, frothy, and sometimes very offensive, with free vom iting as often as either drinks or nourish ment accumulate in the stomach. In from four to six days the patient becomes so much exhausted as to exhibit all the symptoms of approaching collapse de scribed in cases of the first group. Ex cept in children under two years of age, in whom there may be, as in cholera infantum, collapse and death during the first or second week of their progress, the symptoms dominate in intensity, about the end of the first week, and the vomiting ceases or recurs only when the stomach is allowed to become too full of fluids. The intestinal discharges become less frequent, smaller in quantity, and mixed with some mucus and portions of whatever had been taken for nourish ment. At the same stage of progress a moderate grade of febrile reaction takes place, causing the palms of the hands and surface of the abdomen to become dry and warm; the tongue and mouth are very dry; and the patient, if a child, is more peevish and restless. The ap pearance and quality of the intestinal discharges vary much in different cases, being sometimes like turbid water, at other times green or light yellow with little or no odor, and in other cases semifluid and very offensive. The urine continues scanty and sometimes irritates the urethra in passing; the emaciation continues, and in many young- children it becomes so extreme as to cause death from asthenia in from one to three months. But, in nearly all of the adults and many of the children, after the dis ease has continued from one to four weeks the discharges begin to improve both in quality and frequency, digestion and nutrition increase, and in a few weeks more the patients have regained a fair degree of health.